Nursing Care in the Postpartum Period Anuradha Perera

Nursing Care in the Postpartum Period Anuradha Perera (B. Sc. N)Special 3/3/2021

Postdelivery Assessment • Greatest risk for postpartum complications is during the first 24 hours after delivery • Identification of potential problems; immediate intervention; reassessment 3/3/2021

• Assessment includes: – Condition of uterus – Amount of bleeding – Bladder & voiding – Vital Signs – Perineum 3/3/2021

• Fundus = Palpated to assess firm & well contracted • Bleeding = Assess drainage on pad • Pulse & Bp = Assess cardiovascular function • Perineum = Assess for signs of hematoma, lacerations, & edema 3/3/2021

• Assessments are q 15 minutes for the first hour post delivery • Temperature is taken at the end of first hour • Transferred to Postpartum Unit when stable 3/3/2021

Admission to Postpartum Unit • Report between L&D Nurse & PP Nurse • Preparations made for receiving the Mother such as: – Room Ready – IV Pole – Admission Assessment – Vital Signs Equipment 3/3/2021

Assessment • Assessment is immediately upon arrival to the PP Unit – Complete Assessment – BUBBLE HE & VS included • Reassessment q Hour x 4 Hours – Uterus, Lochia, Bladder, Bp & Pulse – Abnormal Findings 3/3/2021

Vital Signs • Elevated Temperature – Normal finding for first 24 hours – Sign of Dehydration – Sign of Infection • Bradycardia – Normal Finding 3/3/2021

• Tachycardia – Infection – Hemorrhage – Pain – Anxiety • Lowered Blood Pressure – Orthostatic Hypotension – Shock 3/3/2021

• Elevated Blood Pressure – Pregnancy-induced Hypertension 3/3/2021

Breasts • • Soft, firm, can be lumpy Secretion of Colostrum Engorgement Assessment of: – Breasts – Nipples 3/3/2021

Uterus • Process of Involution • Height – First Day = at Umbilicus – Decreases 1 FB per Day • Consistency – Firm, Round, Smooth; Not “Boggy” • Location – Midline 3/3/2021

Bladder • Often times will be catheterized in L&D post delivery • Assess for Bladder Distention: – Uterine Atony – UTI • Recatheterize in 6 hours if not voided • Measure Urine Output 3/3/2021

Bowel • • Assessment for Bowel Sounds Complaints of Gas Pains Usually has Stool 2 -3 days post delivery May need medication for gas pains, laxatives, stool softeners, enemas 3/3/2021

Lochia • Amount – Estimate of Drainage – Number of Pads • Color – Rubra – Serosa – Alba 3/3/2021

Episiotomy • Assessment for: – Hematomas – Ecchymosis – Edema – Erythema – Intact Suture Line – Signs of Infection 3/3/2021

Homan’s Sign • Assessment for Thrombophlebitis – Swelling – Reddness – Warmth – Pain • Unilateral Findings • C/S Mother at Higher Risk 3/3/2021

Emotional Status • Can have Mood Swings • Observing Bonding Behavior & Ability to give Infant Care – Rubin’s Phases – En face – Engrossment 3/3/2021

Patient Post Epidural • Assessment of Lower Extremities for: – Sensation – Movement • Remains on Bedrest 3/3/2021

Post C/S • Additional Assessment: – Incision – Fluid Intake – Bladder & Bowel – Ambulation/Orthostatic Hypotention – Thrombophlebitis 3/3/2021

Documentation of Findings • Assessment Checklist Form • Graphic Sheet • Narrative Notes – Admission – Daily 3/3/2021

Nursing Diagnoses • Throughout the chapter • NCP 3/3/2021

Interventions • Prevention of Complications • Reduce Discomfort • ADL – Nutrition – Rest & Sleep – Ambulation – Bathing – Kegel Exercises 3/3/2021

Predischarge • Rubella Vaccine – Titer – Hypersensitivity to eggs – Administration of Vaccine – Patient Teaching • Rho Immune Globulin – Criteria – Administration of Rhogam 3/3/2021

Discharge • Instructions for Mother & Infant Care • Next Appointment • Referrals 3/3/2021