Welcome to OB ward

NCM 107 Care of Mother, Child, Family and Adolescent

(Well Clients)

Getting to know…
Activities/Tasks

DAY 1
(7am)
 Online class via Zoom
 Opening Prayer, checking of attendance
 Orientation: class rules
 Overview of the activities for the day and the
remaining days.
Activities/Tasks

DAY 1
(8am-12nn)
Students should access the canvas module and do the following:
 Read the Announcement, Syllabus and Module.
 Assess their prior knowledge and/or identify possible misconceptions by
engaging themselves with learning Task 1 “Prior Knowledge”.
 Apply process skills such as questioning, investigating, collecting data and
accomplishing form (Learning Task 2 worksheet) “The Interview”. This
provides the students with a common, concrete learning experience.
 Study basic/related concepts on Postpartum care: What to expect after
giving a vaginal birth? (PowerPoint presentation on Canvas)

(12nn – 1pm)
 Lunch break
Activities/Tasks
DAY 1

(1pm – 3 pm)
 Back to Zoom online class
 Orientation of the OB ward (video)
 Students to describe and discuss their exploration
learning experiences.
 Teacher will address any questions or misconceptions
regarding the topic and give more inputs as needed.
 Scenario Video
 Teacher will elaborate on the case scenario and
assignments
Activities/Tasks
DAY 1
Assignments :
#1 Learning Task 3 Case Story
Answer questions #1 and #2 after the case scenario (to be
submitted 9am on day 2)

#2 NCP (to be submitted 9am on day 2)

#3 Drug Study (to be submitted on day 2 afternoon)

#4 Health Teaching (to be submitted day 3 afternoon )

#5 Prayer appropriate for postpartum patients–group work (to be

submitted on day 3 afternoon)

 Feedbacking
 Closing prayer
1. What are the psychological challenges that a woman experiences after delivery?

2. List down the physical changes that a woman experiences post-partum

Introduction ( Learning Task 2)

Becoming a mother in all societies has been considered as the most crucial role for women. Although
some women avoid childbearing or defer it, becoming a mother is mostly inevitable. The birth of the first child
despite being a happy event, puts the mother into crisis and lots of stress and faces her with new roles and
responsibilities. The first year after childbirth is not only a vital period regarding the physical, emotional, and
psychological development, but also a significant time for challenging first -time mothers ’capacities in adjusting to
their maternal roles.

In the process of becoming a mother a woman goes through a period of change, instability and
reorganization of life. This psychological change can be influenced by the individual condition of a woman, her
outlooks and beliefs, her social and economical condition, her preparedness and knowledge of the situation as well
as her psychological condition. The more mothers are developed in this regard, the better they can adopt their
maternal role; this signifies that the experience of being a mother for the first time should be looked upon within the
specific social context to which a woman belongs.
 Learning Task 2

1. Interview a postpartum woman or anybody who has experienced

giving birth. (No face to face, you may interview thru the use of
phone or internet).
2. Complete the profile of the interviewee.
3. Write the salient responses based from the guide questions
below on the space provided.

Guide questions:
1. What are the psychological challenges that the woman
experiences after giving birth?
2. How did she cope up with these challenges?
3. List down all the physical changes observed and
experienced
LEARNING TASK 2 WORKSHEET:
OB ward Concepts
(Day 1 – morning)
 Postpartum care: What to expect after a vaginal birth?
Assessment

 It is accomplished by health interview; awareness of her

prenatal, natal, and medical history; physical examination;
and analysis of laboratory data.

 Psychological changes

 Physical changes
Psychological Changes
Postpartum Blues/Postpartum depression (PPD)
• It is a mood disorder in women shortly after childbirth.
• feelings of extreme sadness, anxiety, and exhaustion that can affect
the woman's ability to care for herself or for others.

Birth-related post-traumatic stress disorder (PTSD)

• This is a serious potentially debilitating condition that can occur in
mothers who have experienced severe difficulty in childbirth such as
feeling of too much pain, and life-threatening experience during
delivery and or death of baby.
• Symptoms: Re-experiencing (flashbacks, nightmares, repetitive and
distressing images or sensations, physical sensations, such as pain,
sweating, feeling sick or trembling
Psychological Changes

Post-partum psychosis
• the most severe form of postpartum psychiatric illness
but rare
• The onset is usually sudden, most often within the first 2
weeks postpartum.
• Symptoms may include: delusions or strange beliefs,
hallucinations (seeing or hearing things that aren’t
there), feeling very irritated, hyperactivity, decreased
need for or inability to sleep, paranoia and
suspiciousness, rapid mood swings and difficulty
communicating at times
Physiological Changes

(A) Reproductive System Changes

The fundus of the uterus is
The Uterus palpable through the
abdominal wall, halfway
Involution is the process between the umbilicus and
whereby the reproductive the symphysis pubis, within a
organs return to their few minutes after birth. One
nonpregnant state. hour later, it will rise to the
level of the umbilicus, where
Possible problems: it remains for approximately
1. Uterine Atony the next 24 hours. From then
2. Afterpains on, it decreases by one
fingerbreadth, or 1 cm, per
day; for example, on the first
postpartal day, it will be
palpable 1 cm below the
umbilicus.
Lochia
 This discharge normally has a musty, stale odor that is not offensive
 Any foul odor = suggestive of infection
 Lochia is heavier in the morning than at night
 The amount of lochia may also be increased by exertion or
breastfeeding
Visual vs. Measuring
o A visual account of blood loss can vary person to person
o Weighing the pads is more accurate
o You must know the dry weight of the pad
o Peripads can be weighed if needed: 1 gram = 1 ml of
blood

Type of Lochia Color Post Partal Day Composition

Lochia Rubra Red 1-3 Blood, fragments of decidua, and mucus
Lochia Serosa Pink 3-10 Blood, mucus, and invading leukocytes
Lochia Alba White 10-14 Largely mucus; leukocyte count high
The Cervix
• Immediately after birth - soft and malleable to palpation, both the internal and external os are open
• By the end of 7 days –feels firm and nongravid again ,the external os - the size of a pencil opening

The Vagina
• After delivery - swollen and has poor tone
• 4rth to 6th week - regains its tone and returns to its original size .
• Kegel’s exercise (perineal tightening). Lacerations resulting from childbirth heal completely.

The Perineum
• After delivery - swelling and tenderness, bruising and rupture of blood vessels are usually evident.
• 4rth to 6th week - the episiotomy or laceration is usually evident, no more swelling and tenderness.

Breasts and lactation

• Progesterone – hormone responsible for growth of breast tissue before birth.
• Colostrum – first secretion , rich in substances that help the newborn adjust to life outside the womb.
• About two to five days after the birth the breasts begin to produce milk. "the milk coming in".
• Sucking causes the pituitary gland to release oxytocin, which contracts the uterus and prevents
bleeding.
• Cracked nipples can develop at this time, which can be managed with pharmacological and
nonpharmacological treatment.
Physiological Changes

(B) Systemic Changes

The Hormonal System
Decrease
• 24 hours after - Human chorionic gonadotropin (hCG) and human placental lactogen (hPL)
• week 1- progestin, estrogen, and estradiol are all at prepregnancy levels
• week 2 - estriol may take an additional week before it reaches prepregnancy levels.
• 12 days - Follicle-stimulating hormone (FSH) remains low , begins to rise as a new menstrual cycle is back

The Urinary System changes

• Transient loss of bladder tone or decreased bladder tone is expected during pregnancy due to the effect
that progesterone has on smooth muscle.
• The fetal head pressing on the bladder during labor may have caused some trauma/edema.
• This may cause a decreased sensation making voiding difficult
Diuresis (increase production of urine) Make Sure Patient’s Know the Signs of a UTI
occurs due to: • Urinary frequency
• Decrease in estrogen which stimulated fluid retention • Dysuria
during pregnancy • Urgency
• Decrease in residual hypervolemia, or fluid overload • Hesitancy
• Reduction in venous pressure in the lower half of the body • Dribbling
• Profound diuresis can begin immediately after delivery and • Nocturia
spontaneous voiding usually returns within 6-8 hours post
• Suprapubic pain
delivery
• Bladder fills rapidly after delivery due to the marked • May have gross hematuria
increase in urine production • Odor
• Urine volume should return to pre-pregnant levels by 2-3
days after delivery

If cystitis is suspected…
• The nurse may need to assist the postpartum women with obtaining a urine sample.
In order to not contaminate the sample it needs to be obtained during midstream to
avoid getting lochia in the sample
• Then the sample is sent for microscopic examination, culture, and sensitivity tests
The Circulatory System changes
• The usual blood loss with a vaginal birth is 300 to 500 ml.
The Gastrointestinal System changes
• Bowels become sluggish after birth due lingering effects of
progesterone
• decreased abdominal and intestinal muscle tone
• the peptide hormone relaxin depresses bowel motility
• Bowel movement may not happen for 2-3 days

To Facilitate Normal Bowel Function

• Drink water • Ambulate
• Eat a high fiber diet • Stool Softeners
• Don’t ignore it • Medication
• Avoid Straining
The Integumentary System changes

• Striae gravidarum - the stretch marks – reddened and more prominent.

• Chloasma - Excessive pigment on the face and neck will be barely detectable after 6 weeks.
• Linea nigra – Excessive pigment on the abdomen upto 6 weeks

Let Your Patients Know…

• After delivery the soft tissue in and around the perineum may be swollen and bruised
• Initial healing of the episiotomy occurs within 2 to 3 weeks
• Supportive tissue of the pelvic floor is stretched and during birth and complete healing may take
4 to 6 months

Signs of infection of the episiotomy or repaired laceration of the perineum may include:
• Redness • Purulent drainage
• Warmth • Gaping of the previously approximated wound
• Edema • Local pain
Physiological Changes
(3) Progressive Changes of the Puerperium
Lactation
The formation of breast milk (lactation) .
• First 2 days after birth - little change in her breasts from the way they were during pregnancy .
• 3rd day - breasts become full and feel tense or tender as milk forms within breast ducts and
replaces colostrum.
Breast Fullness
While breastfeeding, women
Engorgement
must be certain to drink
• transitional fullness will • overfilling and swelling of the breast and/or
usually last about 24 hours areola adequate fluid daily, eat a
• the breast will still be soft • typically be painful, warm to the touch, skin will varied nutritious diet, and
enough for the baby to nurse appear shiny and taut check with their healthcare
• Typically no pain, but a • engorgement can occur at any time provider before ingesting
sense of fullness to the breast medicine or alternative
therapies such as herbs
• will occur about the 3-5th • initiation of breastfeeding soon after delivery, and
day post delivery offering frequent feedings will reduce the chances because most of these can be
of engorgement found in breast milk and their
• breast fullness is normal use may not be evidence-
and will resolve
based.
Return of menstrual flow

• Not breastfeeding – 6 to 10 wks after

• Breastfeeding – may not return 3 to 4 months
- or the entire lactation period
- but does not guarantee that a woman will not get
pregnant
OB ward Concepts
(Day 1 – afternoon)
LEARNING TASK 3 : Case Story
Questions / Instructions

1. Give a brief description of postpartum hemorrhage.

2. From the given scenario, what are the risk factors, that predisposes the client to
experience postpartum hemorrhage?

3. Formulate your nursing care plan for the client basing from the assessments given
in the scenario.

4. Make a drug study of the medication assigned to you utilizing the form given
below.

5. Make a health teaching plan suitable to your patient basing on the scenario.
Include visual aid , be creative as you can.
Follow the prescribed format attached on this module
End of Day 1