C Rle107 Modules Efghi

COLLEGE OF NURSING AND PHARMACY
C-RLE 107 – Care of Mother, Child, Adolescent (Well Client)

First Semester | AY 2021-2022
________________________________________________________________________________
Module 3E: –– Physical

Module 3E: Assessment of the Uterine
Assessment Fundus
During in the
the Early Postpartum
Postpartum Period
Period
Time
Time Frame:
Frame: Week
Week __(2
__(1)hours)
hour
Schedule
Schedule of
of synchronous
synchronous sessions:
sessions: BSN2A-
BSN2A- Thursday
Thursday &
& Saturday:
Saturday: 6:00-2:00
6:00-2:00
pm
pm
BSN2B-
BSN2B- Wednesday
Wednesday &
& Friday
Friday :: 6:00-2:00
6:00-2:00
pm
pm
Mapped Learning Outcomes and Course Content for C-RLE 107, Module 3E
Target Learning Outcomes Content and Activities

Hour (At the close of the period allotted, students Online Session Offline
should have :)
Session
1 At the end of this module, you are Discussion about the -Further
hours expected to: following: Review of the
• Explain the significance of • The significance of Physical
performing the assessment of performing the Assessment
the uterine Fundus during assessment of the During the
postpartum period uterine Fundus Early
• Describe the normal and during postpartum Postpartum
abnormal findings of uterine period Period
Fundus during postpartum • Discussion about the -Answer
period. normal and abnormal
Assessment of
Learning and
• Explain how assessment of findings of uterine
Evaluation
uterine Fundus can prevent Fundus during
-Assignment:
complications during postpartum period.
• Make a
postpartum period. • Explain how
video
• Perform assessment of uterine assessment of uterine
presentation
Fundus by making a video Fundus can prevent
showing the
showing the step to step complications during
entire
procedure. postpartum period.
procedure of
• Perform assessment the
of uterine Fundus by assessment
making a video of the
Faculty:
Lilibeth G. Sales, RN MAN/Marie Aileen L. Domingo, RN, MN Page 1 of 8
showing the step to uterine

step procedure. Fundus.
https://www.google.com/url?sa=i&url=https%3A%2F%2Fcanadian-nurse.com%2Fen%2Farticles%2Fissues%2F2014%2Fnovember-2014%2Faddressing-a-gap-in-
postpartum-care
Faculty:
1. Content / Discussion / Learning Resources / Link
Immediately after delivery of the baby, the mother’s body undergoes changes and as it adapt to the
postpartum transition, the nursing assessment is so crucial starting immediately after delivery till
discharge. The physical care a woman receives during the postpartum period can influence her health
for the rest of her life and the nurse helps by performing accurate assessment and performing correct
procedures.
This module will present one of the most important assessments that need to be done immediately
after delivery of the baby which is the assessment of the Fundus. Failure to assess the condition of the
Fundus can lead to one of the postpartum complications - the postpartum hemorrhage. The importance
and the correct method of performing it will be discussed and as part of the requirement of this module,
you are required to accomplish the activity and assignment posted at the last part.
ASSESSING THE UTERINE FUNDUS
Fundus of the uterus is the top portion, opposite from the cervix.
• Fundal height is measured from the top of the pubic bone, is routinely measured in pregnancy
to determine growth rates and immediate after delivery in order to assess uterine contraction
and involution.
• Approximately one hour post delivery, the Fundus is firm and at the level of the umbilicus.
The Fundus continues to descend into the pelvis at the rate of approximately 1 cm or finger-
breadth per day and should be non-palpable by 14 days postpartum.
Faculty:
https://www.pinterest.ph/pin/427067977138334556/
Faculty:
https://www.pinterest.ph/pin/178455203960242576/
PURPOSE: To determine the location and firmness of the uterus.

Procedure Rationale
1. Explain the procedure and rationale before • Explanations reduce anxiety and elicit
beginning the procedure. cooperation.
2. Ask the mother to empty her bladder if she has • A distended bladder lifts and displaces the
not voided recently. uterus.
3. Place the mother in the supine position with her • This relaxes the abdominal muscles and
knees flexed permits accurate location of the fundus.
4. Put on clean gloves and lower the perineal pad to • Gloves are recommended whenever
observe lochia as the fundus is palpated. contact with body fluids may occur.
5. Place your nondominant hand above the • This supports and anchors the lower
woman's symphysis pubis uterine segment.
6. Use the flat part of your fingers (not the • The larger surface of the fingers provides
fingertips) for palpation. Palpation may be more comfort.
painful, particularly for the mother who had a
cesarean birth.
7. Begin palpation at the umbilicus and palpate • Palpation helps determine the firmness
gently until the fundus is located. It should be and location of the fundus
firm, in the midline, and approximately at the
level of the umbilicus. Locating the fundus is
more difficult if the woman is obese or if the
abdomen is distended.
8. If the fundus is difficult to locate or is “boggy,” • The nondominant hand anchors the lower
(soft) keep the nondominant hand above the segment of the uterus and prevents
woman’s symphysis pubis and massage the inversion while the uterus is massaged.
fundus with the dominant hand until the fundus The uterus contracts in response to tactile
is firm. stimulation, and this helps control
excessive bleeding.
9. After massaging a boggy fundus until it is firm, • Removing clots allows the uterus to
press firmly to expel clots. Do not attempt to contract properly. Attempting to expel
expel clots before the fundus is firm. Keep one clots in a boggy uterus might result in
hand pressed just above the symphysis (over the uterine inversion. A firm fundus and
lower uterine segment) throughout. pressure over the lower uterine segment
help prevent uterine inversion.
10. If the fundus is above or below the umbilicus, use • Using the fingers to measure allows an
your fingers to determine the number of approximation of the number of
fingerbreadths between the fundus and the centimeters.
umbilicus.
Faculty:
11. Document the consistency and location of the • This promotes accurate communication
fundus. Record consistency as "fundus firm," and identifies deviations from expected so
“firm with massage,” or “boggy.” Record fundal that potential problems can be identified
height in fingerbreadths or centimeters above or early.
below the umbilicus. For example, "fundus firm,
midline, if” (one fingerbreadth or 1 cm below the
umbilicus); “fundus firm with light massage, U
+2 (two fingerbreadths or 2 cm above the
umbilicus), displaced to right.”
.
2. Assessment of Learning
To assess overall learning and to synthesize gained information from the module, you need to
accomplish the activity, assignment and exam of this module. Output will be sent on or before (date to
be announced) ______________________
Assignment:
Using the table below, describe the normal and abnormal findings of the assessment of the uterine
Fundus during postpartum period.
Procedure Normal finding Abnormal finding
Assessing Uterine
Fundus
Activity:
• Make a video presentation showing the entire procedure of the assessment of the uterine Fundus.
Faculty:
3. Evaluation of Learning
For the evaluation of learning for Module 3E, a scheduled quiz will be assigned in the Google
Classroom and will be taken before the start of the next Module during the Synchronous Class
4. References:
1. REFERENCES
• Holub, Karen Shaw; Murray, Sharon; McKinney, Emily; Jones, Renee. Foundations of Maternal-
Newborn and Women’s Health Nursing 7th edition (2019). Elsevier Inc. St. Louis, Missouri, USA.
• Ricci, Susan Scott. Essentials of Maternity, Newborn and Women’s Health Nursing 4 th edition
(2017). Wolters Kluwer Philadelphia, USA.
• Pillitteri, Adele. Maternal and Child Health Nursing: Care of the Childbearing and Childrearing
Family 6th edition (2010). Lippincott Williams & Wilkins, Philadelphia,
• McKinney, Emily; Murray, Sharon et.al. Study Guide For Maternal-Child Nursing, 5th edition
(2018). Elsevier Inc. St. Louis, Missouri, USA.
• Leifer, Gloria. Introduction to Maternity and Pediatric Nursing 8 th edition (2019). Elsevier Inc. St.
Louis, Missouri, USA.
• Linnard,-Palmer, Luanne; Coats, Gloria Haile. Safe Maternity and Pediatric Nursing Care(2017).
F. A. Davis Company, Philadelphia.
Congratulations for having completed this RLE 107 Module 3E See you in the next Module
Prepared by:
Lilibeth G. Sales, RN MAN

Instructor
Marie Aileen L. Domingo, RN, MN

Instructor
Faculty:
Approved by:
Anele C. Mallari, RN, MAN, LPT

Dean, College of Nursing and Pharmacy
Faculty:
________________________________________________________________________________
Module 3F: –– Assessment

Module 3E: Assessment of
of the
the Perineal
Uterine Fundus in thePostpartum
Area during PostpartumPeriod
Period
Time Frame:
Time Week __(2
Frame: Week __(1)hours)
hour
Schedule
Schedule of
of synchronous
synchronous sessions:
sessions: BSN2A-
BSN2A- Thursday
Thursday &
& Saturday:
Saturday: 6:00-2:00
6:00-2:00
pm
pm
BSN2B-
BSN2B- Wednesday
Wednesday && Friday
Friday :: 6:00-2:00
6:00-2:00
pm
pm
Mapped Learning Outcomes and Course Content for C-RLE 107, Module 3F
Hour (At the close of the period allotted, students Online Session Offline
should have :)
Session
hour expected to: following: Review of the
• Explain the significance of • The significance of Assessment of
performing the assessment of performing the the Perineal
the perineum during assessment of the Area during
postpartum period perineum during Postpartum
• Describe the normal and postpartum period Period
abnormal findings of the • The normal and -Answer
perineal area during abnormal findings of Assessment of
postpartum period. the perineal area
Learning and
Evaluation
• Explain how assessment of during postpartum
-Assignment:
perineal area can prevent period.
• Presentation
complications during • How assessment of
showing the
postpartum period. perineal area can
entire
• Perform assessment of the prevent
procedure of
perineal area by making a complications during
the
video showing the step to step postpartum period.
assessment
procedure. • Perform assessment
of the
of the perineal area by
perineal
making a video
area.
showing the step to
step procedure.
Faculty:
postpartum-care
Immediately after delivery of the baby, the mother’s body undergoes changes and as it adapt to the
postpartum transition, the nursing assessment is so crucial starting immediately after delivery of the
baby up to discharge of the mother to the hospital. The physical care a woman receives during the
postpartum period can influence her health for the rest of her life and the nurse helps by performing
accurate assessment and performing correct procedures. One of the important procedure to do as part
of this assessment is the assessment of the perineal area.
This module will discuss the significance of checking the perineal area during immediate postpartum
period. The perineum is one of the parts of the female body that usually experience trauma and most of
the time aside from unexpected laceration, intended episiotomy is also being done that needs to be
checked regularly. Failure to assess the condition of the perineum can lead to some postpartum
complications. . The importance and the correct method of performing it will be discussed and as part
of the requirement of this module, you are required to accomplish the activity and assignment posted at
the last part.
Faculty:
ASSESSING THE PERINEAL AREA DURING IMMEDIATE POSTPARTUM PERIOD
PERINEUM - refers to the area between the anus and genitals, extending from either the vaginal opening
to the anus or the scrotum to the anus.
https://www.rcog.org.uk/en/patients/tears/tears-childbirth/
WHAT IS THE DIFFERENCE BETWEEN A TEAR AND AN EPISIOTOMY?

EPISIOTOMY - is a surgical procedure that enlarges the vaginal opening during labor by cutting the
perineum, the skin and muscles between the vulva and anus to make more space for the baby to be born.
Episiotomies are done with your consent. They are only done if your baby needs to be born quickly,
often if you are having an instrumental (forceps or vacuum assisted) birth, or if you are at risk of a
serious perineal tear.
Faculty:
https://www.highmarkblueshield.com/preg/000136.html
WHAT ARE THE TYPES OF PERINEAL TEAR?

1. First-degree
• Small tears affecting only the skin which usually heal quickly and without treatment.
2. Second-degree
• Tears affecting the muscle of the perineum and the skin. These usually require stitches.
3. Third- and fourth-degree
• For some women (3.5 out of 100) the tear may be deeper. Third- or fourth- degree tears, also
known as Obstetric Anal Sphincter Injuries (OASI), extend into the muscle that controls the anus
(anal sphincter). These deeper tears need repair in an operating theatre.
Faculty:
https://www.rcog.org.uk/en/patients/tears/tears-childbirth/
WHY DO TEARS OCCUR?

It is common for the perineum to tear to some extent during childbirth. Tears can also occur inside
the vagina or other parts of the vulva, including the labia. Up to 9 in every 10 first time mothers who
have a vaginal birth will experience some sort of tear, graze or episiotomy. It is slightly less common for
mothers who have had a vaginal birth before. For most women, these tears are minor and heal quickly.
Tears happen spontaneously as the baby stretches the vagina and the perineum during birth.
PERINEAL TEAR is a laceration of the skin and other soft tissue structures which, in women, separate
the vagina from the anus. Perineal tears mainly occur in women as a result of vaginal childbirth, which
strains the perineum. It is the most common form of obstetric injury.
POSTPARTUM PERINEAL SYMPTOMS

• Small hematomas that are usually go away without treatment. Painful, large hematomas may
need drainage of the blood that collects in them. If a lot of tissue swelling occurs around the
urethra, urinating may be difficult. If this happens, a small tube called a catheter can be put into
the bladder until urination is possible.
Faculty:
• Lacerations are tears in the tissues. They may be repaired by suturing or sewing, but small ones
will heal with normal care.
• As the episiotomy heals, it forms a scar. Women who have episiotomies should be careful to
avoid opening the wound while it heals.
• After the baby is born, a discharge called lochia will drain from the vagina. At first, this lochia
will look red, because blood is mixed with it. As the woman heals, the lochia will become white
or even clear, like mucus.
ASSESSMENT OF THE PERINEAL AREA
PURPOSE: To assess perineal trauma and the state of healing.
file:/Maternity%20books/Foundations%20of%20maternal-newborn%20and%20women’s%20health%20nursing
Procedure Rationale
1. Provide privacy and explain the purpose of the • This elicits cooperation and reduces
procedure. anxiety.
2. Put on clean gloves. • Implements standard precautions to
provide protection from possible contact
with body fluids
Faculty:
3. Ask the mother to assume the Sims (side—lying) • Position provides an unobstructed view of
position and flex her upper leg. Lower the the perineum and allows assessment of
perineal pads, and lift her superior buttock. If Lochia that may be under the mother; light
necessary, use a flashlight to inspect the perineal allows better visualization.
area.
4. Note the extent and location of edema or • Extensive bruising or asymmetric edema
bruising. may indicate formation of a hematoma.
5. Examine the episiotomy or laceration for • Redness, edema, or discharge may
redness, ecchymosis, edema, discharge, and indicate infection of the wound; extensive
approximation (REEDA). bruising may delay healing; wound edges
should be in direct contact for
uncomplicated healing to occur.
6. Note the number and size of hemorrhoids. • Swollen, painful hemorrhoids interfere
with activity and bowel elimination.
be announced) ______________________
Assignment:
Using the table below, describe the normal and abnormal findings of the assessment of the perineum
during postpartum period.
Procedure Normal finding Abnormal finding
Assessing the perineum
Faculty:
Activity:
• Make a video presentation showing the entire procedure of the assessment of the perineal area.
For the evaluation of learning for Module 3F, a scheduled quiz will be assigned in the Google
4. References:
Newborn and Women’s Health Nursing 7 th edition (2019). Elsevier Inc. St. Louis, Missouri, USA.
• https://www.rcog.org.uk/en/patients/tears/tears-childbirth
• https://www.emedicinehealth.com/postpartum_perineal_care/article_em.htm
Congratulations for having completed this RLE 107 Module 3F See you in the next Module
Faculty:
Prepared by:
Lilibeth G. Sales, RN MAN/Marie Aileen L. Domingo, RN, MN

Instructor
Approved by:

https://www.youtube.com/watch?v=vAQvwAWqx4o
Faculty:
Module 3G:– –Module

Module3G: 3G – Perineal
Assessment Care (Postpartum)
of the Perineal Area during Postpartum Period
Time
TimeFrame:
Frame: Week
Week__(1)
__(1)hour
hour
Schedule
Scheduleofofsynchronous
synchronoussessions:
sessions:BSN2A-
BSN2A-Thursday
Thursday&&Saturday:
Saturday:6:00-2:00
6:00-2:00pm
pm
BSN2B-
BSN2B-Wednesday
Wednesday&&Friday
Friday: 6:00-2:00
: 6:00-2:00pm
pm
Mapped Learning Outcomes and Course Content for C-RLE 107, Module 3G
Hour (At the close of the period allotted, Online Session Offline
students should have :) Session
hour expected to: following: Review of the
• The importance of Assessment of
• Explain the importance of performing perineal the Perineal
performing perineal care care during Area during
during postpartum period. postpartum period. Postpartum
• Discuss how perineal care • Discuss how perineal Period
can prevent complications care can prevent -Answer
during postpartum period. complications during Assessment of
• Perform the procedure of postpartum period. Learning and
perineal care by making a Evaluation
video showing the step to • Perform the -Assignment:
step procedure. procedure of perineal • Presentation
care by making a showing the
video showing the entire
step to step procedure of
procedure the
assessment
of the
perineal
area.
Faculty:
https://www.google.com/url?sa=i&url=https%3A%2F%2Fcanadian-nurse.com%2Fen%2Farticles%2Fissues%2F2014%2Fnovember-2014%2Faddressing-a-gap-inpostpartum-

care
Overview
The physical care a mother receives during the postpartum period can influence her health for the
rest of her life. One of the important nursing cares during postpartum period is perineal care. The
perineum is the area of skin and muscle between the vagina and anus. This area undergoes a lot of stress
and change during pregnancy and delivery. At the of the labor, the perineum’s skin and muscle layers
thin and stretch to allow the baby to be born and sometime episiotomy is intendedly done and
sometimes unexpected tears will be present. In order to speed up healing and prevent infection, this
wound needs special care afterward and perineal care help a lot.
This module presents information on routine postpartum perineal care during immediate
postpartum period which is being rendered by the nurse and instructions how to perform perineal care
by the mother alone when she is already capable of doing it herself. Video making as an activity is
required in order to assess whether the content of the module is understood or not.
Faculty:
PERINEAL CARE (POSTPARTUM)
POSTPARTUM PERINEAL CARE - is care for your perineum after you have a baby. The perineum is
the area between your vagina and anus.
Perineal care will help your perineum:

• Heal faster Feel better
• Help prevent infection.
https://www.slideshare.net/kayeconstantino/perineal-care
PURPOSES:
• Prevents skin breakdown of perineal area, itching, burning, odor, and infections.
• Remove secretions and provide patient’s comfort.
Procedure Rationale
1. Explain the procedure, assess if the patient is Explanations reduce anxiety and
experiencing any discomfort in the elicit cooperation.
perinealgenital area and how she can cooperate
during the procedure.
Faculty:
2. Prepare the necessary materials. Wash hands Implements standard precautions to provide
and wear clean gloves. protection from possible contact with body
fluids
3. Provide privacy (close the curtains and put a This elicits cooperation and reduces anxiety.
sign outside if necessary)
4. Fold the top linen up to the foot of the bed and To have a visualization of the perineal area.
the gown up to expose the perineal area.
5. Position the patient in back lying position with To have a good visualization of the perineal
the knees flexed and spread well apart. Cover area. Covering with bath blanket will just
the legs with the bath blanket in a diamond exposed the area needed.
shaped position. Tuck the sides on the inner

sides of the legs.
6. Inspect the perineal area (taking note of Redness, edema, or discharge may
R E-E-D-A) indicate infection of the wound;
extensive bruising may delay healing;
wound edges should be in direct
contact for uncomplicated healing to
occur.
7. Pour warm water from the vulva and dry the To wash and clean the area. Provide comfort.
area.
8. Open and clean the labia majora using the Implements standard precautions to prevent
figure of seven strokes. Use separate contamination.
quarters of the wash cloth/ gauze pad
filled with antiseptic solution (depends
on what the hospital is using / protocol)
for each stroke.
9. Clean the labia minora same as the steps in Implements standard precautions to prevent
number 8. contamination.
10. Clean the clitoris to the anus in one downward Implements standard precautions to prevent
stroke. contamination.
11. Clean the inguinal sides from inner to outer. Implements standard precautions to prevent
contamination.
12. Rinse the area well with warm water. You may To wash and clean the area. Provide comfort.
place a woman in a bed pan and dry the area
thoroughly using a dry wash cloth/ gauze.
13. Inspect the orifice for intactness. Inspect the To assess for the urethra and patency of the
urethra in patients with indwelling catheter. indwelling Foley catheter
Faculty:
14. Change the urine bag by slowly pulling the end To prevent infection.
of the catheter and position the new urine bag
lower than the bladder.
15. Assist the patient in placing the sanitary pad if Prevent infection and provide comfort.
necessary and change the incontinent pad and
the soak linen if there’s any.
16. Check the urine output and do after care, throw Implements standard precautions to prevent
all infectious materials to the proper waste bin. contamination. To check for the urinary
output of the postpartum mother.
17. Remove gloves and wash hands. Implements standard precautions to prevent
contamination.
18. Document the findings: REEDA, urine output and This promotes accurate communication and
if there’s any other problems to consider. identifies deviations from expected so that
potential problems can be identified early.
HOW TO DO PERINEUM CARE AFTER DISCHARGE?
• Wash your hands before doing perineal care.
• Remove the soiled peri-pad starting at the front (vaginal area) to the back (anus).
• While you are sitting on the toilet, rinse your perineum. Aim the bottle opening at your perineum
and spray so the water moves from front to back.
• Pat the area dry with toilet paper or cotton wipes starting at the front and moving to the back.
• Put on a fresh peri-pad. Apply the peri-pad from front to back by placing the front part of the
peri-pad against the perineum first. Do not touch the inner surface of the peri-pad. Wash your
hands after doing perineal care.
HOW TO DECREASE PERINEAL SWELLING AND PAIN?

• Take a sitz bath. Fill a bathtub with 4 to 6 inches of warm water. You may also use a sitz bath
pan that fits over a toilet. Sit in the sitz bath for 20 minutes. Do this 2 to 3 times a day, or as
directed.
• Apply ice on your perineal area for 15 to 20 minutes several times a day. Use an ice pack, or put
crushed ice in a plastic bag. Cover it with a towel.
• Use medicine spray, wipes, or pads as directed. Healthcare providers may give you a
medicine spray or wipes soaked with numbing medicine to decrease the pain. Pads that contain
an herb called witch hazel may also help reduce pain. Use these after perineal care or a sitz bath.
WHAT TO REFER TO THE DOCTOR?

• Blood clots those are bigger than a quarter.
• Heavy vaginal bleeding that fills 1 or more sanitary pads in 1 hour.
• Foul-smelling vaginal discharge.
• Pain does not go away or gets worse.
• Fever higher than 100.4°F (38°C) and chills.
• Questions or concerns about your condition or care.
Faculty:
be announced) ______________________
Activity:
• Make a video presentation showing the entire procedure of Perineal Care of Postpartum Mother.
Assignment
• Explain the importance of performing perineal care and how it will prevent possible postpartum
complications.
For the evaluation of learning for Module 3G, a scheduled quiz will be assigned in the Google Classroom
and will be taken before the start of the next Module during the Synchronous Class
Congratulations for having completed this RLE 107 Module 3G See you in the next Module
REFERENCES
• Leifer, Gloria. Introduction to Maternity and Pediatric Nursing 8th edition (2019). Elsevier Inc. St.
• https://www.drugs.com/cg/postpartum-perineal-care-aftercare-instructions.html
Faculty:
Prepared by:

Instructor

Instructor
Approved by:

Faculty:
Module 3H: Performing Hot Sitz Bath during Postpartum Period
Time Frame: Week __(1) hour

Schedule of synchronous sessions: BSN2A- Thursday & Saturday: 6:00-2:00
pm
BSN2B- Wednesday & Friday : 6:00-2:00
pm
Mapped Learning Outcomes and Course Content for C-RLE 107, Module 3H
Hour (At the close of the period allotted, Online Session Offline Session
students should have :)
1 hour At the end of this module, you are Discussion about the -Further Review
expected to: following: of the
• Explain the importance of • Explain the Assessment of
performing hot sitz bath importance of the Perineal
during postpartum period. performing hot sitz Area during
Postpartum
• Discuss how hot sitz bath can bath during
Period
prevent complications during postpartum period. -Answer
postpartum period. • Discuss how hot sitz Assessment of
• Search in the internet the bath can prevent Learning and
actual procedure of complications during Evaluation
postpartum period. -Assignment:
performing hot sitz bath to a
postpartum woman. • Search in the internet • Presentation
the actual procedure showing the
of performing hot sitz entire
bath to a postpartum procedure of
woman. the
assessment
of the
perineal
area.
Faculty:
postpartum-care
After delivery the mother underwent a lot of stress and trauma like possible episiotomy, unexpected
tears or lacerations. Presence of hemorrhoids that is already present from pregnancy stage inflamed
during labor and resulting to pain postpartum period. These are only some of the indications why
performing hot sitz bath is important during postpartum period. It will be a great help to the mother to
soothe discomfort and aid healing of the wound. As part of the perineal care, hot sitz bath can be included
as part of the procedure.
This module discusses sitz bath, its significance and how it helps the postpartum mother. Special
considerations in performing the procedure are also included.
Faculty:
SITZ BATH
A SITZ BATH - is a portable basin that fits on a toilet seat. A reservoir filled with water provides a
constant supply of swirling water to the basin. The term sitz bath is derived from the German word
Sitzbad, meaning a bath (Bad) in which one sits (sitzen).
• It is a bath in which a patient sits in water up to relieve discomfort and pain in the lower part of
the body. Sitz bath works by keeping the affected area clean and increasing the flow of blood.
• The movement of water soothes healing tissue, decreases inflammation by causing vasodilation
in the area, and thereby effectively reduces discomfort and promotes healing.
• Sitz baths usually use water that is maintained at 100° to 105° F (38° to 41° C).
• Be certain that the water in a sitz bath is not too hot before you help a woman to use it; it should
feel pleasantly warm, not hot.
Objectives:
• To relieve muscle spasm
• To soften exudates
• To hasten the suppuration process
• To hasten healing
• To reduce congestion and provide comfort in the perineal area
General Purposes:
1. To aid healing a wound in the area by cleaning on discharges and slough
2. To induce voiding in urinary retention
3. To relieve pain, congestion and inflammation in cases of: hemorrhoids, tenesmus,
rectal surgery, anal fissures, after proctoscopic or cycloscopic exams., sciatica, uterine and
renal colic.
4. To induce menstruation.
Indications:
• Hemorrhoids
• Anal Fissures/Surgery
• Episiotomy
• Uterine Cramps
Important Considerations
• Warm water should not be used if considerable congestion is already present.
• The patient should be observed closely for signs of weakness and faintness.
• After the patient is in the tub or the chair, check to see whether or not there is pressure
against the patient’s thighs or legs.
• Support patients back in the lumbar region.
Faculty:
Source: Essentials of Maternity, Newborn and Women’s Health Nursing 4th edition by Ricci, Susan Scott
PURPOSE: To aid healing of the perineum through application of moist heat

Procedure Rationale
1. Wash your hands; identify client and explain • Handwashing prevents the spread of
procedure. infection; identification ensures that
procedure is performed on correct client,
thereby promoting safety; explanation
assists in alleviating any anxiety.
2. Assess client’s condition; ascertain whether • A sitz bath can make a woman feel
client is able to ambulate to bathroom; assist and lightheaded, increasing her risk of injury.
modify as necessary. Fatigue and exhaustion may interfere with
client’s ability to ambulate or tolerate
procedure, also increasing her risk for
injury.
3. Assemble equipment, including sitz bath, clean • Organization of equipment increases
towel, perineal pad. efficiency of the procedure.
4. Place sitz bath on toilet seat. Fill collecting bag • Using correct temperature of water
with warm water at a temperature of 100° F to (pleasantly warm) eliminates risk of
105° F (38° C to 41° C). Hang the bag overhead thermal injury. Adequate flow of warm
so a steady stream of water will flow from the water increases circulation to the
bag, through the tubing, and into the basin. perineum, thereby reducing inflammation
and aiding healing.
Faculty:
5. Assist client with ambulating to bathroom; help • Assisting ambulation minimizes risk of
with removal of perineal pad from front to back. injury. Removing pad from front to back
Assist client to sit in basin. minimizes risk of infection transmission.
Proper placement ensures effectiveness of
treatment.
6. Instruct client to use clamp on tubing to regulate • Continuous swirling water aids in
water flow; use robe or blankets to prevent reducing edema and promoting comfort.
chilling and provide for privacy. Have call bell Privacy enhances self esteem. Quick, easy
within reach. access to call bell allows for prompt
intervention should problems arise.
7. After 20 minutes, assist client with drying • After 20 minutes, heat is no longer
perineum and applying clean pad (holding pad therapeutic because vasoconstriction
by the bottom side or ends). occurs. Proper handling of pad prevents
contamination and possible risk of
infection.
8. Assist client with ambulating back to room. • Client may become fatigued from the
procedure or lightheaded from the warm
water, increasing her risk of falling.
9. Evaluate client’s tolerance and response to • Evaluation assists with determining
procedure; ask client to report how she feels. effectiveness of procedure and making
Institute health teaching, such as continuing sitz any changes. Health teaching helps to
baths when at home promote continuity of care after discharge.
10. Record completion of procedure, condition of • Documentation provides additional
perineum, and client’s condition and response. means for evaluation of care and client
outcomes.
be announced) ______________________
Activity:
Faculty:
Internet Search: Search for a procedure in the You tube that shows actual procedure of Hot Sitz bath for
a postpartum woman.
For the evaluation of learning for Module 3 H, a scheduled quiz will be assigned in the Google
Congratulations for having completed this RLE 107 Module 3H. See you in the next Module
REFERENCES
• Ricci, Susan Scott. Essentials of Maternity, Newborn and Women’s Health Nursing 4th edition
• Leifer, Gloria. Introduction to Maternity and Pediatric Nursing 8th edition (2019). Elsevier Inc. St.
• https://nurseslabs.com/hot-sitz-bath-nursing-interventions-procedure/
Prepared by:

Instructor

Instructor
Approved by:

Dean, College of Nursing and Pharmac
Faculty:
Module 3I: Homan’s Sign Assessment in the Postpartum Period
Time Frame: Week __(1) hour

Schedule of synchronous sessions: BSN2A- Thursday & Saturday: 6:00-2:00
pm
BSN2B- Wednesday & Friday : 6:00-2:00
pm
Mapped Learning Outcomes and Course Content for C-RLE 107, Module 3I
Hour (At the close of the period allotted, Online Session Offline Session
students should have :)
1 hour At the end of this module, you are Discussion about the -Further Review
expected to: following: of the
Assessment of
At the end of this module, you the Perineal
• Explain the significance of
Area during
performing Homan’s sign test are expected to: Postpartum
to identify needs and give • Explain the Period
appropriate interventions. significance of -Answer
• Describe normal and performing Homan’s Assessment of
abnormal findings of Homan’s sign test to identify Learning and
sign test. needs and give Evaluation
appropriate -Assignment:
• Explain how assessment of
interventions. • Presentation
Homan’s sign can prevent
• Describe normal and showing the
complications during
abnormal findings of entire
postpartum period.
Homan’s sign test. procedure of
• Perform checking for the
• Explain how the
Homan’s sign by making a
assessment of assessment
video showing the step to step
Homan’s sign can of the
procedure.
prevent perineal
complications during area.
postpartum period.
• Perform checking for
the Homan’s sign by
making a video
Faculty:
showing the step to

step procedure.
postpartum-care
From pregnancy period up to postpartum the body of the woman is at risk of several changes, one of
these is possibility of developing DVT. Though the incidence is relatively low but it may lead to a fatal
situation which is Pulmonary Embolism, the most common cause of maternal death in developed
countries. Assessment of DVT is also being done in postpartum period because the mother is still risk of
the same.
The module discusses not only about the procedure of Homan’s sign test but it will also give you a
background on why a pregnant woman and a postpartum mother is prone to have DVT. Proper nursing
Faculty:
assessment will prevent postpartum complications live development of Pulmonary Embolism in the
case of unclogged blood clots.
postpartum-care
CHECKING FOR THE HOMAN’S SIGN

Deep Vein Thrombosis (DVT) is a blood clot that develops in the leg, thigh or pelvis. It is a serious
condition that can be fatal if the clot dislodges and moves into the lungs.
• According to Centers for Disease Control and Prevention (CDC) pregnant women are at least 5
times more likely to develop DVT than non-pregnant women.
• The level of blood-clotting proteins increases during pregnancy, while anti-clotting protein
levels decrease.
• The enlarged uterus during pregnancy may also increase the risk because it puts the veins of the
lower body under additional pressure to return blood to the heart.
• Postpartum period possible development of thrombus to embolism is also a focus of assessment
due to medical practices as instrumental deliveries, prescription of prolonged bed rest after
delivery and used of estrogen to stop lactation.
Faculty:
https://www.practo.com/health-wiki/deep-vein-thrombosis-symptoms-complications-and-treatment/258/article
Symptoms:
• The most obvious symptom is swelling and heavy pain or extreme tenderness in one of the
legs. Up to 90% cases in pregnancy occur in the left leg.
• pain in the leg when standing or moving around
• pain in the leg that worsens when you bend your foot up toward your knee
• warm skin in the affected area
• red skin at the back of the leg, typically below the knee
• slight to severe swelling
HOMAN’S SIGN test also called dorsiflexion sign test - is a physical examination procedure that is
used to test for Deep Vein Thrombosis (DVT). It was defined by John Homans in 1941 as discomfort
behind the knee upon forced dorsiflexion of the foot.
• Positive Homans's sign (calf pain at dorsiflexion of the foot) is thought to be associated with the
presence of thrombosis.
• Negative Homan’s sign (absence of calf pain) – normal.
PURPOSES:
1. To diagnose presence of deep vein thrombosis
Procedure Rationale
Faculty:
1. Wash your hands; identify client and explain • Handwashing prevents the spread of
procedure. infection; identification ensures that
procedure is performed on correct client,
thereby promoting safety; explanation
assists in alleviating any anxiety.
2. Place the patient in a supine position and • Promote comfort.
instruct the patientto extend her knees.
3. Support the patient’s thigh with one hand and • Elicit proper way of checking of the
her foot with the other hand. examination.
4. Raise the patient’s straight leg to 10 degrees. • Elicit proper way of checking of the
examination.
5. Bend the patient’s leg slightly at the knee then • Dorsiflex motion will let the muscle
firmly and abruptly dorsiflex the ankle. contract on he calf region.
6. Observe patient’s reaction. The examiner • Pan in the calf indicates positive result.
observes whether ot not the patient reports pain
in her calf and popliteal region.
7. Document the findings and refer any • Positive Homan’s sign must be reported to
abnormalities. the physician at once.
Faculty:
https://www.slideserve.com/tuvya/postpartum-nursing-care
Faculty:
https://www.google.com/url?sa=i&url=https%3A%2F%2Fnursekey.com%2F12-postpartum-assessment-and-nursing-care
be announced) ______________________
Activity:
• Make a video presentation showing the entire procedure on how to check Homan’s sign.
Assignment
• Explain the importance of performing Homan’s sign test and how it will prevent possible
postpartum complications.
Faculty:
For the evaluation of learning for Module 3 I, a scheduled quiz will be assigned in the Google Classroom
and will be taken before the start of the next Module during the Synchronous Class
REFERENCES
• Pilliteri
• McKinney, Emily; Murray, Sharon et.al. Study Guide for Maternal-Child Nursing, 5th edition
• https://www.healthline.com/health/dvt-in-pregnancy#outlook
Congratulations for having completed this RLE 107 Module 3I. See you in the next Module
Prepared by:

Instructor

Instructor
Approved by:

Faculty:

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COLLEGE OF NURSING AND PHARMACY

C-RLE 107 – Care of Mother, Child, Adolescent (Well Client)

Module 3E: –– Physical

Target Learning Outcomes Content and Activities

showing the step to uterine

1. Content / Discussion / Learning Resources / Link

ASSESSING THE UTERINE FUNDUS

PURPOSE: To determine the location and firmness of the uterus.

Lilibeth G. Sales, RN MAN

Marie Aileen L. Domingo, RN, MN

Anele C. Mallari, RN, MAN, LPT

Module 3F: –– Assessment

1. Content / Discussion / Learning Resources / Link

ASSESSING THE PERINEAL AREA DURING IMMEDIATE POSTPARTUM PERIOD

WHAT IS THE DIFFERENCE BETWEEN A TEAR AND AN EPISIOTOMY?

WHAT ARE THE TYPES OF PERINEAL TEAR?

WHY DO TEARS OCCUR?

POSTPARTUM PERINEAL SYMPTOMS

ASSESSMENT OF THE PERINEAL AREA

PURPOSE: To assess perineal trauma and the state of healing.

Lilibeth G. Sales, RN MAN/Marie Aileen L. Domingo, RN, MN

Anele C. Mallari, RN, MAN, LPT

Module 3G:– –Module

1. Content / Discussion / Learning Resources / Link

PERINEAL CARE (POSTPARTUM)

Perineal care will help your perineum:

shaped position. Tuck the sides on the inner

HOW TO DECREASE PERINEAL SWELLING AND PAIN?

WHAT TO REFER TO THE DOCTOR?

Lilibeth G. Sales, RN MAN

Marie Aileen L. Domingo, RN, MN

Anele C. Mallari, RN, MAN, LPT

Module 3H: Performing Hot Sitz Bath during Postpartum Period

Time Frame: Week __(1) hour

1. Content / Discussion / Learning Resources / Link

PURPOSE: To aid healing of the perineum through application of moist heat

Lilibeth G. Sales, RN MAN

Marie Aileen L. Domingo, RN, MN

Anele C. Mallari, RN, MAN, LPT

Module 3I: Homan’s Sign Assessment in the Postpartum Period

Time Frame: Week __(1) hour

showing the step to

1. Content / Discussion / Learning Resources / Link

CHECKING FOR THE HOMAN’S SIGN

Lilibeth G. Sales, RN MAN

Marie Aileen L. Domingo, RN, MN

Anele C. Mallari, RN, MAN, LPT

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