Flashcards
FMP2 Postnatal Care
Cards in this deck (122)
- 1FMP23 hour exam
Question and answer - 2Session 1Woman Centred Care
- 3RCM definitionTruly woman centered care encompasses:
- midwifery-led care of normal pregnancy, birth and postnatal period
- services are planned and delivered close to women and the communities in which they live / work - 4Changing ChildbirthChoice
Continuity
Control - 5Maternity Matters Department of Health (2007)Guarantee:
- choice on access to maternity care
- place of birth
- midwife-led care
- type of antenatal and postnatal care
- good leadership - 6Better Births The National Maternity Review (2016)- Personalised care
- continuity of carer
- safer care
- postnatal and perinatal mental health
- multi-professional working
- working across boundaries
- payment system - 7Woman centred Midwifery- focuses on woman's individual needs, aspirations and expectations
- recognises need for woman to have choice, control and continuity
- encompases need for baby and extedned family
- follow woman through journey of community and acute setting in maternity care
- address social, emotional, physical, psychological, spiritual and cultural needs
- recognises the woman's expertise in decision - 8Standards for competence for Registered Midwives The Code (NMC 2015)1. Effective midwifery practice
2. Professional and ethical practice
3. Developing the individual midwife and others
4. Achieving quality care through evaluation and research - 9RCM Better Births summary1. Preparing for the birth experience
2. 'Transition points' in birthing experience
3. Continuous journey to prepare for pregnancy and parenthood - 10Expectations of women- Are women generally satisfied with care?
- what are women's main priorities?
- Are expectations different for multifarious and primiparous women?
- What else influences women's expectations?
- What can midwives do to support women with realistic expectations? - 11Role of Midwife- Develop public perspective to maternity care takes account of wider social and environmental factors
- commits resources to preventative health care
- aims to reduce health and social inequalities
- adapt a holistic perspective encompassing emotional, psychological and social as well as physical needs
- midwives support development of confident and effective parenting by working with women in communities to develop strategies to promote breastfeeding, healthy eating and lifestyles which enhance well-being
- develop innovative models of care and services accessible to all women and take account of specific needs of disadvantaged women
- Heads of Midwifery services develop a framework for monitoring the implementation of key maternity care policies - 12Session 2Drug administration
- 13PharmacokineticsAbsorption, distribution, metabolism and excretion of drugs
- Recognise adverse reactions early
- minimise risk of unwanted drug interactions occuring
- prevent drugs been used inadvertently during pregnancy and lactation
- educate women to make informed choices - 14Standards for medicines managementSection 4 - standards for practice of administation of medicines
Standard 8 - administration
Section 5 - `Delegation
Standard 18 - Nursing and Midwifery students - 15PGDPatient Group Direction
- 16PGDs- specific written instructions for the supply or administration of a licensed named medicine including vaccines to specific groups of a patients who may not be individually identified before presenting for treatment
- guidance in the use of PGDs is contained within Health Service Circular (HSC) 2000/26 - 17AnaphylaxisRare but potentially fatal hypersensitivity reaction that can occur following the administration of any drug as well as food fluid or topical applications taking anything from several minutes to several hours to appear
- suddent onset and rapid advancement of symptoms
- life-threatening airway and/or breathing and/or circulation problems
- mucosal and/or skin changes - 18Half LifeA drugs half-life is the time it takes for half of a given dose to be eliminated from the body or bloodstream
- 199 Rights of drug administration1. Right action
2. Right drug
3. Right dose
4. Right documentation
5. Right route
6. Right response
7. Right patient
8. Right form
9. Right time - 20Session 3Physiology of Puerperium
- 21PuerperiumPostnatal/postpartrum period
Period following labour Anatomical and physiological changes following end of pregnancy:
- body returning to non pregnant state
- bio-physio-social recovery
- adaption to parenthood - 22Endocrine changesAfter birth & delivery of placenta (within 72 hours)
oestrogen & progesterone levels return to non-pregnant levels
oxytocin & prolactin levels depend on lactational demands
increase prolactin levels during breastfeeding inhibit LH & FSH levels - 23Reproductive SystemInvolution
- return of uterus to normal size tone and position
- structures affected are vagina, uterus, ligaments of uterus, and muscles of pelvic floor
- uterus, ovaries, fallopian tubes become pelvic organs
Uterus goes from 1000g to 75g
Occurs due to Ischemia, autolysis, phagocytocis - 24cont...Ischemia - state of inadeuate supply of blood to part of body resulting in death and separation of placenta
Autolysis - redundant muscle fibres in myometrium broken down by action of proteolytic enzymes result in a reduction in size of uterus
Phagocytosis - engulf cells and microorganisms often by defence system e.g. macrophages excreted in urine viw renal system - 25cont...Regeneration
- lining of uterus decidua is cast off and replaced by endometrium
- begins about day 10 and most done by week 2-3 postpartrum
- may take up to 6 weeks - 26cont...involution of cervix and vagina
cervix - decreased tone and oedematous after birth, internal OS closes during 2nd week PP, external OS reformed as a slit rather than primiparous dimple
Vagina - elasticity returns but not to pre pregnant state, wound healing and perineal pain depends on severity od any prenieal trauma, fall in oestrogen leads to lack of lubrication
Vagin and cervix - over 3-4 weeks vasculatiry decreases and oedema resolves (i.e. reasbsorption) - 27cont...After pains
- oxytocin acts on uterine muscles to aid contraction
- explaining the cause is important to women
- oral analgesia used for pain relief
- woman who BF may have after pains / heavier loss particularly during feeding
- after pains may be worse with subsequent pregnancies - 28cont...Pelvic floor muscles
- muscular tone and strengths normally return to pre-pregancy levels within two months
- pelvic floor excersises aid in process but may need specialist advice - 29cont...Post Natal Blood Loss
- lochia means discharge from uterus occuring after childbirth
- changes occur with uterine involution
- Lochia rubra = intially fresh, red, contains blood and sheds of decidua
- Lochia serosa = pink/brown, contains altered blood, serum, leucocytes and organisms
- Lochia alba = yellow/white contains cervical mucus leukocytes and organisms
Can persist for 12 weeks, midwife should ask about amount and colour and smell - 30cont...Ovulation and return to fertility:
- varies from woman to woman
- nonlactating women = 40-50 days
- lactating women = 30-40 weeks
- possible to convieve 2 weeks after birth - 31Cardiovascular system changes- loss of excess blood volume through blood loss at birth & diuresis
- hypercoagulable state of pregnancy is increase in early puerperium, slowly returns to pre-pregnant state over several weeks
Haemoglobin levels return to pre-pregnancy levels within 4-6 weeks
WBC normalise within a week
more efficient stroke volume due to improved venous return and high blood volume can lead to mild bradycardia for up to 12 weeks - 32Respiratory system chagesuterus no longer impedes diahragm so full ventilation of lungs is possible
tidal volume and respiratory rates return to normal in 1-3 weeks
increased elasticity of rib cage may persist for months - 33Renal system changesBladder and urethra may be traumatised during delivery
Can increase likelihood of UTI
INcreased diuresis leads to frequency of micturition
NICE 2006 - advise and document re ensuring a women has passed urine within 6 hours of birth
tales around six months for kidneys to return to pre-pregnant size - 34GI system changesReduced muscle tone and relaxed abdomen can lead to constapation in early postnatal period
Haemorrhoids which appeards during late pregnancy or labour tend to resolve uickly after birth
NICE 2006 - ensure a woman has defacated within 3 days after birth
Faecal incontinence may suggest anal sphincter damage and needs assessment of severity, duration and frequency of systems - 35Skin changesStriae gravidarum becomes paler silvery white lines over period of several months
Other pregnancy induced chages to skin normally fade completely although hyperpigmentation and melasma may persist in women with darker skin and hair - 36Musculo-skeletal changesRelaxed joints especially in pelvis may persist for 6 months
abdominal wall remains soft and flabby for several weeks
tonging exercises are advised postnatally - 37Session 4Postnatal Care
- 38Postnatal care- examine and care for babies immediately following birth
- confirm vital signs and take appropriate action
- carry out full assessment and physical examination
- work in partnership with women and other care providers during postnatal period
- provide seamless care and interventions which are appropriate, promote wellbeing, evicednce based, consistent with management of risk, undertaken by midwife, optimise health outcomes - 39cont...- providing support and advice
- provide particular support which is needed to women
- provide post-operative care for women which have had C-Sec and operative deliveries
- providing pain relief
- team-working
- facilitating discussion about future reproductive choices
- providing care for women who suffered pregnancy loss, stillbirth or neonatal death - 40cont...examine and care for babies with specific health or social needs and refer to other professionals or agencies as appropriate including:
- child protection
- congenital disorders
- birth defects
- low birth weight
- pathological conditions - 41cont...care and monitor for puerperium offering necessary evidence based care advice and support regarding baby and self-care including:
- feeding babies and teaching women about the importance of nutrition in child development
- hygiene, safety, protection, security, child development
- adress issues about their babies and families health and social wellbeing
- monitoring and supporting women who have potential depression or other mental illnesses
- bladder control
- recuperation
- contraception
- ill/preterm babies - 42Why is midwife's input important?challenge physically
challenge emotionally
challenge mentally
develop new skills
adaption to new role - 43Care planningNICE 2006
- documented individualised postnatal care plan should be developed with the woman in antenatal period or shortly after birth
- including relevant factors from anteneal, intrapartum and immediate postnatal period
- details of healthcare professionals and contact details
- plans for poastnatal period - 44Confidential Enquiries into Maternal Deaths and Morbidity 2009-2012MBRRACE - Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries
Part of Maternal, Newborn and Infant Clinical Outcome Review Programme
Thrombosis & thromboemolism are leading causes of death
Maternal deaths have reduce from 11 to 10 per 100,000
'Think Sepsis' - 1/4 maternal deaths due to sepsis
'Prevent Flu' 1 in 11 deaths due to flu - 45The postnatal checkAt each postnatal visit must:
- ask woman and baby about health and well-being and
- offer info and clear explanations to empower care of health of her and baby
- encourage woman to report any concerns in physical, mental, social, emotional health
- document in care plan any problems & follow up - 46General physical wellbeing HeadachesMild - differential diagnosis, local treatment protocols
Tension headache / migraine - relaxation & avoidance factors
pre-eclampsia, epidural spinal headache - 47General Physical Wellbeing FatiguePersistent - advise on diet, exercise, activities, time with baby
Underlying physical/social/psychological causes
consider testing haemoglobin if PPH or persistent fatigue - 48General Physical Wellbeing Backachemanage as usual
- 49Postnatal nutritionHealthy eating, eat to satisfy appetite, avoid eating to excess, varied balanced diet
intake of fluids and fibre to reduce problems with constapation
postnatal weight loss, care when breastfeeding, increased Ca demands, vit.D supplement,
avoid excessive alcohol intake
no evidence to avoid allergens while breastfeeding - 50BreastfeedingSupport available, written policies on breastfeeding, implemetation of externally evaluated structured programme, BFI
Sufficient time for healthcare professionals to give support to woman and baby to initiate to continue breastfeeding
engorgement
- advise breasts may feel tender firm & painful until approx. day 3 when milk comes in, wear well-fitting bra
- treat with frequent unrestiricted breastfeeding, including prolonged feeding from affected breast, breast massage and hand expression, analgesia
Mastisis, thrush, cracked / damaged nipples - 51Postnatal blood lossAssessment of uterus by abdominal palpation
Assessment of vaginal loss and uterine involution and position should be undertaken in women with excessive or offensive vaginal loss, abdomen tenderness or fever - 52Perineal care Nice 2006women should be asked whether they have any concerns about healing process of any perineal wound e.g. pain, offensive oudor, dyspareunia
healthcare professional should offer to assess the perineum if woman has pain or discomfort
women should be advised on pernieal / wound hygiene comfort measures and analgesia
perineal hygiene advice - advise of the importance and give example of care - 53Resuming sexual activityWomen should be asked about resumption and possible dyspareuria
if anxious about resuming intercourse, reasons should be explored
offer assessment of perineum for women with dyspareuria who have perineal trauma
methods and timing of resumption of contraception should be discussed within 1st week of birth
advise using a water-based lubricant gel especially for BF women - 54Eliminationopen bowels within 3 days of birth
advise on diet, laxatives
prolapsed haemorrhoids should be evaluated
women with faecal incontinence should be assessed for severity duration and frequency of symptoms - should evaluate further if do not resolve
Urine passed by 6 hours after birth and measures to encourage micturition are not immediately successful, bladder volume should be assessed and catheterisation considered
women with involuntary leakage should be given pelvic floor exercises and evaluated if it gets worse - 55Legs & thromboembelismencourage mobilisation
evaluate for DVT if calf pain, redness or swelling
women with shortness of breath or chest pain - evaluate for pulmonary embolism as an emergency action
if woman needs thromoprophylaxis - is she wearing TEDS and confident with self-administering anti-coagulants with appropriate supply - 56Mental health & wellbeingask at each contact
encourage women and partners to discuss any changes in mood, emotional state and behaviour
formal debriefing of birth not recommended but should be offered to talk about experiences and ask questions
at 10-14 days assess for PND or baby blues
encourage to help look after mental wellbeing by looking after themselves e.g. gental exercise, rest, help with care of baby, talk about feelings, social support networks - 57Parenting and attachmentassessment and emotional attachment at each contact
home visits - promote parent mother to baby emotional attachment
encouraged to develop social networks
group based training promote attachment and improve parenting skills
healthcare providers offer fathers info and support in adjustment to new role and responsibilities within family unit - 58SafetyDomestic abuse: ask at every contact, follow up using evidence based guidance
6-8 week check: co-ordinate healthcare professionals to ensure health and well-being is reviewed holistically
screening and medical history included - 59Pre-conceptual careanti-D within 72 hours of birth where indicated
women not immune offered MMR vaccination following birth and before discharge from mat. centre
women advised pregnancy should be avoided for 1 month after recieving MMR vaccination but can breastfeed
mode of next birth
pre-coneptual advice for medical conditions - 60Professional communication and handing over careReferral and communication
- local protocols, audited, hand-held maternity records, postnatal plans, child health records promote communication with women
Role of General Practitioner
- postnatal home visit, 6-8 week postnatal check
Role of health visitor
- overlap between midwifery and health care visitor - 61Session 5Postnatal body image
- 62What factors affect how pregnancy is perceived ?Past history
Psychological coping skills
Socioeconomic status
Social support
Recent life events
Planned or unplanned pregnancy
Culture
Other children
Physical health
Pre-existing medical conditions
Religion
Relationships - 63Transition to motherhood / parenthoodWhat do we mean?
-Transition is the process of changing from one state to another
Why is it important?
- To provide appropriate support - 64Factors that influence transition to parenthood?Social
Financial
Psychological
Physical - 65Van Gepp 1960Considered transition to be a rite of passage
A woman exchanges one social status for another
3 phases:
Separation from her former social status i.e. an independent person. Society views her as different.
Marginality woman is between socially recognised states. During pregnancy, looks and behaves differently (e.g. diet, alcohol, physical activity).
Reincorporation back in to society with an altered social status- now a mother with altered responsibilities
Cultural implications - 66Rubin 1967Qualitative research. 9 women (4 multiparous, 5 primiparous)
Antenatal and postnatal interviews (12 interviews during pregnancy
and 11 times during first month post birth)
Three main topic areas emerged:
The ‘taking in’ process is a description of the woman trying to understand the meaning of becoming a mother. Nothing is considered relevant to her unless she can link it to her maternal role.
The self system suggests concern for body image, self image and ideal image. Body image- focussing not on physical changes but the body’s ability to accommodate and function in a new role. Self esteem and role achievement or failure are linked to this ability
Operations are the active processes. Five operational levels- Mimicry, role play, fantasy, introjection/projection/rejection and grief work. Once these processes have been worked through role identity is achieved. - 67Rubin cont...Mimicry adoption of simple behaviours e.g. wearing maternity clothes, not lifting, not eating certain foods.
Role play ‘acting out’ situations e.g. baby sitting.
Fantasy ‘how will it be for me’ women talk to other mothers about labour etc.
Introjection/projection/rejection the most important aspect of the model. Do the mimicry and role play ‘fit’ with the woman’s personality and experience e.g. which nappies to use.
Grief work ‘letting go’ of former identity e.g. meeting work colleagues for lunch
Role identity acceptance of new role
Significant others own mothers then peers
used as models. Husband/partners were not
seen as fathers. - 68Rogan et al 19979 antenatal focus groups. 55 women.
Grounded theory approach.
6 stages emerged:
Realising women found reality different to expectations talking through birth experiences helped
Drained physical, mental and emotional demands of childbirth on women
Alone lack of confidence and awareness of what they have to learn. Night feeds
Unreality unaffected by attending antenatal classes
Loss of time for partner, friends, self, freedom
Working it out personal resilience, assertiveness, trust own judgements and feelings. Not reached by all women - 69Role of midiwfeEvidence based practice
NICE
Guidance with new skills e.g. baby bathing
Education
Have an approachable attitude
Individualised care
Be encouraging
Make yourself available
Good communication and relationship building skills
Facilitate informed choice for women
Be receptive to women's ideas
Empower women
Work in partnership with women
Health visitor
Encourage social support e.g. groups, family, friends - 70Why important?Mental health- maternal and paternal
Parent-child bonding
Child development
Relationships
Recognising when referral may be needed
Society/ friends and family may not understand the significance of this transition
Media - 71Session 6Minor disorders of the newborn
- 72Vascular NaeviStork marks
Glabella
Found on forehead or nape of neck
Capillary malformations, superficial capillaries increased growth of capillaries
No treatment, reassure parents, document in notes - 73Vasuclar NaeviCapillary haemangiomata
Strawberry marks
10% of babies appear by age 1, dissappear by age 5-6
Raised lesions
Capillariy malformations - 74Spina bifida occultaBase of spine, neural tube defect
Incomplete closure of skin over spinal cord
Offer genetic counselling - 75Ankyloglossia tounge tieCant extend tounge
Tounge too short or frenulum not stretchy enough
Can have it snipped (frenotomy) - 76Conjunctival haemorrhageBlood in whites of eye
Burst blood vessel, from quick or traumatic birth
Should ressolve in a few days if not seek help from doctor - 77opthalmia neonatorumConjunctivitus, profuse/purulent discharge from eyes
Infection, gonococcal, staphylocci & chlamydial conjunctivitus
Breast milk and cooled boiled water used to wipe eye, swab and send for culture and sensitivity, documentation, eye drops, ointments - 78positional talipes equinovarusPostitional & Structural
How they were in room
Due to formation of bones
Gently manipulate, physiotherapy, cast - 79Capt sucedaneumSwelling under skin, above periosteum
Can cross suture lines
Present at birth
Being in difficult position
Pressure on cervix
Ventouse delivery
Should settle within 36 hours, gentle handling - 80cepal haematomaSwelling under periosteum
Unilateral or bilateral
Doesnt cross suture lines
Appears 12 hours after birth
Haemorrhages due to trauma
Rubbing of skull on pelvic bones
No treatment, blood will be reabsorbed, can cause jaundice sepsis or menigitus - 81umbilical cord infectionTemperature, lethargic, poor feeding, offesnive smell
staphilococcus , group B strep, bacterial infection
Keep clean and dry, out of nappy, could swab, antibiotics - 82miliaWhite spots on face
Retension of keratin or sebaceous secretions
Resolve after 4 weeks, antibiotics for blister-like spots - 83mongolian blue spotBlue patch on back, legs and bum
Clusters of melanocytes
Benine, no significance, aisian cultures more prone, should fade must document - 84paroncyhiaNail infection, red and dry skin
Infection caused by ragged nails and long nails
Use file but don’t bite or use scissors - 85oral candidiasisWhite tounge, can be on nappy area and spreads through whole GI tract
Fungal infection caused by unsterilised feeding equiptment
Prescribe drops, can be confused with milk on tonge - 86erytherma toxicum neonatrumSpots between 2-5 days
Activation of immune system, hypersensitivity
No treatment, distinguish between more severe conditions - 87Pseudo periodsBlood in nappy with discharge (without can be urinary
Withdrawl of maternal oestrogen
Only needs investigation if significant blood loss - 88possetingBringing up of milk
Overfeeding, over winding, infection in GI, abnormalities
Ask about feeding, responsive feeding, ask about stained vomit that could be bile or blood - 89nappy rashRed blotchy rash
Response to irritance, baby wipes, dirty bottom from unchanged nappy
Keep nappy off, clean with water, contact GP if bleeds, regularly change nappy - 90constapationSolid faeces or no faeces
Not enough milk, formula fed babies, frequency of feeding
Change formula, how are they making up the formula - 91birth traumamuscle/nerve/fractures/ haemorrhage
Birth difficulties - 92Jaundiceellow colouration of skin or scolema
Affects 60% term babies and 80% of preterm babies - 10% of breastfed babies will be jaundice at 1month old
Caused by high levels of bilirubin in circulation (hyperbilirubinermia) - 93Session 11BFI
- 94Assessment of feedingHistory, what’s happened before now?
Breast observation
Attachment / positioning assessment
Feeding pattern over 24 hours
Building hope and confidence - 951. HIstoryBirth weight / centile
Gestational age
Time first to breast after birth
Mother’s awareness of milk coming in
How easy was it to get the baby on?
What strategies have been used? Eg milk expression, nipple shields etc - 962. Breast observationNo need to particularly examine breast unless problem reported.
Notice / observe breasts whilst the mother is feeding.
What might you look for?
(Remember – relate observation to the number of days) - 973. Attachment / positioningWatch the mother position, attach and breastfeed her baby
Suggest alternative positions if necessary
Always assess attachment - 984. Feeding pattern over 24 hoursMuch better than assessment of how often the baby feeds.
Remember relate it to the days/weeks post-natal - 995. building hope and confidenceConsider language
Instil hope
Build confidence - 100Using WHO chartsplot and follow centile lines
shouldn't drop centile or increase unless due to gestational diabetes or restircted uterine growth - 101Building BF relationships and role of oxytocin'The Triune Brain' - neocortex, reptilian brain, mammalian brain
Smoothing the baby when crying
Frequent skin-to-skin
Keeping baby nearby
Offering the breast
Touching, massaging, rocking
Talking and looking into baby’s eyes
Oxytocin vs cotrisol
loving relationships:
Begin in pregnancy
Enable skin contact after birth
Promote closeness for mothers and babies
Encourage responsive feeding, nurturing and comfort
Support instinctive parenting
Responsive feeding:
A sensitive reciprocal relationship between a mother and her baby. A mother responds to her baby when
he shows feeding cues
he is distressed or lonely
her breasts are full (if breastfeeding)
she simply wants a sit down and cuddle
Responsive bottle feeding:
Hold baby close, slightly more upright than a breastfeeding baby
Encourage rooting by moving the teat against her top lip
Invite her to take teat into her mouth rather than push it in
Ensure the teat is full of milk
Pace the feed – that means remove the teat when sucking slows to give a natural gap, watch the baby’s cues
Wind the baby by sitting her upright - 102Session 12Blood groups, Clotting, Haemostasis
- 103Haemostasis'the arrest of bleeding’
‘prevention of blood loss’
‘Arrest of blood flow and control of haemorrhage from an injured blood vessel’
‘Process by which bleeding at any site is arrested by formation of haemostatic plug’ - 104blood groupsA
B
AB
O
Rhesus negative or positive - 105antibodiesa blood protein produced in response to and counteracting a specific antigen. Antibodies combine chemically with substances which the body recognizes as alien, such as bacteria, viruses, and foreign substances in the blood
- 106antigensa toxin or other foreign substance which induces an immune response in the body, especially the production of antibodies
- 107maternal antibodiesSuch as anti-D means cross matching should be undertaken
Maternal antibodies can have life-threatening consequences for fetus
Booking bloods
Prophylactic anti-D
Postnatal anti-D if required should be within 72 hours - 108blood componentsYour body carries around four to six litres (7 to 10.5 pints) of blood. Blood is made up of red blood cells, white blood cells and platelets in a liquid called plasma.
Plasma is about 90% water, but also contains proteins, nutrients, hormones and waste products. Blood is made up of about 60% plasma and 40% blood cells.
red blood cells carry oxygen around the body and remove carbon dioxide and other waste products; they give blood its red colour
white blood cells are part of the immune system (the body's natural defence mechanism) and help fight infection
platelets help the blood clot (thicken) to stop bleeding - 109full blood count (FBC)Usually taken routinely at booking and throughout pregnancy
Detecting fall in haemoglobin (Hb)
Indicating iron deficiency anaemia
Possibly other rare conditions also detected
Haemoglobin (Hb)
Mean corpuscular volume (MCV)
Platelets
White cell count - 110white blood cells and immune functionProgesterone plays a major role in immunological tolerance in pregnancy
White cell count rises from 8 weeks’ gestation and reaches peak at 30 weeks - 111Iron metabolismIncrease significantly in pregnancy (ranging from 500-1150mg)
Iron requirements increase dramatically to 3-8 mg iron/day
Iron rich diet required
Many women have insufficient iron reserves
Haemoglobin levels 115-165 (non-pregnant)
100-120 (pregnant) should be > 100 in third trimester. - 112Session 12 continfection, resistance, immunity
- 113Physiology of wound healingFour phases:
1. Haemostasis
2. Inflammation
3. Proliferation
4. Maturation - 114Factors affecting wound healingWound size
Suturing
Clinical condition of patient/woman
Presence/absence of infection - 115haemostasisBegins immediately
Vasoconstriction occurs
A fibrin clot forms, closing wound
Blood or serous fluid may exude - 116inflammationBlood vessels dilate
Causing localised erythema, oedema, heat discomfort, throbbing and sometimes functional disturbance
Macrophages clear debris and necrotic area forms
Epithelial tissue forms over wound
Usually lasts between 1-3 days - 117proliferationBegins within 3 days in acute wounds
Includes 3 processes:
Granulation
Wound contraction
Epithelialization - 118MaturationNew tissue is ‘re-modelled’ to increase the tensile strength of scar tissue
Begins after approx 21 days and can take up to 2 years
May be why some wounds appear to have healed and then break down - 119factors that affect wound healingTemperature
Infection
Nutritional status
Psych-social factors
Increasing age
Medical disorders
Drugs
Impaired oxygenation
Surgery-related care
Wound stress - 120ComplicationsHaemorrhage
Infection
Dehiscence
Evisceration
Fistula - 121wound managementPreoperative considerations
Skin preparation
Hair removal
Skin cleanser/technique
Intraoperative care
Postoperative care
Perineal wounds
Caesarean section wounds - 122Session 13Adaption to extra-uterine life
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- MIdwifery Year 1 Flashcards on FMP2 Postnatal Care, created by Ella Clark on 21/01/2018.
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