MANAGEMENT OF NORMAL PUERPERIUM

 Objective:-

Restore health to pre-pregnant stage

To prevent infection

To take care of breasts including promotion of breast feeding

Contraceptive advise

Infant case

To give need based health education

(1) Immediate case:-

Record vitals

Note that uterus be contracted & vaginal bleeding should be in normal limit

(2) Rest & Early Ambulation:-

Provide adequate rest to the Pt. after a good resting period the Pt. moves out of bed to go to the toilet.

Early ambulation is encourage

Bladder complication reduces & constipation are seduced

Facilitate Uterine drainage

To restore self confidence & recovery

Encourage drainage of lochis & uterine involution

(3) Hospital Stay:- Normal labour – 24-48 hrs.

Perineal stitches – 3-5 days

If no any perineal stitches & cesareans delivery 7 to 8 day discharged

(4) Diet:-  Increase sep calorie  req. is 300 to 400 k cal (500) 10% of fluid easily digestible diet milk & protein rich food should be given,

(5) Case of the bladder:-

The Pt is encourage to pass urine following delivery as room as convenient

At times the Pt. is fails to pass urine because of reflex pain

If the Pt. still fails to pass urine catheterization should done 

Continuous drainage is kept until the bladder tone is regained

Use antiseptic techniques.

(6) Bowel case:-

A diet containing sufficient roughen& fluid is enough to move to bowel

Early Ambulation of the Pt.

Constipation occurs mild laxatives given (Isopgol)

(7) Sleep:-

- The Pt is in need of rest both physical & Mental

- Any discomfort like pain should deal analgesics

(8) Case of Valve & episiotomy wound:-

Vulva & buttocks are washed with soap water down over the anus & a sterile pad is applied

The perineal wound dress with spirit & antiseptic powder

The nurse should use sterile gloves during dressing

(9) Case of Breast:-

Nipple should be washed with sterile water before each feedings

Nipple should be cleaned & kept dry after the feeding is over

Not offering any supplementary fluid to the infant

(10) Maternal Infant bonding (Rooming In):-

- Manifested by fondling, kissing cuddling the infant baby should be kept in her bed or in a cot bed side her bed.

(11) Asepsis & antiseptic:-

- Maintenance of asepsis especially during the first week of puerperium 

- Use of antiseptic use of clean bed linen & clothing are positive step

- Clean surrounding & Limitted no of visitor

(12) Immunization:-

- Baby’s Immunization according to schedule

- If baby is Rh + ve & mother Rh – ve than Anti-D

- Immune prophylaxis should be given in 72 hrs.

(13) Contraception:-

- Avoid inter courses for 6 weeks

- Use barrier methods after 6 weeks

(14) Post partum exercise:-

Encourage to move limits at short intervals

Deep breathing

Lie in supine position with knees bend & feet lie flat on bed try to release abdominal muscle 

Perineal muscles – Voluntary contraction & relax perineal muscles back muscles- Lie in prone position & left herd & shoulder

(15) Medications:-

Oral Iron supplements

Oral calcium & vitamin supplements

Mild laxatives 

Antibiotics & Analgesics

Sedatives

(16) Post Natal Visit:- 6 week after delivery

Objective:-

To discuss any problem regarding breast feeding diet, ensure, medication etc.

Baby case & Immunization

Clinical exam of mother & baby

Lab tests

HB estimation for anemia’s

Urine test for albumin & any infection

Blood sugar estimation

(17) Management of Ailments:-

(1) After Pain:- It is the infrequent, spasmodic pain in lower abdomen after delivery for 2-4 days due to presence of blood clot and bits of membrane after birth contraction of uterus to expel them out, this cause of pain

T/+ - Massage the uterus with expulsion of clot followed by administration of analgesic & antispasmodic

(2) Pain on the perineum:- Sitz bath (Hot or cold)

Hip bath (110-1150F) additional pain relief

(3) Cassation of Anadem’s:- Supplementary iron therapy

(FeSo4 200 mg) given daily for 4-6 week

(4) Maintain chart:-

Temp. pulse & respiration twice a day

Measurement of the height of uterus above the symphysis pubis (One a day)

Character of Lochia

Urination  bowel movement

(5) Post partum exercise:-

- To improve the muscle tone

- To minimize the risk of puerperal venous thrombosis

(6) Check up & advise on discharge:-

Check – up to the mother & the body prior to discharge

Measure to Improve general Health

Continuation of Iron therapy

Post natal exercise

Breast feeding & case of new born

Family planning advise & guidance

Post natal check up after 3 weeks

Complications of Puerperium

Puerperal Sepsis

Puerperal Pyrexia

Sub Involution 

Shock

Urinary Complication

Urinary tract infection

Puerperal Venous thrombosis

Pulmonary embolism

Psychiatric disorder

Post Partum haemorrhage

Inversion of Uterus

Post partum eclampsia