Transcript
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NORMAL REACTIONS AND PROBLEMSRELATED TO CONCEPTION,
PREGNANCY & PUERPERIUM AND ITS
MANAGEMENT
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TERMINOLOGIES
PuerperiumPuerperium: The period of about six weeks after: The period of about six weeks afterchildbirth during which the mother's reproductivechildbirth during which the mother's reproductiveorgans return to their originalorgans return to their original nonpregnant nonpregnant condition.condition.
Ambivalence: Having mixed feelings or contradictoryAmbivalence: Having mixed feelings or contradictory
ideas about something or someoneideas about something or someone
Psychosis: A severe mental disorder in whichPsychosis: A severe mental disorder in whichthought and emotions are so impaired that contact isthought and emotions are so impaired that contact islost with external reality.lost with external reality.
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Contd«
Trimester: A period of three monthsTrimester: A period of three months
Anticipatory: Regard as probable; expect orAnticipatory: Regard as probable; expect orpredict predict
Blues: Informal feelings of melancholy, sadness,Blues: Informal feelings of melancholy, sadness,or depressionor depression
Exhaustion: A state of extreme physical orExhaustion: A state of extreme physical ormental fatiguemental fatigue
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NORMAL REACTIONS TO
CONCEPTION, PREGNANCY
AND PUERPERIUM
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PSYCHOLOGICAL ADAPTATION
TO PREGNANCY
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BODY IMAGE
Appearance
Appearance Function
Function
Sensation
Sensation Mobility
Mobility
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TRIMESTER TASK
Accept thePREGNANCY
Accept the BABY Prepare forPARENTHOOD
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PSYCHOLOGICAL ADAPTATIONTO PUERPERIUM
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MATERNAL ROLE
DEVELOPMENT
Taking in
phase
Taking in
phase
Taking hold
phase
Taking hold
phase
Letting go
phase
Letting go
phase
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ATTAINMENT OF
MATERNAL ROLE
Maternal role attainment is the process byMaternal role attainment is the process by
which the woman learns mothering behaviorswhich the woman learns mothering behaviors
and becomes comfortable with her identity as aand becomes comfortable with her identity as a
mother.mother.
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DEVELOPMENT OF PARENT
INFANT ATTACHMENT
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PSYCHOLOGICALDISTURBANCE IN
PREGNANCY
´ANTEPARTUM DEPRESSIONµ
Approximately 10-20%
of women will struggle with
symptoms of depression
during their pregnancy.
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RISK FACTORS
Having a history of depression or PMDDHaving a history of depression or PMDD
Age at time of pregnancyAge at time of pregnancy
Living alone.Living alone.
Limited social support.Limited social support.
ChildrenChildren ---- the more children they have, the more likelythe more children they have, the more likelythey are to be depressed during a subsequent pregnancy.they are to be depressed during a subsequent pregnancy.
Marital conflict Marital conflict
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Contd..
Ambivalence about the pregnancy.Ambivalence about the pregnancy.
Relationship difficultiesRelationship difficulties
Fertility treatment Fertility treatment
Previous pregnancy lossPrevious pregnancy loss
Problems with pregnancyProblems with pregnancy
Stressful life event Stressful life event
Past history of abusePast history of abuse
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SYMPTOMS
SadnessSadness ² ² hopelessness, helplessness, tearfulness, etc.hopelessness, helplessness, tearfulness, etc.
Loss of interest in daily activitiesLoss of interest in daily activities
Changes in sleep patternsChanges in sleep patterns
Difficulty focusing or concentrating.Difficulty focusing or concentrating.
Sudden and/or drastic increase or decrease in weight or fatigue.Sudden and/or drastic increase or decrease in weight or fatigue.
Decreased low self Decreased low self--esteem.esteem.
Thoughts of death in regard to self or others.Thoughts of death in regard to self or others.
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IMPACT OF DEPRESSION
ON PREGNANCY
Depression can interfere with a woman's abilityDepression can interfere with a woman's abilityto care for her self during pregnancy.to care for her self during pregnancy.
Depression can put her at risk for increased useDepression can put her at risk for increased useof substances that can harm both her andof substances that can harm both her and
developing baby.developing baby.
Depression may interfere with her ability to bondDepression may interfere with her ability to bondwith her growing baby.with her growing baby.
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HOW DOES PREGNANCY
IMPACT DEPRESSION??
The stresses of pregnancy can causeThe stresses of pregnancy can cause
depression or a recurrence or worsening of depression or a recurrence or worsening of
depression symptoms.depression symptoms.
Depression during pregnancy can place aDepression during pregnancy can place a
woman at risk for having an episode of woman at risk for having an episode of
depression after delivery.depression after delivery.
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TREATMENT
Support groupsSupport groups PsychotherapyPsychotherapy
MedicationsMedications Light therapyLight therapy
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LIGHT THERAPY
Treatment consists of
exposure to light of a highintensity and/or specific
spectra for an hour per day
from a light box placed on the
floor or on a table. The light
intensity is usually 10,000 lux,
which is similar to the light of a sunny day.
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MECHANISM OF ACTION
MELATONINMELATONIN
SERETONINSERETONIN
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CONTRAINDICATION
If they have current medical illness (eye disease)If they have current medical illness (eye disease)
If they are using psychiatric medicationIf they are using psychiatric medication
Who are not able to maintain a regular sleepWho are not able to maintain a regular sleep
scheduleschedule
Use of alcohol or drugsUse of alcohol or drugs
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HOW IS IT
ADMINISTERED??Participants will be loaned a portable, lightweight light box forParticipants will be loaned a portable, lightweight light box foruse at home.use at home.
Participants reserve 60 minutes each morning when they sit at Participants reserve 60 minutes each morning when they sit at
the light box and engage in any quiet activity with eyes open.the light box and engage in any quiet activity with eyes open.
Treatment continues daily for five weeks, during which progressTreatment continues daily for five weeks, during which progressis monitored .is monitored .
After the fiveAfter the five--week trial participants will have the opportunity toweek trial participants will have the opportunity to
continue with treatment if it has been successful, or try ancontinue with treatment if it has been successful, or try an
enhanced treatment regimen if it appears that a higher light enhanced treatment regimen if it appears that a higher light
dose would be beneficial.dose would be beneficial.
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SIDE-EFFECTS
The potential risks of light therapy are very low.The potential risks of light therapy are very low.
If patients receive too much light, they canIf patients receive too much light, they can
become irritable or show disturbed sleepbecome irritable or show disturbed sleep
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PREVENTION
Take it easyTake it easy
Suggest her to bond with her partnerSuggest her to bond with her partner
Talk it out Talk it out
Manage stressManage stress
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PSYCHOLOGICAL
DISTURBANCES IN PUERPERIUM
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PSYCHOLOGICAL
DISTURBANCES IN PUERPERIUM
Postpartum exhaustionPostpartum exhaustion
Postpartum blues (Baby blues)Postpartum blues (Baby blues)
Baby pinksBaby pinks
Postpartum depressionPostpartum depression
Puerperal psychosisPuerperal psychosis
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POSTPARTUM
EXHAUSTION (PPE)
PPE is caused by sleep deprivation coupled withPPE is caused by sleep deprivation coupled withhormonal changes in a woman's body shortlyhormonal changes in a woman's body shortly
after giving birth.after giving birth.
TREATMENTTREATMENT
Medical treatment is minimal. PPE can last fromMedical treatment is minimal. PPE can last from
1 to 20 days and responds with adequate1 to 20 days and responds with adequate
amounts of sleep.amounts of sleep.
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POSTPARTUM BLUES
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POSTPARTUM BLUES
It is a mild, benign and transient mood changeIt is a mild, benign and transient mood changethat begins within 3 to 4 days after delivery andthat begins within 3 to 4 days after delivery and
peaks on 4peaks on 4thth to 5to 5thth day. It affects nearly 7 in 10day. It affects nearly 7 in 10
mothers.mothers.
CAUSE:CAUSE:
A biological cause rather than a psychologicalA biological cause rather than a psychological
causecause
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SYMPTOMS
Unprovoked weepingUnprovoked weeping
Spikes of elation.Spikes of elation.
IrritabilityIrritability
Anger, hostilityAnger, hostility
HeadacheHeadache
Feelings of unrealityFeelings of unreality
ExhaustionExhaustion
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Contd..
Sleep deprivationSleep deprivation
RestlessnessRestlessness
Sudden mood swings.Sudden mood swings.
Anxious and hypersensitive to criticism.Anxious and hypersensitive to criticism.
Low spiritsLow spirits
Poor concentration and indecisiveness.Poor concentration and indecisiveness.
Feeling 'Feeling 'unbondedunbonded' with baby' with baby
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TREATMENT
Baby blues generally disappear without medicalBaby blues generally disappear without medical
intervention within two weeks.intervention within two weeks.
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BABY PINKS
Some women experienceSome women experience baby pinksbaby pinks when theywhen theyare overly and illogically on top of the world (aare overly and illogically on top of the world (a
mild to severe form of mania).mild to severe form of mania).
TREATMENT:TREATMENT:
The pinks do not require treatment.The pinks do not require treatment.
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POSTPARTUM
DEPRESSION
The onset of postpartum
depression is gradual, developing
after the second week. The
condition may last for 3-6 months
and in some cases, it will persist
throughout the first year of the
baby·s life.
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CAUSES
Experiencing stressExperiencing stress--inducing life events around the time of inducing life events around the time of
childbirth.childbirth.
Low self Low self--esteem and stress associated with postnatal care.esteem and stress associated with postnatal care.
Demands of motherhood and loss of personal freedomDemands of motherhood and loss of personal freedom
Formula feeding rather than breast feedingFormula feeding rather than breast feeding
A history of depressionA history of depression
Cigarette smokingCigarette smoking
Low self esteemLow self esteem
Childcare stressChildcare stress
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Contd..
Prenatal depression during pregnancyPrenatal depression during pregnancy
Prenatal anxietyPrenatal anxiety
Low social support Low social support
Poor marital relationshipPoor marital relationship
Infant temperament problems/colicInfant temperament problems/colic
Maternity bluesMaternity blues
Single parent Single parent
Low socioeconomic statusLow socioeconomic status
Unplanned/unwanted pregnancyUnplanned/unwanted pregnancy
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SYMPTOMS
Bouts of cryingBouts of crying
SadnessSadness
Emotional liabilityEmotional liability
Guilt Guilt
Loss of appetite or anorexiaLoss of appetite or anorexia
Profound sleep disturbancesProfound sleep disturbances
Poor concentration and memoryPoor concentration and memory
IrritabilityIrritability
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Contd..
Feeling of ambivalence toward her infant Feeling of ambivalence toward her infant
Feelings of inadequacy to care for the newbornFeelings of inadequacy to care for the newborn
Constantly feeling tired in spite of adequate periodsConstantly feeling tired in spite of adequate periodsof rest of rest
May experience difficulty falling asleep but onceMay experience difficulty falling asleep but onceasleep, the woman will sleep for long periods.asleep, the woman will sleep for long periods.
They often feel well in the morning but deteriorate asThey often feel well in the morning but deteriorate asthe day goes on.the day goes on.
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EFFECTS ON PARENT-
INFANT RELATIONSHIP
TYPES OF COPING STRATEGIES:TYPES OF COPING STRATEGIES:
Avoidance coping:Avoidance coping: denial, behavioral disengagement denial, behavioral disengagement
ProblemProblem--focused coping: focused coping: active coping, planning,active coping, planning,positive reframingpositive reframing
Support seeking coping:Support seeking coping: emotional support,emotional support,instrumental support instrumental support
Venting coping:Venting coping: venting, self venting, self--blameblame
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ATTACHMENT STUDY
THREE CLASSIFIED GROUPS:THREE CLASSIFIED GROUPS:
Secure and joyful attachment Secure and joyful attachment
Secure attachment but restricted in expressedSecure attachment but restricted in expressed
enjoyment and pleasureenjoyment and pleasure
Insecure attachment Insecure attachment
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PREVENTION
Early identification and intervention improves longEarly identification and intervention improves long--termtermprognoses for most women.prognoses for most women.
A major part of prevention is being informed about the riskA major part of prevention is being informed about the risk factors, and the medical community can play a key role in factors, and the medical community can play a key role inidentifying and treating postpartum depression.identifying and treating postpartum depression.
Women should be screened by their physician toWomen should be screened by their physician todetermine their risk for acquiring postpartum depression.determine their risk for acquiring postpartum depression.
Also, proper exercise and nutrition appears to play a roleAlso, proper exercise and nutrition appears to play a rolein preventing postpartum, and general, depression.in preventing postpartum, and general, depression.
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MANAGEMENT
Medical evaluation to rule out physiological problemsMedical evaluation to rule out physiological problems
Cognitive behavioral therapyCognitive behavioral therapy
Medication (Antidepressant)Medication (Antidepressant)
Support groupsSupport groups
Home visits/Home visitorsHome visits/Home visitors
Healthy diet Healthy diet
Consistent/healthy sleep patternsConsistent/healthy sleep patterns
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PUERPERAL PSYCHOSIS
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PUERPERAL PSYCHOSIS
The onset of puerperal psychosis is usuallyThe onset of puerperal psychosis is usuallyrapid occurring within 4 days of delivery andrapid occurring within 4 days of delivery and
rarely beyond the first 2rarely beyond the first 2--3 weeks.3 weeks.
INCIDENCEINCIDENCE
Less than 1/1,000 deliveriesLess than 1/1,000 deliveries
More common in first time mothers.More common in first time mothers.
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CAUSES
Studies suggest that postpartum psychosisStudies suggest that postpartum psychosishas a genetic or biological cause and is morehas a genetic or biological cause and is more
common in women diagnosed with bipolarcommon in women diagnosed with bipolar
disorder or with a family history of mooddisorder or with a family history of mood
disorders. Women with a prior diagnosis of andisorders. Women with a prior diagnosis of anaffective disorder have a 20% to 25% chance of affective disorder have a 20% to 25% chance of
a postpartum psychosis.a postpartum psychosis.
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Contd..
May experience delusions or hallucinations andMay experience delusions or hallucinations andbecome detached from the reality of the situation.become detached from the reality of the situation.
May state that her baby is abnormal, believe it to beMay state that her baby is abnormal, believe it to bepossessed and may avoid the baby.possessed and may avoid the baby.
There may be periods of normal behavior and at There may be periods of normal behavior and at other times, she may appear depressed.other times, she may appear depressed.
May experience suicidal impulses or desires to harmMay experience suicidal impulses or desires to harmher baby.her baby.
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TREATMENT
Because of extreme nature of illness, medical help isBecause of extreme nature of illness, medical help is
required as a matter of emergency.required as a matter of emergency.
The woman must be kept under constant observation untilThe woman must be kept under constant observation untilappropriate psychiatric help is obtained.appropriate psychiatric help is obtained.
Heavy sedation is given at the time of onset.Heavy sedation is given at the time of onset.
Early treatment with antiEarly treatment with anti--psychotic drugs.psychotic drugs.
Admission to a psychiatric unit and treatment with lithiumAdmission to a psychiatric unit and treatment with lithiumand/or electroconvulsive therapy is given.and/or electroconvulsive therapy is given.
Psychosis may persist for 8Psychosis may persist for 8 ² ² 10 weeks even with prompt 10 weeks even with prompt treatment especially when the woman has a pretreatment especially when the woman has a pre--existingexisting
history of schizophrenia or manichistory of schizophrenia or manic--depressive illnessdepressive illness
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PROGNOSIS
While complete recovery is often achieved, it While complete recovery is often achieved, it is possible that further episodes of illness willis possible that further episodes of illness will
occur throughout the woman·s life and there isoccur throughout the woman·s life and there is
an increased risk of recurrence in subsequent an increased risk of recurrence in subsequent
pregnancies.pregnancies.
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NURSING MANAGEMENT
NURSING ASSESSMENTNURSING ASSESSMENT
Assess posture and affect Assess posture and affect
Assess thought processAssess thought process
Explore feelingsExplore feelings
Assess physical behaviorAssess physical behavior
Assess for parent Assess for parent--infant bondinginfant bonding
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NURSING DIAGNOSIS
1.1. Hopelessness related to depressive thoughts.Hopelessness related to depressive thoughts.
2.2. Social isolation related to lack of interest or energy to interact withSocial isolation related to lack of interest or energy to interact withothers.others.
3.3. Ineffective family coping: compromised related to impact of Ineffective family coping: compromised related to impact of symptoms of depression in one member.symptoms of depression in one member.
4.4. Sleep pattern disturbance related to insomnia.Sleep pattern disturbance related to insomnia.
5.5. Self Self--care deficit related to lack of motivation and poorcare deficit related to lack of motivation and poorconcentration.concentration.
6.6. Risk for injury related to hopelessness an impaired problem solving.Risk for injury related to hopelessness an impaired problem solving.
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EDINBURGH POSTNATAL
DEPRESSION SCALE
INSTRUCTIONS:INSTRUCTIONS:
1.1. The mother is asked to check the response that comesThe mother is asked to check the response that comesclosest to how she has been feeling in the previous 7 days.closest to how she has been feeling in the previous 7 days.
2.2. All the items must be completed.All the items must be completed.
3.3. Care should be taken to avoid the possibility of the motherCare should be taken to avoid the possibility of the motherdiscussing her answers with others. (Answers come fromdiscussing her answers with others. (Answers come fromthe mother or pregnant woman.)the mother or pregnant woman.)
4.4. The mother should complete the scale herself, unless sheThe mother should complete the scale herself, unless shehas limited English or has difficulty with reading.has limited English or has difficulty with reading.
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CONCLUSION
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BIBLIOGRAPHY
1.1. Burroughs. ´Maternity Nursing, An Introductory Textµ. 7Burroughs. ´Maternity Nursing, An Introductory Textµ. 7thth
Edition.Edition.Saunders Publication.Saunders Publication.
2.2. D. C.D. C. DuttaDutta. ´Textbook of Obstetricsµ. 6. ´Textbook of Obstetricsµ. 6thth Edition. CentralEdition. CentralPublications.Publications.
3.3. Gail. W. Stuart. ´Principles and Practice of Psychiatric Nursingµ. 8Gail. W. Stuart. ´Principles and Practice of Psychiatric Nursingµ. 8thth
Edition. Elsevier Publication.Edition. Elsevier Publication.
4.4. Mary C. Townsend. ´Psychiatric Mental Health Nursingµ. 5Mary C. Townsend. ´Psychiatric Mental Health Nursingµ. 5thth Edition.Edition.F. A. Davis Publication.F. A. Davis Publication.
5.5. SandraSandra MettinaMettina. ´Manual of Nursing Practiceµ. 8. ´Manual of Nursing Practiceµ. 8thth Edition.Edition.Lippincott Publication.Lippincott Publication.
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