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7/23/2019 ADAPTASI MASA NIFAS.ppt
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ADAPTASI MASA NIFAS
NUR AFI DARTI
7/23/2019 ADAPTASI MASA NIFAS.ppt
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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
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Cont’….
• *astrointestinal System
• Urinary tract• (ital signs
• +eight loss
• Postpartum chill
• Postpartal diaphoresis
• A)terpains or A)ter%irth pains
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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/
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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
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#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/
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'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<
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(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
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Perineal 'hanges
• May appear edematous 0ith some%ruising
• >pisiotomy edges should %eappro?imated
• >cchymosis may occur and delayhealing
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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
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#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/
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*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
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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/
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(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/
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!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#/
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+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/
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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/
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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<
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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$el dan %terutama&bladder.
•
:tot a%domen& meliputi otot rectus a%dominis&sering terpisah dan terHadi diastasis recti 6.7cm
'al ini mempen"aruhi resi#o #onstipasi.
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(#stremitas ba$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
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Cont’….
• Leluhan nyeri pada peregangan tendoarchiles Huga dapat dise%a%3an oleh
trauma persalinan seperti penempatantung3ai %a0ah tida3 tepat padapenyangga
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Postpartum Psychological
Adaptations
4 Maternal Role
• Postpartum %lues
•
Development o) Parent .In)antattachment
• Initial attachment !ehavior
•
Father.In)ant Interactions• 'ultural In9uences
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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<
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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/
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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<
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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/
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'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