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Submitted to, Mrs. Nethravathi Assistant Professor OBG Dept. KIN, Banglore-4
Submitted by, Ms. Mamatha B.V 1st Year MSc.(N), OBG KIN, Banglore-4
is a time of rapid physical and emotional changes. 2. 2 gauze piece 1 spatula 1 right hand autoclaved gloves/paper gloves Inch tape PURPOSES To check temperature. ARTICLES NO. The number of changes that occur and the magnitude of these changes make the postpartum period a potentially dangerous time. but it is also a challenging responsibility. pulse and Respiration. . To observe tongue. Initiate appropriate interventions when problems do occur. AIMS: Demonstrate understanding of the normal and expected postpartum changes. A trolley consists of. EQUIPMENTS: SL.POSTNATAL ASSESSMENT INTRODUCTION The postpartum period. To observe vagina and lochia. which lasts for approximately 6 weeks following delivery. To check blood pressure. 3. To check milk secretion. 1. Prevent problems by teaching the woman appropriate ways to care for herself and her newborn. Providing care to new mothers is normally a pleasant experience. TPR tray BP apparatus and stethoscope A sterile bin with. To check fundal height 4. Conduct thorough assessments to identify signs and symptoms of problems before they become serious complications.
Postpartum assessments: BUBBLE HE should be checked carefully to know the deviation from normal and prevent complications. ears. Check vital signs including temperature. PROCEDURE: Explain the procedure to the woman completely and clearly. Postpartum assessment is performed according to institutional policy. Physiologic stability is assessed by monitoring vital signs. pulse. 6. Head to foot examination. Provide privacy and assemble articles at bedside. 7. determining the amount and type of lochia and assessing the tissues of the perineum.5. respiration and blood pressure. Check anthropometric measurements. To collect waste. assessing the contraction of the uterus. Torch Weighing machine Kidney dish To observe eyes. General appearance – Looks dull/good/fair. B – Breast U – Uterus . ASSESSMENT Before beginning postpartum assessment. This review will enable the nurse to pay special attention to those areas most at risk. the nurse should review the woman’s records to determine physical or psychosocial problems that may have been identified during labour or delivery. nose. To check weight of the mother. Ask mother to empty the bladder. In most facilities this includes assessments every hour until 4 hours after delivery and then at 4-8 hours intervals until discharge. mouth and genitalia.
B – Bowels B – Bladder L – Lochia E – Episiotomy H – Homan’s Sign E – Emotional status HEAD TO FOOT EXAMINATION: HEAD: Scalp – Dandruff/ lies Hair distribution Colour of hair Ay surgical scars FACE: Fore head is normal / any abnormality EYES: Eyebrows and eyelashes Reaction to light Discharges/haemorrhage/any other Visual acquity EARS: Lowset ears/any other abnormalities. Discharges/wax NOSE: Deviated nasal septum/any other abnormalities Discharges / epistaxis MOUTH: Colour of the lips and tongue Dental carries/any other abnormalities .
with the nipples erect and free of any sign of redness or other irritation. ABDOMEN: INSPECTION Size and shape of the abdomen Surgical scar previous/present Umbilicus dimpled or flattened . The breast should be soft.Thyroid/lymph node enlargement CHEST: INSPECTION Symmetrical/non symmetrical in chest movements Breast. Symmetry of breast Primary and secondary areola development Montgomery’s tubercles Nipples erected/cracked PALPATION Clockwise and anticlockwise palpation to check the lumps or nodules in Breasts and for breast engorgement. Colostrums secretion in both the breast. A thin yellow serous fluid may be visible on the breast. PERCUSSION Check for pleural effusion AUSCULTATION Respiratory sounds normal/abnormal Usually no breast changes are evident immediately following delivery.
Striae gravidae/linea albicans PALPATION Fundal height Centralization of the uterus Diastesis of recti Any other abnormalities/enlargement of organs PERCUSSION Accumulation of fluid AUSCULTATION Bowel sounds UTERUS: Examine the fundus by placing one hand above the symphysis pubis to support the lower uterine segment and using the side of the other hand to locate the fundus. Loss of abdominal tone contributes to Problems with constipation following child birth. the fundal height decreases 1. Immediately after delivey the fundus should be firm and in the midline at approximately the level of the umbilicus. Fear of pain or tissue damage during the first . If the uterus is not contracting adequately. Following delivery the uterine muscle must remain in a state of contraction to prevent hemorrhage. the nurse can support the lower uterine segment and use gentle massage to increase contraction of the uterine muscle fibres. although some may do so.25cm daily to get beyond the symphysis pubis and become a pelvic organ at 6weeks of puerperial period. Here. And measure the fundal height with inch tape. BOWELS: Most women do not have the urge to defecate for a few days following delivery.
Subsequent voiding should be measured if incomplete emptying of the bladder is suspected. LOCHIA – The amount and characteristics of the lochia are assessed each time the fundus is checked. This time is monitored closely. general condition should be checked by monitoring vital signs. The nurse Should identify specific concerns so that any potential problems can be addressed. When the bladder becomes distended . The nurse must be careful to look underneath the woman’s buttocks and back to make sure that the drainage is not missing the pad and pooling in the bed linens. The volume of the initial voiding is typically measures and documented. hematoma and lacerations. small clots and tissue fragments. The nurse should maintains careful records of the number of pads saturated in an hour inorder to determine overall blood loss. such as pain or burning with urination should be documented and reported.defecation after delivery is also common. A heavier rate of flow than this is considered excessive. with one or two pads being saturated in an hour. inspection and palpation will reveal a bulge directly above the symphysis pubis. BLADDER: The urinary bladder should be assessed for the presence of distention. This is determined by assessing how rapidly perineal pads are saturated. moderate or heavy. light. A distended bladder is dangerous following delivery because it will interfere with normal contraction of the uterus. Immediately after delivery this drainage is red and contains blood. Any signs or symptoms of infection. GENITALIA: Inspect for vulval oedema. The woman should void within 4-6 hours following delivery. For the first 1-2 hours following delivery the flow is expected to be moderate. . The amount of lochia described as scant. So. In case of uterine atony increases blood loss.
Impaired venous return increases the risk of thrombus formation. The amount of lochia diminishes gradually over time. Less than expected flow should also be viewed with caution to determine that the uterus is contracting and clots are not forming within the uterus or vaginal canal. the pads can be weighed to determine blood loss more precisely. REEDA should be observed. EPISIOTOMY: The woman should be positioned in lithotomy position and good room light or flash light is needed to visualize the stitches/suture line adequately. Problems related to venous stasis generally begin during the last few months of pregnancy when the enlarged uterus restricts the return of blood to the heart. These problems are further aggravated by pressure on the femoral veins during bearing down and use of stirrups during delivery. One gram of weight is approximately equivalent to 1ml of blood. When more detailed assessment is needed. Lochia changes colour and consistency as healing of the endometrium takesplace. . EXTREMITIES: Any congenital abnormalities syndactyly/polydactyl Capillary refill HOMAN’S Sign. R – Redness E – Edema E – Ecchymosis D – Discharges A – Approximation of suture line RECTUM: Inspect for hemorroids.
warmth. postnatal diet. The nurse inspects both the legs for any signs of superficial or deep vein thrombosis (DVT) formation. With the woman lying in the supine position. Replace the articles. Both the legs are checked for the presence of Homan’s sign. the nurse supports the knee of one leg while dorsiflexing the foot.breast feeding techniques. Documentation of procedure and informing the deviations from normal to the physiciens. Education to the mother regarding personal hygiene. such as pain in the calf muscle. postnatal exercise. immunization schedule and care of the newborn. which is an indicator of venous thrombosis. redness or swelling. And the rooming-in or bonding should be developed between mother and the baby. Self care ability: The nurse must assess the woman’s ability to care for herself and her newborn. The nurse should provide privacy and encourage the family to interact with a minimum amount of interruption. EMOTIONAL STATUS: Relationship with the newborn and family dynamics: The early postpartum period is the ideal time for bonding between mother and newborn. The immediate family should have the opportunity to spend time with each other and the newborn while their emotions and level of excitement are high. Homan’s sign is considered positive when the woman reports pain. . not just a stretching sensation in the calf.
381-397. 2.2006. teaching and other interventions that the new mother requires. “Contemporary maternity nursing”. Philadelphia. Newdelhi. With short hospital stays the nurse must work efficiently and effectively to complete all of the necessary assessments. B. Mosby publications.258-264.”Text book of midwifery and Reproductive health nursing”.page no.T Basavantappa. . BIBLIOGRAPHY: 1.1997. Jaypee publications. Gloria Hoffmann Wold.page no.CONCLUSION: The postpartum period is a time of major adjustments.
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