Published on March 6, 2014
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.
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