PUERPERA the term for a woman who has just delivered her baby PUERPERIUM/4TH TRIMESTER postpartum period,

d, is approximately 6 weeks after delivery of the placenta and 4 weeks after an abortion or miscarriage.

Immediate postpartum period 1st 24 hrs after

delivery Early postpartum period from day 2 to day 7 after delivery

A woman who has had a normal and uneventful labor and delivery and who has a roomed-in baby is likely to be up and about as soon as she feels like it. Early walking is most beneficial for the puerpera; the earlier she walks the better for her circulatory, respiratory, reproductive, urinary and gastrointestinal systems. Walking promotes the general strength and well-being of the puerpera.

 Decreased incidence of thrombophlebitis

----When inflammation due to a blood clot occurs in a

vein

uterine drainage and enhanced uterine involution Improved tone of bladder and intestinal tract, preventing and/or alleviating urinary retention and constipation
Better

respiratory complications like pneumonia and pulmonary embolism Early regain of maternal strength Improved well-being and self-esteem Greater confidence in providing baby care If hospitalized, shorter hospitalization days
Less

The disease is also characterized by the slow oxygen in the blood, rapid breathing and rapid heartbeat.

 Puerperas

are now advised to get out of bed well within the first 24 hours after vaginal delivery and numerous well-controlled studies have confirmed the many advantages of early ambulation, including the marked reduction in the frequency of venous thromboembolic disease during puerperium (Cunningham et al., 1989).

 Early

ambulation promotes urination. Four hours after delivery the woman should be able to urinate, at least 300 mL, with complete bladder emptying (AWHONN, 1996). Teach the newly delivered woman to empty her bladder frequently, as an empty bladder promotes comfort and uterine contraction. A full bladder displaces the uterus to the side resulting in poor uterine contraction, poor uterine involution and more blood loss.

Six hours after normal delivery women may have a shower bath with a mobile hand spray or a tub bath in the kneeling position (Myles, 1982).

The puerpera who is out of bed for the first time should not be left alone as she may become dizzy and faint. Immediately after delivery, she should be assisted to the bathroom the first two to three times to protect against falls due to possible orthostatic hypotension and faintness (Littletle & Engebretson, 2006).

 Explain

the necessity and advantages of early and frequent ambulation. Evaluate the physical condition of the puerpera, the state of her fundus and the character of her lochia. A woman with soft uterus and vaginal bleeding must stay in bed.

 Check her vital signs.

Pulse Rate Respiratory Rate Blood Pressure Temperature

Immediately after delivery, the PR may be slightly because of the effect of epinephrine from stress of labor. Rates greater than 100 bpm may mean bleeding and hypovolemia, dehydration, fever, infection or pain. There is usually slight bradycardia during early postpartum, with the average PR at 60 bpm.

16-24 breaths per minute normal range of RR For women who received epidural narcotics such as morphine, their RR should be closely monitored because these drugs have the potential to depress the RR to < 12 bpm CAUTION: always have a narcotic antagonist ( Naloxone (NARCAN)) on hand whenever narcotics like fentanyl and morphine are administered to a woman in labor.

During postpartum, the clients BP changes minimally and is usually stabilized within the first 6 hours. Hypotension may be due to the effects of epidural analgesia or anesthesia or bleeding. Hemorrhage may be difficult to identify in the postpartum woman if BP is used as a parameter. The womans BP may still be within normal limits even if she is bleeding due to the increased circulating volume during pregnancy.

Hypotension from hemorrhage , therefore, may be a late sign of hemorrhage in the puerpera. Orthostatic hypotension is common and may cause dizziness and faintness. Instruct the client to avoid sudden positional changes such as rising.

Blood pressure elevation in the postpartum may be related to oxytocin use, excessive use of medication, pregnancy-induced hypertension, essential hypertension or anxiety (AWHONN, 1996).

 It

is common for the postpartum woman to have slight elevation of temp after delivery. Normal postpartum oral temperature should range from 36.2C (97.1F) to 38C (100.4F)

 In

the first 24 hours after delivery, a temp reading > 38C (100.4F) may indicate dehydration from loss of fluids during delivery, but may also be due to the excitement and stress of labor. But after 24 hours, temp readings > 38C (100.4F) six hours apart for two consecutive days indicate a postpartum infection (AWHONN, 1996).

 Explain that there is the possibility of a

sudden temporary gush of vaginal discharge the first time the client gets up and that it reflects the effect of the change in her posture from being recumbent for several hours to sudden upright, favoring effective uterine drainage.

 Assist

the puerpera in getting up and out of bed. Instruct her to dangle her legs for a few minutes. If the puerpera becomes dizzy or faints, help her get onto a chair. Instruct her to lower her head to her knees to improve blood flow to the brain. Ask if she feels better.

 Accompany

the puerpera throughout the initial ambulation. The initial ambulation may be to the bathroom. Do not leave the puerpera alone! From the bathroom, instruct the client to walk back to her room slowly and sit on the bedside chair. The health care giver may take this opportunity to promote bonding between the mother and her baby: hand to the mother her roomed-in baby to hold or to feed.

 Assist

the first to second ambulations. Evaluate the clients condition. Ask how she feels. Praise the client for her effort/behavior/cooperation. Do proper recording.

the puerpera to her bed after

 ___________________

the term for a woman who has just delivered her baby

 _____________________

denotes postpartum period, is approximately 6 weeks after delivery of the placenta and 4 weeks after an abortion or miscarriage

 _____________________

period is delivery

the1st

this 24 hrs after

 ______________________

this period is from day 2 to day 7 after delivery

 Give 3 advantages of early ambulation

 According

to AWHONN, four hours after delivery the woman should be able to urinate, at least ________ mL, with complete bladder emptying

_____________hours after normal delivery women may have a shower bath with a mobile hand spray or a tub bath in the kneeling position.

TRUE OR FALSE. The puerpera who is out of bed for the first time can be left alone.

 Rates

greater than 100 bpm may mean _____________, _____________, _____________.

__________________is common and may cause dizziness and faintness. Instruct the client to avoid sudden positional changes such as rising.

 after

24 hours, temp readings > 38C (100.4F) six hours apart for two consecutive days indicate a __________________________ (AWHONN, 1996).