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8-POINT POSTPARTUM ASSESSMENT WORKSHEET

INSTRUCTIONS SPECIAL POINTS TO NOTE


1. Breast
A. Gently palpate each breast A. What is the contour?
B. If you feel nodules in the breast, the ducts B. Are the breast full, firm, tender,
may not have been emptied at last feeding. shiny?
Encourge breast feeding. C. Are the veins distended?
C. Take this opportunity to explain the process of D. Is the skin warm?
milk production, what to do about E. Does the patient complain of sore
engorgement, how to perform self breast nipples? Are nipples cracked,
examinations, and answer any questions she blistered or bleeding?
may have about breastfeeding. F. Are breasts so engorged that the
client requires pain medication or
that the infant is unable to latch onto
the nipple?
2. Uterus
NOTE: Be sure that the client has emptied her A. Uterus should the firm, midline, and
bladder and that she is lying in supine position on a decrease approximately one finger
flat bed before beginning assessment. breadth or one centimeter per day
A. Suipport and palpate the uterus. below umbilicus.
B. Have the patient feel her uterus as you B. Unsatisfactory involution may result
explain the process of involution if there are retained POC or the
C. If uterus is not involunting properly, check for bladder not completely empty.
infection and lack of tone.
D. Massage if boggy.

3. Bladder
A. Inspect and palpate the bladder A. Bladder distention should not be
simultaneously while checking the height of present after recent emptying.
the fundus. B. When bladder distention does occur,
B. Utilize standing orders if client unable to void a pouch over the bladder area is
C. Talk to mother about proper perineal care. observed, felt upon palpation;
Explain that she should wipe from front to mother usually feels need to urinate.
back after voiding and defecating. Teach use C. Some facilities require the post-
of squirt bottle and application of clean pad. partum voidings be measured and
Teach use of topical treatments. should be at least 150cc. Frequent
small voidings with or without pain
and burning may indicate infection or
urinary retentiion.
4. Bowel Function
A. Question patient daily about bowel A. Record reports of daily bowel
movements. Help her to avoid constipated. If function.
her bowels have not functioned by the second B. Encourage fluids and fiber to
postpartum day, request a stool softerner/ promote normal bowel function.
mild laxative if not already ordered.
5. Lochia
A. Describe to the client about what changes A. Notify the doctor if the lochia looks
she should expect in the lochia and when it abnormal in to color,has a foul odor,
should cease. or contains large clots (> silver
B. Discuss resumption of menstral cycle and dollar).
when she can resume sexual relations.
C. Use this opportunity to discuss family
planning.
6. Episiotomy/ Laceration
A. Inspect laceration/ episiotomy with the cleint A. Check laceration/ episiotomy for
in the Sim’s position using flashlight if proper wound healing, infection,
necessary, for better visibility. inflammation.
B. Check rectal area. If hemorrhoids are B. Is the surrounding skin warm to
present, the doctor may want to start on sitz touch?
bath and topical analgesic medication. C. Does the patient complain of
Reassure patient and answer questions she preineal or rectal discomfort?
may have regarding pain and cleanliness.
C. Teach measure to discease discomfort.
7. Homan’s Sign /Reflexes
A. To assess for DVT: Press down gently on the A. Pain or tenderness in the calf is a
patient’s knee (legs extended flat on bed) ask positive Homan’s sign and indication
her to flex her foot. Question client if this of possible thrombophlebitis.
cauese discomfort. Further diagnostic evaluation is
B. Assess for hyperreflexia required and a HCP should be
notified immediately.
B. Review baseline DTR and evaluate
for changes from baseline
8. Emotional Status
A. Throughout the physical assessment, notice A. Does the patient appear dependent
and evaluate the mother’s emotional status. or independent? Is she elated or
B. Explain to the mother and to her family that despondent?
she may cry easily for a while and that her B. What does she say about her
emotions may shift from high to low. The family? About the baby?
changes are normal and are probably caused C. Are there other nonverbal
by the tremendous hormonal changes responses?
occurring in her body and by her realization of
new responsibilities that accompany child’s
birth.