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RCH POST NATAL CARE

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Information about RCH POST NATAL CARE
Health & Medicine

Published on March 6, 2014

Author: maheswarijaikumar

Source: slideshare.net

Description

RCH POST NATAL CARE
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POST NATAL CARE MJ. .

CONTENTS. Management of normal puerperium. Advise on breast feeding & related problems. Diagnose puerperal complications & management. Health education on post natal care of the mother & the baby. Counsel for contraception. Identify & manage complications of puerperium.

Examination of post natal women. Advice for breast feeding & related problems. Management of normal puerperium. Diagnosis & management of normal puerperium. Health education on post natal care. Advice on contraception. Detection of puerperal pyrexia & management. Detection of puerperal sepsis & management. Detection & management of UTI. Detection & management of breast complications. Detection & management of puerperal psychosis.

EXAMINATION OF POST NATAL WOMEN ADVICE ATLEST TWO POST NATAL CHECK UPS. First within 10 days of delivery. Second at 6 wks of delivery. THE FIRST CHECK UP AIMS, History about delivery,bowel & bladder functions,sleep,lactation,& any ailment. Examination – fever,anemia,breast,uterus,& lochia.

GUIDELINES FOR GENERAL EXAMINATION. Note the size of the Ut .The involution occurs a follows. Immediately following the delivery – Ut is at the level of the umbilicus. During the first 24 hrs it remains the same & then comes just below umbilicus at the rate of 1 inch per day during first 2-3 days. Then half an inch per day. By about 7-10 days it descends beneath pubic symphysis & enters the pelvic cavity. Within 6 wks it regains its original size.

Note the smell & colour of lochia . Examine the episiotomy – for healing. S/S of abnormal puerperium – fever,tachycardia,breast complaints,pain in abdomen,fullness of abdomen,foulsmelling discharge,tender uterus,sub involution.

SECOND POST NATAL CHECK UP. Is done end of 6 wks. Assess the following. Involution of uterus. Assessment of Hb. Screen for fitness for contraception. General systemic & local examination & Hb estimation.

MANAGEMENT OF NORMAL PUERPERIUM. Advice 2-3 hrs of rest. Advocate early ambulation. Maintain personal & perineal hygiene. Advice light diet on the first day. Subsequently advice normal diet .(+300 kcal than non lactating women). Diet should be rich in roughage to avoid constipation. Encourage to viod frequently atleast 4-6 hrly. Encourage perineal hygiene.(perineal cleaning to be done). Stitch area should be cleaned dressed with antiseptic powder & covered with sterile pad daily.

Advice to change diaper frequently. Encourage daily bathing & general cleanliness. Encourage to wash hands each time before feeding the baby. The mother should avoid frequent visitors to avoid infections. Administer IFA tablet for at least 6 month following the delivery. Educate on abstinence for 6 wks. Focus on contraception advice after 6 wks. Educate on the importance of breast feeding. Advice extra food during lactation period. (milk,jaggery,green leafy veg, chappatis,rice & pulse to increase the caloric intake – 550 kcal.) Advice on child care.

WARNING SIGNS. EDUCATE THE MOTHER TO REPORT IF THERE IS, FEVER. BREAST ENGORGEMENT. PAIN ABDOMEN. INFECTED LOCHIAL DISCHARGE. PAINFUL URINATION. ANY PAIN IN CHEST OR LEGS.

DIAGNOSIS & MANAGEMENT OF MINOR AILMENTS. AFTER PAIN. RETENTION OF URINE. PAIN.

AFTER PAIN. IS THE INFREQUENT LOW ABDOMINAL COLICKY PAIN FELT AFTER DELIVERY,MORE SO DURINF BREAST FEEDING FOR 2-4 DAYS. This is due to oxytocin secretion during breast feeding & due to contractions to expel blood clots. Treatment.--- Reassurance. ----------------Mild analgesic.

PAIN. AT THE SITE OF THE EPISIOTOMY. MAY BE DUE TO DUE TO TIGHTLY APPLIED STICHES IN THE SKIN. TAB IBUPROFEN 400 mg. 8 hrly 8 3-4 days. RETENTION OF URINE. HOT WATER / COLD WATER APPLICATION ON THE SUPRAPUBIC REGION,(SOUND OF RUNNING WATER.)

ENGORGEMENT OF BREAST. Hot water fomentation & light massage (from periphery towards nipple ). 5 units of syntocinon IM may be given following manual expression of milk.

HEALTH EDUCATION ON POST NATAL CARE. INCLUDE POINTS FROM NORMA PUERPERIAL CARE.

DETECTECTION OF PUERPERAL PYREXIA & MANAGEMENT. ANY FEBRILE CONDITION –100 F OR MORE , WITHIN 14 DAYS AFTER CONFINEMENT OR IF THE TEMP IS MORE THAN 6 HRS APART AFTER 24 HRS OF DELIVERY. CAUSES : Puerperal sepsis. UTI. Breast engorgement. Inter current infection. Deep vein thrombosis of leg.

INVESTIGATION : Hb. TLC. DLC. Urine for pus cells. MANAGEMENT : PREVENTIVE CARE THROUGHOUT PREGNANCY IN ALL THE STAGES.

CARE

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