Karteikarten
FMP2 Session 4 - Postnatal care
Karten in diesem Stapel (19)
- 1What is postnatal care?Examining and caring for babies immediately after birth (checking their vital signs, and taking appropriate action.) Carrying out a full assessment and physical examination. Work in partnership with women and other care providers, provide evidence based seamless care and interventions appropriate to women to promote her wellbeing.
- 2What does the care include?Infant feeding support and guidance,
support for women with disabilities
post op care for women with caesareans and operative deliveries
pain relief
facilitating discussion red contraception
pregnancy loss, stillbirth, neonatal death
"to recognise warning signs of abnormality" - European union midwives directive - 3What is care planning?NICE (2006) recommend a documented and individualised care plan should be developed antenatally for the postnatal period.
- 4What are the main conditions we are looking for postnatally and what are their signs/symptoms?PPH - profuse blood loss, tachycardia, faintness, dizziness, pale
INFECTION - fever, temperature, pain, odour, offensive vaginal loss, shivering, abdominal pain
ECLAMPSIA - high blood pressure, headaches, visual disturbances, vomiting within 72 hrs
THROMBOEMBOLISM - redness/ swelling in calves, unilateral calf pain, chest pain. - 5What possible birth related infections can occur?uterus/genital tract
meningitis (epidural)
perineum
breasts (mastitis)
caesarean wound
cannula site - 6What did MBBRACE - UK 'confidential enquiries into maternal deaths and morbidity 2009-2012' find?maternal deaths down 11 to 10 per 100,000
1/4 deaths due to sepsis
1 in 11 died due to the flu
TE leading cause of direct deaths - 7What is the postnatal check?Clinical observations and questioning of woman's well being. Empower women to take care of own health and document in care plan specific problems and follow up on them.
- 8What observations do we make about her general physical wellbeing?Headaches, - mild/severe? Migraines? check other symptoms for possible eclampsia?
epidural/spinal headache.
Fatigue - diet, exercise, time with baby
physical/social/psychological cause?
consider testing haemoglobin if pph or persistent fatigue.
backache - treat as you would normal non pregnant women - 9What advice do we give about postnatal nutrition?healthy varied diet, to meet vitamin and mineral requirements, especially if breastfeeding, 10 mg vit d supplement for increased calcium requirements for bf, lots of fluid and fibre to ease constipation, and thus help recovery of haemorrhoids. BF can help loss of weight.
- 10What support do we give in reference to women's breasts?Minimum standard is BFI, Breastfeeding support priority to ensure sufficient time to initiate and continue bf. Engorgement to be mentioned at around day 3, wear non restrictive, well fitting bra, may feel tender firm and painful. treat with freq breastfeeding, hand massage, expression and analgesia. check for development of thrush, mastitis and cracked nipples.
- 11What do we ask about Lochia?Check for signs of abnormal lochia, if concern palpation of uterus may be necessary to check involution. excessive or offensive blood loss fever, abdominal tenderness may be assessed.
- 12Perineal care?Ask to examine stitches if concerned, and document if rejected or consented. wound hygiene to be discussed, comfort measures and analgesia.
- 13Sexual acitivity?Possible dyspareunia? any time 2-6 wks postnatally. reasons for anxiety to be explained, assessment of perineum to be offered. contraception to be discussed and used of water based lubricant.
- 14What do we look for in relation to elimination?Have they defecated within 3 days? (NICE 2006)
Have they urinated within 6 hrs of birth? (NICE 2006). POssible consitipation consider use of gentle laxatives, dietary advice, fluid, faecal incontinence to be assessed for severity freq and duration. If no micturition occurs catheterisation to be considered. pelvic floor exercises to be encouraged to prevent prolapse and incontinence. - 15Legs and thromboembolsim?assess for DVT, unilateral calf pain? redness/swelling, encourage mobilisation. Thromboprophylaxis -
wearing TEDS or using anticoagulants (fragmin)?
shortness of breath or chest pain emergency action, poss pulmonary embolism - 16mental health and wellbeing?each appt ask about mental health and wellbeing, support and coping strategies, encouraged to tell if mood changes, ask partner to keep an eye, see GP if worried, 10 - 14 assess for baby blues, possible PND, social support networks, rest, gentle exercise. warn of day 3 baby blues, hormones and lactation
- 17Parenting and attachementcheck for bonding and emotional attachment at each pn visit/contact. home visits to promote mother baby dyad. support groups and group based parent training programmes
- 18safetydomestic violence q at every appropriate contact, 6 - 8 week check
- 19pre conceptual care?MMR vac advised if women not already immune to rubella. pregnancy to be avoided for 1 month after receiving vaccine, anti d or immunoglobulin within 72 hrs if rhesus neg.
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- FMP2 Karteikarten am FMP2 Session 4 - Postnatal care, erstellt von Phoebe Crossing am 06/03/2018.
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- Phoebe Crossing
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