Colomb Medica
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The puerperium is a stage that produces changes and adaptations in women, couples and family. Effective coping, during this stage, depends on the relationship between the demands of stressful or difficult situations and the recourses that the puerperal individual has. Roy (2004), in her Middle Range Theory about the Coping and Adaptation Processing, defines Coping as the ''behavioral and cognitive efforts that a person makes to meet the environment demands''. For the puerperal individual, the correct coping is necessary to maintain her physical and mental well being, especially against situations that can be stressful like breastfeeding and return to work. According to Lazarus and Folkman (1986), a resource for coping is to have someone who receives emotional support, informative and / or tangible. ⋯ the need to recognize the puerperium as a stage that requires comprehensive care is evident, where nurses must be protagonist with the care offered to women and their families, considering the specific demands of this situation and recourses that promote effective coping and the family, education and health services.
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The determination of the values of central venous pressure has long been used as a guideline for volumetric therapy in the resuscitation of the critical patient, but the performance of such parameter is currently being questioned as an effective measurement of cardiac preload. This has aroused great interest in the search for more accurate parameters to determine cardiac preload and a patient's blood volume. ⋯ Estimating variables such as end-diastolic ventricular area and global end-diastolic volume have a better performance than central venous pressure in determining cardiac preload. Despite the best performance of these devices, central venous pressure is still considered in our setting as the most practical and most commonly available way to assess the patient's preload. Only dynamic variables such as pulse pressure change are superior in determining an individual's blood volume.