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Management of normal purperium

The document discusses postnatal care and management. It defines puerperium as the period following childbirth when the body's tissues, especially the pelvic organs, return to their non-pregnant state over approximately 6 weeks. It outlines the principal goals of postnatal management as restoring the mother's health, preventing infection, promoting breastfeeding, and providing contraceptive information. It also describes various postnatal exercises that can help recovery.

Health & Medicine◦
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INTRODUCTION  Postnatal period is usually considered the interval extending from the birth of baby until 6 weeks after.  In this period dramatic changes begin to occur in women’s body system.  As soon as a baby’s born the processes that occurred during pregnancy are reversed.
DEFINITION  Puerperium is the period following childbirth during which the body tissues ,specially the pelvic organs revert back approximately to the pre-pregnant state both anatomically and physiologically.  Involution is the process where by the reproductive organs return to their non pregnant state .
 DURATION :- Puerperium begins as soon as placenta is expelled and lasts for approximately 6 weeks when the uterus becomes regressed almost to the non pregnant size.  The period is divided into –  Immediate within 24 hrs  Early upto 7 days  Remote upto 6 weeks
Principal of management  To restore the health of the mother  To prevent infection  To take care of the breast including promotion of breast feeding  To motivate the mother for contraception
1) Immediate care- After about 2 hrs of observation following delivery, the patient is examined thoroughly before shifting her to room or ward. 2) Rest and Ambulation 3)Hospital stay- All patient’s with perineal stitches should preferably be hospitalized for 2 -4 days to ensure satisfactory healing &to safeguard her against infection.
4)Diet- Encourage the patient to drink lots of fluids &to take simple easy to digest diet. Fatty foods should be restricted. 5)Sleep- it is important to ensure adequate rest and sleep .it is good restrict visiting hours and to prescribe mild hypnotics to ensure sound restful sleep.
 6)Care of the bladder- The patient is encouraged to pass urine following delivery,if fails than catheterization should be done.  7)Care of perineum - Perineal wound should receive proper surgical attention to promote healing & prevent infection. Perineal wound should be kept clean & dry.
 9)Well baby care- care of the baby should be explained and direct her to the pediatrician.  10)Contraception- couples should be provided with necessary information & counseled to adopt the method of their choice. Oral contraceptives should be avoided as it may reduce breast milk flow. Multi parous women who have completed their family may be offered the option of surgical sterilization  11) care of bowel-
12) Care of episiotomy- -REEDA ASSESSMENT R- redness E- Edema E- Ecchymosis D- discharge A- Approximation of suture 13) Care of breast 14) Immunization
15)Medication- All medication prescribed to the mother must be consulted as many of these drugs may pass through breast milk to new born baby & can be harmful..
Advice on discharge- Thorough examination of the mother and child is to be taken before discharge  Gradual return to normal activity at home.  Care of the newborn & breast feeding .  Iron and vitamin supplements to improve mother’s health.  Contraception.  For regular follow up.
MANAGEMENT OF AILMENTS  After pains  Pain at site of perineum  Engorgement of breast  Treatment of Anaemia  Hypertension
Health and nutrition education  Family planning advise  Sexual intercourse can be resumed till to 6 weeks after delivery  Breast feeding is best  Immunization of child  Calorie need per day-2200+700 =2900  Role of post natal exercises
Postnatal exercise  Objectives –  To improve the muscle tone which are stretch during pregnancy and labour specially the abdominal and perineal muscles  To educate about correct posture to be attained when the patient is getting up from her bed  This also include the correct principal of lifting & working position day to day activities
IMPORTANCE OF POSTNATAL EXERCISE Improve circulation Strengthen pelvic floor muscle Prevent backache Strengthen the tummy muscles
IMPORTANT INFORMATION Wear loose supportive clothing Environment-stable environment Nutrition-do not exercise on full stomach Safety-do not exercise alone in the dark Low impact exercise is preferable during postnatal period.
PRINCIPLE OF EXERCISE Frequency Intensity- mild to moderate exercise are recommended Duration-30 minutes of exercise per day
POSTNATAL EXERCISE  Deep breathing Exercise  Foot and ankle exercise  Pelvic floor Exercise  Pelvic Tilting Exercise  Abdominal Breathing  Head and shoulder raising  Leg raising  Knee rolling  Hip hitching or leg shortening.
Deep breathing exercise  Lie on bed with knees bent, with a pillow behind  Breathe in deeply through nose. Sigh out.  Repeat 5 times
FOOT AND ANKLE EXERCISE Keep knees relaxed for both exercises. Bend and stretch ankles vigorously up and down for 30 seconds.  Circle both feet 10 times in each direction. Repeat these exercises frequently
PELVIC FLOOR EXERCISE  Pelvic floor muscles are stretched during pregnancy and childbirth.  Strong pelvic floor muscles are essential to prevent leakage of urine when sneeze or cough, for enjoyable sexual intercourse .
Cont…  Can do this exercise standing, sitting or lying.  Pull the area around vagina up and down  The contraction should be held for 10 seconds(to a count of 6) and repeated upto 10 times
• to give complete control of bowels. • Strong muscles will also help prevent developing a prolapsed womb
 The exercise should be continued for 2-3 months.  This exercise is especially important if mother have stitches.  It helps to improve the circulation and will help to heal quickly
PELVIC TILTING EXERCISE  Lie on a firm surface with knees bent and a comfortable pillow beneath the head  Pull in your tummy (in hale, while exhale flatten the back)  Press the lower part of back down flat  Hold for several seconds and repeat.
ABDOMINAL BREATHING  This is to strengthen the diaphragm  Take a deep breath, raising her abdominal wall and exhale slowly.  To ensure correct method ask to keep one hand on chest and one on abdomen.
• while inhaling the hand on the abdomen should be raised and hand on the chest should remain stationary. • Repeat the exercise five times
HEAD AND SHOULDER RAISING  On the 2nd post partum day-Lie flat and raise head until the chin is touching the chest.  On the 3 rd post partum day-raise both head and shoulder off the bed and lower them slowly , increase gradually
LEG RAISING  Begun on the 7 th post partum day  Lying down on the floor with no pillows under the head  Point toe and slowly raise one leg keeping the knee straight  Lower the leg slowly.
KNEE ROLLING  This is to strengthen the oblique abdominal muscles.  In back lying with knees bent, pull in the abdomen and roll both knees to one side as far is comfortable, keeping shoulders flat.
 Return knees to upright position and relax the abdomen.  Pull in again and roll both knees to other side.  Perform 10 times
HIP HITCHING OR LEG SHORTENING  In back lying with one knee bent and the other knee straight.  Slide the heel of the straight leg down word thus lengthening the leg.  Shorten the same leg by drawing the hip up
 Towards the ribs on the same side.  Repeat up to 10 times  Change to the opposite side and repeat.
ROOMING IN  Definition :- Rooming in means your baby stays with mother through your hospital stay .This arrangement gives an opportunity for the mother and father to know their baby.  Advantages :- -Baby sleeps better and cries less . -It is less stressful for the baby . -Moms get more rest. -Mothers milk comes in sooner -Baby feeds more often
 Baby gain weight more better.  Baby develops less jaundice  You can get to know your baby better .  Women exclusively breastfeed longer and continue to breastfeed longer.  You are better prepared to take care of your baby .  You can recognise your baby’s feeding cues .
BONDING  Bonding is the formation of a mutual emotional and psychological closeness between parents and their newborn child .Babies usually bond with their parents in the minutes ,hours,or days following birth .
BONDING WITH BABY  Mother can create and strengthen the emotional bond with baby by:-  Making frequent eye contact, such as during feeding times. Young babies love to look at your face and eyes. Cuddling baby in the crook of your arm is about the perfect distance for your baby to see you well.  Smiling ,talking ,and singing to your baby. Responding promptly to crying .Your baby will learn to trust that when he or she is need ,you will consistently come to give comfort.
WARM CHAIN  Baby must be kept warm at all times right from birth . Satisfactory control of temperature demands both prevention of heat loss and promotion of heat gain.
The warm chain is a set of interlinked procedures to be taken at birth and during the next few hours and days in order to minimize heat loss in all newborn.
 Warm delivery room  Immediate drying  Skin to skin contact  Breast feeding  Bathing and weighing postponed
 Appropriate clothing/ together  Mother and baby together  Warm transportation  Warm resuscitation  Training and awareness raising
WARM CHAIN PRINCIPLE IN POSTNANTAL CARE  The mother should understand that keeping the baby warm is not a one time job ,it is rather a continous job which means adhering to the warm chain principle . A warm chain is a system of keeping a baby warm immediately after delivery.Whenever it occurs during transportation and while feeding and caring for the baby.
RESEARCH FINDINGS  A study conducted in Taiwan on effectiveness of an exercise program on reducing level of fatigue among postnatal women were demonstrate that a low intensity exercise program can offer a good platform for researcher to help fatigue in postpartum women.  A study conducted by Baby Centre Medical Advisory Board for constipation that start eating high fibre food, drink water regularly as soon as can after birth and exercise daily ,avoiding medication with constipating side-effect prevents the constipation.
SUMMARY So today we have discussed about:-  Definition of Puerperium  Duration of Puerperium  Anatomical and physiological changes during puerperium  General physiological changes  Management of normal Puerperium  Management of ailments  Postnatal Exercise
 Rooming –in  Bonding  Warm Chain.
CONCLUSION  Puerperium is the period following childbirth during which the body tissues ,especially the pelvic organs ,revert approximately to the pre-pregnant state both anatomically and physiologically .During the postpartum period ,assesssment of maternal condition must be done on a regular basis and a progress record to be maintained.
BIBLIOGRAPHY  “Rimple Sharma” Essential of pediatric Nursing, First edition, published by Jaypee brothers, page no. 231-240.  Dr.B.T Basavanthapa, “Child health nursing , First edition,published Ahuja Publishing house no., Pageno.222-225.  Parul Dutta :Pediatic Nursing 2nd edition ,Published by Jaypee Brothers ,Pg no.75-77.  Dutta DC: textbook of obstetric 7th edition jaypee brothers publication
Management of normal purperium