adaptasi masa nifas.ppt

7/23/2019 ADAPTASI MASA NIFAS.ppt

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ADAPTASI MASA NIFAS

NUR AFI DARTI



Postpartum Physical Adaptations

• Uterine Involution• Fundal position changes ; !oggy"• #ochia$ Ru%ra& Serosa& Al%a

• 'ervical changes• (aginal changes• Perineal changes•

Recurrence o) ovulation andmenustration• #actation



Cont’….

• *astrointestinal System

• Urinary tract• (ital signs

• +eight loss

• Postpartum chill

• Postpartal diaphoresis

• A)terpains or A)ter%irth pains



Uterine Involution

•

The rapid reduction in si,e o) theuterus and it-s return to a conditionsimilar to its pre.pregnancy state/

•

The uterus remains slightly largerthan it 0as %e)ore the 1rstpregnancy/

•

Process is complete at 2 0ee3s• Subinvolution may %e caused %y an

in)ection or retained placenta

)ragments/



Fundal position changes

4 A)ter %irth the top o) the )undusremains at the level o) the um%ilicus)or 56 to 67 hours/

• The 1rst postpartum day it is located5 cm or 1nger%readth %elo0 theum%ilicus/

• May %e displaced to the le)t or right%y a distended %ladder/

• !ecomes %oggy" 0ith uterine atony



#ochia$ Ru%ra& Serosa& Al%a

4 Ru%ra

– dar3 red in color& present the 1rst 6.2 dayspostpartum& should not contain clots& a)e0 small clots are considered normal/

•

Serosa – pin3ish to %ro0nish in color& )rom the 2rd

to the 58th day post delivery/

•

Al%a – creamy or yello0ish in color& persists )or a

0ee3 or t0o a)ter serosa& may %e later in%reast)eeding clients/



'ervical 'hanges

• Follo0ing %irth it is spongy and9a%%y and )ormless and may appear%ruised/

• :riginal )orm is regained in a )e0hours

• The shape is permanently changed

%y the 1rst child%earing/• *oes )rom dimple li3e to a lateral slit

1sh mouth<



(aginal 'hanges

• Follo0ing %irth appears edematous

• May %e %ruised

•

Small super1cial lacerations may %epresent

• Si,e and rugae return to pre

pregnancy in 2 0ee3s !y = 0ee3sappears normal



Perineal 'hanges

• May appear edematous 0ith some%ruising

• >pisiotomy edges should %eappro?imated

• >cchymosis may occur and delayhealing



Recurrence o) :vulation andMenustration

• (aries )or each postpartum client

• *enerally returns to non.nursingmothers %et0een @ and 0ee3s a)ter

%irth

• The 1rst cycle is non.ovulatory

• !reast)eeding clients may e?perience

menustration and ovulation %ased on the• amount o) time nursingBmay occur )rom

6nd to5Cth month



#actation

• During pregnancy& the %reastsdevelop in preparation )or lactationas a result o) %oth estrogen and

progesterone/

• A)ter %irth& the interplay o) maternalhormones leads to the esta%lishment

o) mil3 production/



*astrointestinal System

• May have a regular diet

• !o0els tend to %e sluggish

• >pisiotomy clients may delay %o0elmovement )or )ear o) pain

• 'esarean %irth clients may receiveclear liuids and progress to aregular diet

• Stool so)teners may %e used



Urinary Tract

• The postpartum client has an increased%ladder capacity& s0elling and %ruisingo) tissue& decreased sensitivity to 9uidpressure& and decreased sensation o)

%ladder 1lling/• At ris3 )or over.distention& incomplete

emptying& and %uildup o) residual urine/

•

Urinary output increases 5rst 67 hourspost delivery puerperal diuresis<

• Urine specimens should %e o%tained asa catheteri,ed specimen/



(ital Signs

• 'lient should %e a)e%rile a)ter the1rst 67 hours/

• A temperature up to 100.4 may bedue to dehydration and/or exertion in

the frst 24 hours/• !P +N#& a decrease may occur / An E

!P may indicate to?emia& PI/

•

Pulse rate may decrease to G8.@8/Tachycardia should alert the nurse toblood loss/dicult birth/



!lood (alues

• !lood values should return to the prepregnantstate %y the end o) the postpartum period/

• Predisposed to the development o)throm%oem%olism

• #eu3ocytosis 0ith 0hite %lood cell +!'<counts up to 28&888 per m# may occur earlypostpartum/

• Treat the symptoms& not the la% 0or3/

• 'onvenient rule o) thum% is a 6 point drop inhematocrit euals a %lood loss o) G88 m#/



+eight #oss

•

An initial 0eight loss o) 58 to 56 l%soccurs as a result o) the %irth o) thein)ant& placenta and amniotic 9uid/

•

Puerperal diuresis accounts )or losso) an additional G l%s during the earlypostpartum period/

•

Normally return to pre.pregnant0eight %y = 0ee3s postpartum/



Postpartum 'hill andPostpartal Diaphoresis

• Most clients e?perience a sha3ing chillor tremor a)ter delivery/ +arm %lan3etsusually relieve this tremor or chill/

• 'hills and )ever late in the postpartumperiod may indicate sepsis/

• Diaphoretic episodes may occur at

night& a normal occurrence as the %odyrids itsel) o) 0aste products/



A)terpains or A)ter%irth pains

• :ccur more commonly in multiparasthan the primiparas/

• 'aused %y intermittent contractions/

• May cause severe discom)ort )or the1rst 6.2 days/

• !reast)eeding may increase the severity/

• :?ytocins may increase severity/Pitocin& Methergine& >rgotrate<



Perubahan pada SistemMuskuloskeletal

• Selama %e%erapa hari level hormon “relaxin"menurun& dan ligamen dan 3artilago pelvismulai 3em%ali 3e3eadaan se%elum hamil/

• Tonus otot rectus a%dominis dan

pu%ococcygeal melemah/ !elemahan otot inimempen"aruhi #ontrol bo$el dan %terutama&bladder.

•

:tot a%domen& meliputi otot rectus a%dominis&sering terpisah dan terHadi diastasis recti 6.7cm

'al ini mempen"aruhi resi#o #onstipasi.



(#stremitas ba$ah• Trombofeblitis a3i%at statis vena dapat

dicegah dengan mo%ilisasi dini setelahpersalinan/

• i3a terdapat varises pada tung3ai

%a0ah& penggunaan sto3ing elastis yangdisertai mo%ilisasi dini dan inta3e cairanyang ade3uat setelah persalinan dapat

mencegah statis vena/• Trom%o)e%litis pada tung3ai %a0ah dapat

di3etahui dengan meng3aHi Jtanda

homan-Koman-s sign



Cont’….

• Leluhan nyeri pada peregangan tendoarchiles Huga dapat dise%a%3an oleh

trauma persalinan seperti penempatantung3ai %a0ah tida3 tepat padapenyangga



Postpartum Psychological

Adaptations

4 Maternal Role

• Postpartum %lues

•

Development o) Parent .In)antattachment

• Initial attachment !ehavior

•

Father.In)ant Interactions• 'ultural In9uences



Maternal Role

• Time o) readHustment and adaptation•

During the 1rst day or t0o& the client tendsto %e passive and some0hat dependent• esitant a%out ma3ing decisions• Food or sleep are o) maHor importance& May

)eel a great need to tal3 “Taking In” phaseaccording to Ru%in• !y second or third day& client is ready to

resume control/ “Taking Hold” phaseoccurs during this time/

• Today-s client adHust more rapidly as #:S hasshortened/

• Maternal role attainment$ process %y 0hich a0oman learns mothering %ehaviors/

anticipatory& )ormal& in)ormal& and personal<



Postpartum %lues

•

Descri%es a transient period o) depressionthat occurs in most 0omen during the 1rst0ee3 or t0o a)ter %irth/

• May %e mani)ested %y mood s0ings& anger&

0eepiness& anore?ia& diculty sleeping&and a )eeling o) letdo0n/

• ormonal changes and psychologicaladHustments are thought to %e main

causes/• Usually resolve naturally in 6 to 2 0ee3s

0ith support and reassurance/ I) symptomspersist& the client should %e evaluated )or

postpartum depression/



Initial attachment !ehavior

• Progression o) touching activities

• >n )ace position dominates• Relies heavily on senses o) sight& touch&

hearing in getting to 3no0 the %a%y• >motional distance may %e occur/•

The acuaintance phase& the phase o)mutual regulation• Some negative )eelings may occur; %e

understanding not condescending•

Reciprocity is an interactional cycle thatoccurs simultaneously %et0een mother andin)ant/ mutual cueing %ehaviors&e?pectancy&

• delight in each others company 0hen

synchronous<



Father.In)ant Interactions

• Primary role has %een supporting role

• >ngrossment the characteristicsense o) a%sorption& preoccupation&and interest in the in)antdemonstrated %y )athers during earlycontact 0ith the ne0%orn/



'ultural In9uences

• Postpartum care my %e aected %ycultural %elie)s $ No sho0er& no%reast)eeding )or the 1rst three days&

hot" and cold" )oods

• Do not ma3e generali,ations

• >?tended )amily may play animportant role in care

adaptasi masa nifas.ppt

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