Nursing Care in the Postpartum Period

Anuradha Perera (B.Sc.N)Special

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Postdelivery Assessment

• Greatest risk for postpartum complications is during the first 24 hours after delivery

• Identification of potential problems; immediate intervention; reassessment

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

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• 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

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• 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

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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

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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

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Vital Signs

• Elevated Temperature– Normal finding for first 24 hours– Sign of Dehydration– Sign of Infection

• Bradycardia– Normal Finding

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• Tachycardia– Infection– Hemorrhage– Pain– Anxiety

• Lowered Blood Pressure– Orthostatic Hypotension– Shock

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• Elevated Blood Pressure– Pregnancy-induced Hypertension

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Breasts

• Soft, firm, can be lumpy• Secretion of Colostrum• Engorgement• Assessment of:

– Breasts– Nipples

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Uterus• Process of Involution• Height

– First Day = at Umbilicus– Decreases 1 FB per Day

• Consistency– Firm, Round, Smooth; Not “Boggy”

• Location– Midline

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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

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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

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Lochia

• Amount– Estimate of Drainage– Number of Pads

• Color– Rubra– Serosa– Alba

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Episiotomy

• Assessment for:– Hematomas– Ecchymosis– Edema– Erythema– Intact Suture Line– Signs of Infection

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Homan’s Sign

• Assessment for Thrombophlebitis– Swelling– Reddness– Warmth– Pain

• Unilateral Findings• C/S Mother at Higher Risk

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Emotional Status

• Can have Mood Swings

• Observing Bonding Behavior & Ability to give Infant Care– Rubin’s Phases– En face– Engrossment

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Patient Post Epidural

• Assessment of Lower Extremities for:– Sensation– Movement

• Remains on Bedrest

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Post C/S

• Additional Assessment:– Incision– Fluid Intake– Bladder & Bowel– Ambulation/Orthostatic Hypotention– Thrombophlebitis

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Documentation of Findings

• Assessment Checklist Form• Graphic Sheet• Narrative Notes

– Admission– Daily

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Nursing Diagnoses

• Throughout the chapter

• NCP

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Interventions

• Prevention of Complications• Reduce Discomfort• ADL

– Nutrition– Rest & Sleep– Ambulation– Bathing– Kegel Exercises

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Predischarge

• Rubella Vaccine– Titer– Hypersensitivity to eggs– Administration of Vaccine– Patient Teaching

• Rho Immune Globulin– Criteria– Administration of Rhogam

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Discharge

• Instructions for Mother & Infant Care• Next Appointment• Referrals

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