Nursing Care in the Postpartum Period

Presented By Chris Hicks

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

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

 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

 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

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

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

Vital Signs
Elevated Temperature
Normal finding for first 24 hours Sign of Dehydration Sign of Infection

Bradycardia
Normal Finding

 Tachycardia
Infection Hemorrhage Pain Anxiety

Lowered Blood Pressure

Orthostatic Hypotension Shock

 Elevated Blood Pressure

Pregnancy-induced Hypertension

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

Uterus
Process of Involution Height
First Day = at Umbilicus Decreases 1 FB per Day

Consistency
Firm, Round, Smooth; Not Boggy

Location
Midline

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 (Dr.) Measure Urine Output

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

Lochia
Amount
Estimate of Drainage Number of Pads

Color
Rubra Serosa Alba

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

Homans Sign
Assessment for Thrombophlebitis
Swelling Reddness Warmth Pain

Unilateral Findings C/S Mother at Higher Risk

Emotional Status
Can have Mood Swings
Observing Bonding Behavior & Ability to give Infant Care
Rubins Phases En face Engrossment

Patient Post Epidural

Assessment of Lower Extremities for:
Sensation Movement

Remains on Bedrest

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

Documentation of Findings
Assessment Checklist Form Graphic Sheet Narrative Notes
Admission Daily

Nursing Diagnoses
Throughout the chapter
NCP

Interventions
Prevention of Complications Reduce Discomfort ADL
Nutrition Rest & Sleep Ambulation Bathing Kegel Exercises

Predischarge
Rubella Vaccine
Titer Hypersensitivity to eggs Administration of Vaccine Patient Teaching

Rho Immune Globulin

Criteria Administration of Rhogam

Discharge
Instructions for Mother & Infant Care Next Appointment Referrals