Postpartum

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POSTPARTUM The postpartum period, or puerperium, refers to the 6-to-8-week period after delivery during which the mother’s body returns to its prepregnant state. Some people refer to this period as the fourth trimester of pregnancy. Many physiologic and psychological changes occur in the mother during this time. Nursing care should focus on helping the mother and her family adjust to these changes and on easing the transition to the parenting role.  Known as the 5th stages labor. Puerperium – covers 1st 6 -8wks wks post partum Involution – return of reproductive organ to its non pregnant state. Hyperfibrinogenia - prone to thrombus formation - early ambulation Physiologic changes: Two types of physiologic changes occur during the postpartum period: retrogressive and progressive changes. Getting back to normal: Retrogressive changes involve returning the body to its prepregnant state. Retrogressive changes include: • Shrinkage and descent of the uterus into its prepregnancy position in the pelvis • Sloughing of the uterine lining and development of lochia • Contraction of the cervix & vagina • Recovery of vaginal and pelvic floor muscle tone. Postpartum care should respond to the special needs of the mother and baby and should include • Prevention and early detection and treatment of complications and disease. • Provision of advice and services on breastfeeding, birth spacing, immunization and maternal nutrition. Rubin’s Postpartum phase Psychological Responses: a. Taking in phase – dependent phase (1st three days) mom – passive, cant make decisions, activity is to

tell child birth experiences. During this time, the woman’s attention is focused on her own needs for sleep, rest and she is dependent on others. Nursing Care: - proper hygiene b. Taking hold phase – dependent to independent phase (4 to 7 days). Mom is active, can make decisions,

The concern of the mother at this time is focused on her ability to control body function and her ability to assume the mothering role. She prefers to do things by herself. As she is not yet completely recovered, she feels impatient that she’s not strong enough to do everything she wishes to accomplish.

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Because of the tendency of the woman to overwork herself, fatigue and exhaustion is common at this stage. HT: Begins to take a strong interest for her child - Give the woman brief demonstration of baby care - Allow her to care for the child herself with watchful guidance common post partum blues/ baby blues present 4 – 5 days 50-80% moms – overwhelming feeling of depression characterized by crying, despondence- inability to sleep & lack of appetite. – let mom cry – therapeutic. c. Letting go – interdependent phase – 7 days & above. Mom - redefines new roles may extend until child

grows. Letting-Go – the act of ending old ways of thinking or believing - The woman finally redefines her new role - Gives up fantasized image of her child and accepts the real one - Gives up her old role of being childless or the mother of only one or two - Extended and continues during the child’s growing years Maternal Concerns & Feelings during Postpartum:  ABANDONMENT - Only hours before, they were the center of attention, with everyone asking about their health and well-being. Now suddenly, the baby is the chief interest. The woman may feel confused by a sensation very close to jealousy. Father may have much same feelings Shared responsibility for infant care can help to make both partners feel equally involved in the baby’s care and can help alleviate these feelings.  DISAPPOINTMENT - It can be difficult for parents to feel positive immediately about a child who does not meet their expectations. Handle the child warmly. Comment on the child good points.  POSTPARTUM BLUES (Baby blues)- 50% of women experience some feelings of overwhelming sadness. The mother burst into tears easily or may feel let down or be irritable. Maybe due to hormonal changes (decrease estrogen & progesterone). It maybe a response to dependence and low self-esteem caused by exhaustion, being away from home, physical discomfort, and the tension endangered by assuming a new role. A woman needs aasurance that sudden crying episodes are normal. Allow to Verbalize feelings Physiologic Changes of Postpartal Period  CARDIOVASCULAR SYSTEM – 1st or 2nd week postpartum, the blood volume has returned to its

normal pre-pregnancy level. Blood Volume Hemorrhage – bleeding of > 500cc CS – 600 – 800 cc normal

NSD 500 cc

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Early postpartum hemorrhage– bleeding within 1st 24 hrs. Baggy or relaxed uterus & profuse bleeding – uterine atony. Complications: hypovolemic shock. Mgt: 1.) massage uterus until contracted 2.) cold compress 3.) modified trendelenberg 4.) IV fast drip/ oxytocin IV drip  The 40% increase in blood volume during pregnancy enters the maternal circulation within 5 to 10 minutes after placental delivery making this period very critical to gravidocardiacs because their damaged heart may not be able to handle this sudden increase in cardiac workload.  Blood volume returns to nonpregnant levels 1-2 weeks after delivery resulting in a decline in cardiac output by 30%. Blood Components  Hct rises in the first 3 to 7 days due to hemoconcentration caused by excretion of large amounts of fluids in the urine (diuresis during the first few days after delivery). Hct level returns to normal on the fourth to fifth postpartum week.  Leukocytosis of 20,000 to 30,000 (normal is 5000 to 10000) during the first 12 days characterized by increased neutrophils and easinophils and decreased lymphocytes.  Fibrinogen and thromboplastin remains elevated until the 3rd postpartum week.  Increased leukocyte sedimentation rate. INTEGUMENTARY SYSTEM  -Chloasma, palmar erythema, linea nigra and other skin changes during pregnancy gradually disappear during the postpartum period.  -Striae gravidarum do not disappear and assumes a silvery white appearance.  -Hyperpigmentation of the areola may not disappear completely. Some women are left with a wider and darker areola after pregnancy.  Linea nigra will be barely detectable in 6 weeks time GASTROINTESTINAL SYSTEM  Many women are hungry after delivery because of foods and fluids restriction during labor, diaphoresis and the strenuous labor they just went through.  Bowel movement maybe delayed for days after delivery resulting in constipation. This is caused by:  Decreased muscle tone during labor and puerperium  Lack of food during labor  Dehydration  Perineal pain caused by episiotomy, hemorrhage,laceration  Bowel sounds are active, but passage of stool through the bowel may be slow URINARY SYSTEM o VOIDING is difficult because of the pressure on the bladder and urethra making it edematous

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o To prevent permanent damage to the bladder from over distention, assess the woman’s abdomen frequently in the immediate postpartum period o Increase daily output o From 1500ml/day to 3000ml/day during the second to fifth day after birth Diuresis begins 12 hour after delivery and extends up to the 5th day as the body gets rid of extracellular fluid accumulated during pregnancy. The woman loses up to 9 lbs. weight from the excretion of these fluids and electrolytes. o Acetone in the urine right after labor and lactosuria during the first week is normal. o The bladder and urethra are traumatized by the pressure exerted by the fetal head as it passes through the birth canal. Trauma to bladder results in loss of bladder tone, edema and hyperemia. As a result, the woman experiences ↓ bladder tone that results in ↑ bladder capacity. Decreased bladder tone causes decreased sensation to the filling and distention of the bladder, the woman may not experience the urge to void even if her bladder is already distended with urine w/c predisposes to infection.  When catheterization of postpartum patient with urinary retention:  Use straight catheter if one hour catheterization is ordered; use foley for 24 hours catheterization  Maitain aseptic technique.  Provide gentle touch as the area is sore.  When amount of urine reaches 900-1000 cc, clamp catheter to prevent rapid decompression in the abdomen w/c can cause hypotension  Check vital signs after catheterization.  Unclamp after 1 hour to drain urine. o

HORMONAL SYSTEM  HCG & HPL almost negligible by 24 hours  Progestin, Estrone & Estradiol are at pre-pregnant level by 7th day  FSH remains low for about 12 days, then begins to rise to initiate a new menstrual cycle  Pregnancy hormones begin to decrease as soon as the placenta is no longer present. REPRODUCTIVE SYSTEM  Uterus  INVOLUTION – a process whereby the reproductive organs return to their non-pregnant state.  2 main processes of involution of the uterus:  The area where the placenta was implanted is sealed off, preventing bleeding  Organ is reduced to its approximate pregestational size  Promotion of Uterine Involution : (well-nourished, ambulates early after birth,breastfeeding)  24 hours after birth the uterus is at the level of umbilicus.  1 cm or 1 fingerbreadths every postpartum day.  After 9-10 days the fundus is no longer palpable.  a well-contracted fundus should feel firm

5  Uterine Atony – relaxed uterus, woman may loss blood rapidly  After pains – intermittent cramping of the uterus

 Common in multiparas, and those who have given birth to large babies  Uterus contracts more forcefully  Intense with breastfeeding (because of oxytocin) Weight of the uterus:  Right after delivery : 1000 grams  One week after delivery: 500 grams  2 weeks after delivery: 300 grams  6 weeks after delivery: 50-60 grams  Palpation of the fundus:  Place woman supine with small pillow under her head and knees flexed to relaxed abdominal muscles. Make sure the bed is flat. Palpate the fundus by placing a hand @ the umbilicus and pressing it downward while the other hand is placed just above the symphysis to support the lower segment of the uterus. Never palpate the uterus without supporting the lower segment as this can result to uterine inversion. If on palpation,the uterus feels boggy:  Massage it gently in circular motion, this is the first action to take  Place infant on mother’s breast to stimulate uterine contractions by the release of oxytocin  Administer oxytocin (as ordered) or increase infusion, do not administer ergot products if BP is above 140/90. HEIGHT OF THE FUNDUS  Measure the position or height of fundus by using umbilicus as a landmark. Place fingers on the abdomen of the woman just below the umbilicus and count the number of fingerbreadths that fit btwn the top of the fundus and umbilicus.  Immediately after delivery, the fundus is located midway btwn the umbilicus and symphysis pubis or slightly higher. After several hours, it rises to the level of the umbilicus. It then, descends into the pelvic cavity by one cm or one fingerbreadth a day. LOCHIA -The seperation of the placenta and membranes occurs in the spongy layer or outer portion of the decidua basalis -2nd day after birth, the layer of the deciduas remaining under the placental site and throughout the uterus differentiates into two distinct layers. 1. Inner layer 2. Adjacent layer -Uterine flow, consisting of blood, fragments of deciduas, white blood cells, mucus and some bacteria The placental implantation site will take approx. 6 weeks to be cleansed and healed Type of Lochia

Color

Duration

Composition

Rubra

red

1-3 days

Blood,fragments of deciduas, mucus

Serosa

pink

3-10 days

Blood,mucus,invading leukocytes

Alba

white

10-14 days

Largely mucus,leukocyte count high

CERVIX

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 Immediately after birth, the cervix is soft and malleable  Both the internal and external os are open  By the end of 7 days the external os is narrowed to the size of a pencil opening and the cervix feels firm and nongravid again  Does not return exactly to its prepregnant state  External will usually remain slightly open  Cervical os appears slitlike or stellate (star shaped) VAGINA  After a vaginal birth, the vagina is soft with few rugae  Hymen is permanently torn and heals with small separate tags of tissue  Gradually turns to its approximate prepregnant state  Outlet will remain slightly more distended than before. AMBULATION Advantages of early ambulation  Prevent constipation  Prevent thrombophlebitis  Prevent urinary problems  Promote rapid recovery and return of woman’s strength  Hastens drainage of lochia  Improves GIT & GUT function  Provides a sense of well-being REST & SLEEP  The woman should rest & sleep as much as needed during the early postpartum period to overcome fatigue, excitement, anxiety & discomfort associated with long & exhausting labor & delivery. Sleep and rest promote healing by reducing BMR and allowing O2 & nutrients to be utilized for tissue growth, healing & regeneration.  Instruct the mother to avoid heavy lifting and strenous activity after discharge  The woman may resume light housekeeping on the second week and can go back to normal activities by 4 to 6 weeks. Resumption of Sex  Sexual intercourse can be resumed 3 to 4 weeks after vaginal delivery if bleeding has stopped, perineum is healed and if does not cause pain to the woman. DISCHARGE  The newly delivered mother is ready to go out of the health care facility 24-48 hours after NSD  Primiparas may leave after 2-3 days and multiparas after 1-2 days if they are recovering normally.  After a CS, a woman maybe discharged on the 3rd or 4th day.  Before leaving, she should be insructed re: schedule of follow-up clinic visit and to report immediately to the doctor if the ff. signs & symptoms appear:  Heavy vaginal bleeding or bright red vaginal discharge  Fever  Foul smelling lochia  Swollen, tender, hot area on her leg  Burning sensation on urination  Persistent pelvic or perineal pain

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BENEFITS OF BREASTFEEDING               

Best for baby, also best for mommy Reduces the incidence of allergies Economical – no waste Antibodies to protect baby against infection Sterile and pure Temperature is always ideal Fresh milk never goes off Easy to prepare and to digest Eradicates feeding difficulties Develops mother & child bonding Immediately available Nutritionally optimal Gastroenteritis greatly reduced Promote rapid involution LAM (Lactation Amenorrhea Method)3-4months

POSTPARTAL COMPLICATIONS (Potential) POSTPARTAL HEMORRHAGE  Assess Any blood loss from the uterus greater than 500 ml within 24 hour period.  EARLY POSTPARTUM HEMORRHAGE >500mL in first 24 hrs (blood loss often underestimated) • LATE POSTPARTUM HEMORRHAGE >500mL after first 24 hrs Acreta – attached placenta to myometrium. Increta – deeper attachment of placenta to myometrium Percreta – invasion of placenta to perimetrium SYMPTOMS OF POSTPARTUM HEMORRHAGE  uncontrolled bleeding (>2pads/30min)  decreased blood pressure  increased heart rate  decrease in the red blood cell count (hematocrit)  swelling and pain in tissues in the vaginal and perineal area  Light headedness, nausea and visual disturbances  Anxiety, pale and clammy skin  Increase in pulse rate and respiratory rate  Decrease in blood pressure because of the blood loss CAUSES OF POSTPARTAL HEMORRHAGE

hysterectomy

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UTERINE ATONY - Failure of the uterus to stay or firmly contracted  CAUSE OF 80-90% OF EARLY HEMORRHAGE  SLOW/STEADY OR SUDDEN/MASSIVE  BLEEDING MAY OR MAY NOT BE VISIBLE  BP/P MAY NOT CHANGE TILL LATE CAUSES OF UTERINE ATONY  Multiple pregnancy  Hydramnios  Large babies (macrosomia)  Placental accidents  Prolonged and difficult labor  Previous uterine surgeries  Deep anesthesia  Endometritis  Anemia  History of post partum hemorrhage  Maternal age>30yrs. NURSING MANAGEMENT • medication (to stimulate uterine contractions) - IM Methergine - IV Oxytocin • manual massage of the uterus (to stimulate contractions) • Administer ice pack. • Bimanual massage. • Blood transfusion.  Hysterectomy - surgical removal of the uterus.  If with respiratory distress from decreasing blood volume: give O2 place in supine to allow adequate blood flow to brain and kidneys LACERATIONS OF GENITAL TRACT  POSSIBLY 20% OF EARLY PP HEMORRHAGE  RISKS: PRIMIGRAVIDA, PRECIPITOUS BIRTH, MACROSOMIA, FORCEPS OR VACUUM EXTRACTION  THOROUGH PP INSPECTION IMPORTANT WITH REPAIR PRN  SUSPECT WHEN VAGINAL BLEEDING PRESENT, BUT FUNDUS FIRM TYPES OF LACERATIONS  CERVICAL LACERATION - Arterial Bleeding (Bright red) -Usually on the sides of the cervix, near the branches of the uterine artery.

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VAGINAL LACERATION  Easier to assess but harder to repair  Vaginal tissue is friable so lacerations are harder to repair. PERINEAL LACERATION  Occurs when woman is placed on lithotomy position during delivery (increase tension on the perineum). CLASSIFICATIONS OF PERINEAL LACERATIONS Classification

Description of Involvement

First Degree

Vaginal mucus membrane & skin of the perineum to the fourchette

Second Degree Vagina,perineal skin,fascia,levator ani muscles,& perineal body Third Degree

Entire perineum,& reaches the external sphincter of the rectum

Fourth Degree Entire perineum, rectal sphincter,and some of the mucus membrane of the rectum NURSING MANAGEMENT  Repair as episiorrhapy.  document degree of laceration.  Provide increase fluid and stool softener for 1 week.  For 3rd and 4th degree: no enema, suppository or rectal temperature. DISSEMINATED INTRAVASCULAR COAGULATION  A deficiency in clotting ability caused by vascular injury an emergency.  Hypofibrinogenemia  May occur in any postpartal woman  CAUSES: Premature separation of the placenta (abruptio placenta); Missed abortion ; Fetal death in utero. NURSING MANAGEMENT  Start IV Heparin as ordered.  Prepare blood replacement blood typing. SUBINVOLUTION  Uterus remains large, and soft at 4 to 6 weeks postpartum.  Incomplete return of the uterus to its prepregnant size and shape.  Lochia is still present. CAUSES OF SUBINVOLUTION  Endometritis or postpartal infection

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 Retained placental fragments  Accompanying problem like myoma  Any factor that interferes with complete contraction SYMPTOMS OF SUBINVOLUTION  Lochia fails to progress it returns to rubra  Leukorrhea with backache and infection NURSING MANAGEMENT  If cause by infection, administer an oral antibiotic as prescribed.  Oral methergine as ordered  Instruct the woman on the normal process of involution and lochial discharge to help prevent delay in seeking healthcare. PERINEAL HEMATOMA  Result from injury to a blood vessel, usually in vagina or vulva, may extend upward into broad ligament or other pelvic structures.  Develop rapidly  May contain 300-500mL blood  Collection of blood in the subcutaneous layer of the perineum.  Cause discomfort but usually only minor bleeding.  Appears as an area of purplish discoloration on and obvious swelling. CAUSES OF PERINEAL HEMATOMA  Rapid, spontaneous birth (precipitate delivery)  Women with perineal varicosities  If a vein is punctured during episiorrhapy or repair of laceration.. NURSING MANAGEMENT  Report presence of hematoma.  Assess the size by measuring in cms with each inspection.  Administer mild analgesic as ordered.  Apply ice pack covered with towel (cold compress).  It may be left open and packed with gauze rather than resuture. ENDOMETRITIS  Infection of the endometrium  Uterus not well contracted and painful to touch.  SYMPTOMS: discharge (scant and profuse) bloody, foul smelling; jagged and irregular temperature elevations; tachycardia; chills; subinvolution  oral temp > 100 C for 2 consecutive 24 hrs periods exceeding the 1st , 2nd period after birth NURSING MANAGEMENT  Administer antibiotic as ordered – determine by culture of lochia  Administer an oxytocic agent as ordered.  Sitting in a fowler’s position or walking encourages lochia discharges  Encourage good handwashing. INFECTION OF THE PERINEUM  Originates from incision site  Usually remain localized; with pain, heat & feeling of pressure and inflammation of suture line  May or may not have fever.

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NURSING MANAGEMENT  Administer topical or systemic antibiotic as ordered.  Perineal packing to allow drainage  Analgesic as ordered for pain relief  Sitz baths or warm compress to hasten drainage  Encourage good handwashing  Encourage the woman to ambulate. MASTITIS  Infection of the breast may occur as early as 7th postpartal day or may not occur until the baby is weeks or months old.  It is cause by the nasal-oral cavity of the infant  It is caused by the agent: Staph. aureus and Candidiasis NURSING MANAGEMENT  The mother will placed on a broad spectrum antibiotic, such as cephalosporin  Ice compress  Good, supportive bra give a great deal of pain relief until the process improves  Warm, wet compress PERITONITIS  Life-threatening infection of the peritoneum  Abcesses on the uterine ligaments, in the cul de sac, and/or in the subdiaphragmatic space.  May result from pelvic thromboplebitis  Infection of the peritoneal cavity which usually an extension of endometritis  One of the gravest complications of childbearing  A major cause of death from puerperal infection  Infection spreads through lymphatic system or directly through fallopian tubes or uterine wall  Interferes with future fertility ( LEAVING SCARRING) SYMPTOMS OF PERITONITIS  High temperature  Chills  Malaise  Lethargy  Pain  Subinvolution  Abdominal Rigidity (Uterus may be well-contracted but remainder of abdomen is soft guarding )  Tachycardia  Local or referred pain  Rebound tenderness  Thirst  Distension  Nausea and vomiting NURSING MANAGEMENT  Insertion of NGT (Nasogastric tube) -to prevent vomiting & rest bowel  IVF or Total Parenteral Nutrition

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 Analgesics and antibiotics as ordered. THROMBOPLEBITIS  Inflammation with formation of blood clots, usually extension of endometritis  Classified as superficial vein disease (SVD) or deep vein thrombosis (DVT)  ETIOLOGIES: Increased in blood clotting factors; postpartal thrombocytosis (Increased Platelets)  Thromboplastin release (placenta, amnion)  Increased fibrinolysin and fibrinogen inhibitors. SUPERFICIAL VEIN DISEASE (SVD) - SYMPTOMS: tenderness, heat, redness, low grade fever, (+) Homan’s Sign and tachycardia - TREATMENT: elevation of leg, analgesics, bed rest DEEP VEIN THROMBOSIS (DVT) - SYMPTOMS: edema, low grade fever, chills, pain in limb below affected area and decreased peripheral pulses. - TREATMENT: Heparin as ordered, antibiotics, bedrest, elevation and analgesics. PREDISPOSING FACTORS  Obesity  Varicose veins  > 30 yrs. Of age or high parity  High incidence of thrombophlebotic disease in the family PREVENTIVE MEASURES  Use aseptic technique  Early ambulation encourages circulation in the lower extremities and decrease clot formation  Leg exercises with 9 her flexing and straightening her knee, raising the leg and drawing a circle in the air by 8 hrs. after birth.  Wear stockings for 2 wks. postpartum FEMORAL THROMBOPLEBITIS  Decreased circulation, along with edema, gives the leg a white or drained appearance.  Formerly called milk leg or phlegmasia alba dolens ( white inflammation NURSING MANAGEMENT  Bed rest with the affected leg elevated  Administer anticoagulants as ordered  Apply moist heat  Bed cradle may be used  Cover wet, warm dressings with plastic pad to hold in heat and moisture  Check for wrinkles to prevent pressure ulcers  Never massage the skin over the clot  Aspirin is contraindicated PELVIC THROMBOPLEBITIS  Involves the ovarian, uterine, or hypogastric veins.  It occurs later than femoral thrombophlebitis , often around 14th or 15th day of the puerperium. NURSING MANAGEMENT  Total bed rest

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 Administer antibiotics and anticoagulants  Teach woman preventive measures: - avoid constrictive clothing - rest with feet elevated - ambulate daily during pregnancy PULMONARY EMBOLUS  Obstruction of Pulmonary Artery with blood clot.  SIGNS AND SYMPTOMS: Sudden, sharp chest pain, Tachypnea, Tachycardia, Orthopnea and Cyanosis ( blood clot is obstructing the pulmonary artery obstructing blood flow to the lungs and return to the heart Urinary retention  Implies inadequate bladder emptying  It occurs following childbirth because of decrease bladder sensation for voiding due to edema of the bladder from the pressure of birth.  Unable to empty, the bladder fills to overdistention Signs and Symptoms  Woman is not only voiding but is voiding very frequently  As a rule: If output /void is <100 ml, retention is suspected  Confirmed by catheterization, immediately after voiding (if amount of urine left in bladder after voiding-residual urine is > 100 ml, the woman has retention of more than the normal amount Nursing Management  Catheterization, indwelling or intermittent  Aseptic technique at all times Urinary tract infection  Common to catheterized women during childbirth or the postpartal period. CYSTITIS  inflammation of the urinary bladder. The condition more often affects women, but can affect either sex and all age groups. Symptoms  Pressure in the lower pelvis  Painful urination (dysuria)  Frequent or urgent need to urinate  Need to urinate at night (nocturia, similar to prostate cancer or BPH)  Abnormal urine color (cloudy), similar to a urinary tract infection  Blood in the urine (hematuria) (similar to a female's period or bladder cancer)  Foul or strong urine odor Signs and Tests  A urinalysis commonly reveals white blood cells (WBCs) or red blood cells (RBCs).  A urine culture (clean catch) or catheterized urine specimen may be performed to determine the type of bacteria in the urine and the appropriate antibiotic for treatment. Treatment  Because of the risk of the infection spreading to the kidneys (complicated UTI) and due to the high complication rate in the elderly population and in diabetics, prompt treatment is almost always recommended.

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 Anti biotic Prevention  Keeping the genital area clean and remembering to wipe from front to back may reduce the chance of introducing bacteria from the rectal area to the urethra.  Increase fluid intake. SALPHINGITIS  In contrast, salpingitis only refers to infection and inflammation in the fallopian tubes. Causes and pathophysiology  The infection usually has its origin in the vagina, and ascends to the fallopian tube from there.  Because the infection can spread via the lymph vessels, infection in one fallopian tube usually leads to infection of the other. Treatment  Salpingitis is most commonly treated with antibiotics Diagnosis  By Pelvic examination, blood tests and mucus swab a doctor can diagnose salpingitis.  Oophoritis is an inflammation of the ovaries. It is often seen in combination with salpingitis (inflammation of the fallopian tubes). PYELONEPHRITIS  Kidney infection, usually of the R. kidney  Ascends from bladder  SYMPTOMS: elevated temperature, chills, flank pain, CVA pain, Nausea and vomiting, history of asymptomatic bacteruria or pyelonephritis  Urgency, frequency, dysuria  Back pain PREVENTION AND TREATMENT  Increased Fluid Intake  Ensure complete emptying of the bladder  Sterile technique for catheterization  Good perineal care

PP Blues

PP Depression

PP Psychosis

1-10 days after birth

1-12 months after birth

Within first month after birth

symptoms Sadness, tears

Anxiety,feeling of loss,sadness

Delusions or hallucinations

incidence

10% of all births

1% to 2% of all births

onset

70% of all births

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Etiology Probable hormonal (possible) changes,stress of life changes

Hx of previous depression,hormonal Possible activation of previous mental response,lack of social support illness family hx of bipolar d/o

therapy

Support, empathy

Counseling,drug therapy

Psychotherapy,drug therapy

Nursing Role

Offering compassion & understanding

Referring to counseling

Referring to counseling,safeguarding mother from injury to self or to newborn