Normal Puerperium?
Puerperium wo period hota hai jo childbirth (placenta delivery) ke turant baad shuru hota hai aur lagbhag 6 weeks (42 days) tak chalta hai. Is dauran maa ke reproductive organs wapas apni pre-pregnancy state (delivery se pehle wali halat) mein lautne ki koshish karte hain.
Ise hum Postnatal Period bhi kehte hain. Ek ANM ke naate, aapko ye pata hona chahiye ki kya "Normal" hai aur kab "Danger" sign hai.
Physiological Changes During Postnatal Periods
Delivery ke baad sharir mein kai tarah ke badlav aate hain. Inhe samajhna nursing care ke liye bahut zaroori hai.
1. Involution of Uterus
Involution ka matlab hai uterus (pate) ka wapas apne normal size mein aana.
Delivery ke turant baad, uterus ka weight lagbhag 1 kg hota hai.
6 weeks ke ant tak, ye sirf 60 grams ka reh jata hai.
Agar ye process slow ho, toh use Sub-involution kehte hain.
2. Lochia (Vaginal Discharge)
Delivery ke baad jo vaginal discharge hota hai use Lochia kehte hain. Iske teen types hote hain jo aapko exams mein zaroor puche jayenge:
Lochia Rubra: (1-4 days) Ye red color ka hota hai kyunki isme blood zada hota hai.
Lochia Serosa: (5-9 days) Ye pinkish ya brownish color ka hota hai.
Lochia Alba: (10-14 days tak, kabhi 3 weeks tak) Ye pale white ya yellowish color ka hota hai.
3. Breast Changes (Lactation)
Postnatal period mein Breast Changes sabse mahatvapurn hote hain kyunki bache ka poshan isi par nirbhar karta hai.
Colostrum: Delivery ke pehle 2-3 din tak breast se ek gaadha peela doodh nikalta hai. Isme antibodies hoti hain jo bache ko bimariyon se bachati hain. Ise phenke nahi, bache ko zaroor pilayein.
Engorgement: Teesre din ke baad jab doodh ka flow badhta hai, toh breasts bhari aur sakht ho sakte hain.
Hormones: Prolactin doodh banane mein madad karta hai aur Oxytocin doodh ko bahar nikalne (let-down reflex) mein madad karta hai.
4. Vital Signs mein Badlav
Ek ANM ko maa ke Vital Signs par kadi nazar rakhni chahiye:
Temperature: Delivery ke pehle 24 ghante mein halka bukhar (up to $38^\circ C$) normal ho sakta hai kyunki body thak jati hai. Lekin agar bukhar 24 ghante baad bhi rahe, toh ye infection (Puerperal Sepsis) ho sakta hai.
Pulse: Shuruat mein pulse thodi slow ho sakti hai, lekin agar pulse rate 100 se upar jaye (Tachycardia), toh ye bleeding ya shock ka sign hai.
Blood Pressure: BP normal hona chahiye. High BP "Postpartum Preeclampsia" ka sanket ho sakta hai.
.
Nursing Management of Puerperium
Ek ANM student ke roop mein, aapki zimmedari sirf dawai dena nahi, balki maa ki sahi dekhbhaal aur counseling karna hai.
1. Hygiene aur Rest (Sabse Zaroori)
Rural areas mein aksar safai ko lekar purani manyatayein hoti hain. Ek ANM ko inhein badalna hai.
Rest (Aaram):
Maa ko kam se kam 8-10 ghante ki neend raat mein aur 2 ghante dopahar mein leni chahiye.
Lekin, "Early Ambulation" (jaldi chalna-phirna) bhi zaroori hai. Delivery ke 6-8 ghante baad maa ko dhire-dhire chalne ko kahein taaki blood circulation sahi rahe.
Hygiene (Safai):
Perineal Care: Har baar toilet jaane ke baad antiseptic solution ya gungune paani se niche ki safai karein.
Sutures Care: Agar delivery ke dauran taanke (Episiotomy) aaye hain, toh unhe sukha rakhein.
Personal Hygiene: Rozana nahaana aur saaf kapde pehenna infection se bachne ke liye anivarya hai.
2. Early Ambulation (Jaldi Chalna-Phirna)
Ye point sabse mahatvapurn hai. Delivery ke 6 se 12 ghante baad (agar sab normal hai) maa ko dheere-dheere chalne ke liye kahein.
Fayde: Isse blood circulation badhta hai, kabz (constipation) kam hota hai, aur pairon mein blood clots (DVT) banne ka khatra khatam ho jata hai.
Counseling: Gaon mein log maa ko bistar se utarne nahi dete, par aapko unhe samjhana hai ki Early Ambulation se maa jaldi theek hogi.
3. Exclusive Breastfeeding (Sirf Maa ka Doodh)
Ye ek ANM ki sabse badi zimmedari hai. Maa ko samjhayein ki bache ko 6 mahine tak sirf aur sirf maa ka doodh dena hai.
Benefits: Isse bache ki immunity badhti hai aur maa ka uterus jaldi contract hota hai.
Colostrum: Delivery ke baad ka pehla peela gaadha doodh bache ko zaroor pilayein. Ise phenke nahi, kyunki ye bache ka "pehla teeka" hai.
No Water/Honey: Bache ko upar ka paani, shehed ya ghutti bilkul na dein.
4. Nutrition (Khan-paan) ki Salah
Rural areas mein maa ko aksar sirf ghee-shakkar di jati hai, par aapko batana hai ki maa ko Extra Calories aur Proteins ki zaroori hai.
Calories: Ek doodh pilane wali maa ko rozana lagbhag 500-600 extra calories leni chahiye.
Proteins: Daal, paneer, ande aur doodh zakhmon ko bharne mein madad karte hain.
Hydration: Maa ko kahein ki din mein kam se kam 3-4 litre liquid (paani, juice, doodh) piyein taaki breastfeeding acchi ho.
IFA Tablets: Delivery ke baad kam se kam 180 din tak Iron aur Folic Acid ki goli zaroor khayein.
5. Family Planning Counseling (Parivar Niyojan)
Ye ek bahut critical point hai. Rural areas mein bacho ke beech antar rakhna maa ki jaan bacha sakta hai.
Counseling kab karein: Puerperium ke dauran hi maa aur uske pati se baat karein.
Options: Unhe PPIUCD (delivery ke turant baad), Chhaya tablets, ya Antara injection ke baare mein batayein.
Spacing: Maa ko samjhayein ki agle bache mein kam se kam 3 saal ka antar hona chahiye taaki uska sharir dobara taiyar ho sake.
Essential Care of Mother: Nursing Management
Essential care ka matlab hai wo sabhi zaroori kadam jo maa ko delivery ke baad healthy rakhne ke liye uthaye jaate hain. Iska main goal hota hai:
Maa ko infection (Sepsis) se bachana.
Uske sharir ko wapas purani sthiti mein laana (Involution).
Breastfeeding ko badhava dena.
Maa ko physical aur emotional support dena.
1. Diet (Khan-Paan) aur Nutrition
Rural areas mein ek galat-femi hai ki maa ko sirf ghee aur shakkar deni chahiye. Par ek Nursing Professor ke naate, main aapko batati hoon ki maa ko "Balanced Diet" ki zaroorat hoti hai.
Dietary Guidelines for Postnatal Mother:
Extra Calories: Doodh pilane wali maa ko rozana lagbhag 500-600 extra calories ki zaroorat hoti hai.
Protein Rich Food: Daal, paneer, ande, aur doodh zakhmon (stitches) ko jaldi bharne mein madad karte hain.
Iron & Calcium: Maa ko 180 din tak Iron (IFA) aur Calcium ki goli leni chahiye.
Hydration: Din mein kam se kam 3-4 litre liquid (paani, daliya, soup, doodh) lene se breast milk ka production accha hota hai.
Fiber: Kabz (constipation) se bachne ke liye hari sabziyan aur phal zaroor khayein.
2. Rest
Delivery ke baad maa bahut thak jati hai. Sharir ko recover karne ke liye aur doodh (milk production) banane ke liye Rest (Aaram) sabse bada tonic hai.
Proper Sleep: Maa ko din mein kam se kam 2 ghante aur raat mein 8 ghante ki neend leni chahiye.
ANM ka Role: Rural areas mein maa par ghar ke kaam ka bojh hota hai. Aapko parivaar ko samjhana hai ki agar maa ko Rest (Aaram) nahi mila, toh uski recovery dheemi ho jayegi aur wo bache ka dhyan nahi rakh payegi.
Comfort: Maa ka bistar saaf aur kamra havadar hona chahiye.
3. Postnatal Exercise
Rural areas mein ek myth hai ki maa ko mahino tak sirf bistar par leta rehna chahiye. Par as a Nursing Professor, main aapko batati hoon ki sahi samay par Exercise (Vyayam) shuru karna kitna zaroori hai.
Fayde of Postnatal Exercise (Vyayam):
Muscle Strength: Ye pet (abdominal) aur niche ki (pelvic floor) muscles ko mazboot banata hai.
Prevents DVT: Pairon ko hilane-dulane se khoon ke thakke (clots) nahi jamte.
Better Mood: Halka Exercise (Vyayam) maa ko chinta aur depression se door rakhta hai.
Weight Loss: Garbhavastha ke dauran bade hue vajan ko kam karne mein madad milti hai.
4. Sabse Zaroori: Hygiene (Safai)
Rural areas mein ek sabse badi samasya hoti hai infection ki, jise medical term mein Puerperal Sepsis kehte hain. Isse bachne ka ek hi rasta hai—Hygiene (Safai).
ANM dwara di jaane wali Hygiene (Safai) ki Salah:
Perineal Care: Maa ko sikhayein ki har baar peshab ya potty jaane ke baad apne private parts ko gungune paani se saaf karein. Safai hamesha Aage se Piche (Front to Back) ki taraf honi chahiye taaki potty ka infection aage na aaye.
Sanitary Pads: Maa ko kahein ki kapde ki jagah sanitary pad ka use karein. Agar kapda use kar rahi hain, toh wo saaf aur dhoop mein sukha hua hona chahiye. Pad ko har 4-6 ghante mein badalna zaroori hai.
Hand Washing: Bache ko chhune ya breastfeeding se pehle maa ko apne haath sabun se acche se dhone chahiye.
Breast Hygiene: Nipple ko saaf rakhein taaki "Mastitis" (breast infection) na ho.
Managment of Breast Feeding (Sabse Zaruri Kaam)
Ek ANM ke liye managment of breast feeding sabse badi zimmedari hai. Maa aur bache ke rishte aur bache ki sehat ke liye ye steps follow karein:
Early Initiation: Delivery ke 30 minutes ke andar bache ko doodh pilana shuru karwa dein.
Colostrum ka Mahatva: Maa ko samjhayein ki pehla gaadha peela doodh (Colostrum) bache ke liye "Pehla Teeka" (First Vaccine) hai. Ise phekna nahi chahiye.
Positioning and Latch: Maa ko sahi se baithna sikhayein. Bache ka pura muh nipple aur areola (kala hissa) par hona chahiye taaki maa ko dard na ho aur bache ko pura doodh mile.
Demand Feeding: Jab bhi bacha roye ya bhookha lage, doodh pilayein. Din aur raat dono samay.
No Pre-lacteal Feeds: Bache ko shehed, janam ghutti ya upar ka doodh bilkul na dein. Sirf maa ka doodh hi kafi hai.
Prophylactic Medications ka Use
Infection aur dard se bachane ke liye prophylactic medications ka sahi dose dena zaroori hai.
Iron & Folic Acid: Blood loss ki recovery ke liye.
Antibiotics: Agar delivery aseptic conditions mein nahi hui hai, toh doctor ki salaah par infection se bachne ke liye.
Calcium Supplements: Breastfeeding mothers ke liye calcium bahut zaroori hai.
टिप्पणियाँ
एक टिप्पणी भेजें