OB

Postpartum
Assessment
and Patient
Education
Prepared by: Gail Chantel
Spring Saludares, RN., MN
 BUBBLEHED Assessment
BREAST
1. Check nipples for pressure sores, cracks, or fissures.
Evaluate whether nipples are flat or inverted.
2. Assess signs and symptoms of mastitis.
3. Palpate both breasts for engorgement. Engorgement--
usually occurs 2-3 days post-partum. Teach mom to:
a. Apply warm packs 15-20 minutes pre-nursing.
b. Try a warm shower before nursing
c. ice bags and/or binders for non-nursing moms
PATIENT EDUCATION
Teach the mother how to perform Breast examination:
◼ mother to gently palpate each breast and check for
presence of nodules- if with nodules milk ducts are
not emptied well.
◼ Stroke downward towards the nipple, then gently
release the milk manually. If nodules remain, notify
the doctor.
UTERUS
The fundus is palpated for the following:
1. Height-- Record finger widths above or below the umbilicus.
e.g., 2 fingerbreadths above the umbilicus
2 fingerbreadths below the umbilicus
Fundus descends 1 fingerbreadth each day and should be
nonpalpable by 14 days postpartum.
2. Position-- Fundus should be midline
3. Tone-- Fundus should remain firm
▪ If uterus becomes boggy gently massage the uterus to help the
muscles to contract .
▪ Adjust IV flow rate to control bleeding if oxytocin is in the IV
solution
▪ If no IV, administer p.o. or IM oxytocin per Dr.’s order.
4. Assess for uterine cramping and administer pain meds as
prescribed.
Patient education
➢ Teach the mother how to palpate the uterus and explain the
process of Involution
BLADDER
1. Palpate for distention above the symphysis pubis. Check fullness of bladder
2. Accompany mother and record first 2 voidings. Return of urination should
occur within six to eight hours of delivery
3. If patient has not voided in 6-8 hours post-delivery
--notify Doctor for any voiding difficulties
--straight cath or indwelling as per Doctor’s order
4. Monitor intake and output for 24 hrs.
5. Be alert for S/S of UTI
6. Assess for Postpartum voiding difficulties related to other factors

Patient Education
A. Patients are encouraged to drink adequate fluid each day
B. Educate Patient about effects of bladder distension
hemorrhage- Distended bladder displaces uterus results to relaxation
Infection- stasis of urine promote bacterial growth
Increase discomfort
BOWEL
1. Assess for presence of Bowel sounds q shift, return of bowel
2. Administer daily stool softeners or laxatives per doctor’s order
3. Avoid use of enemas and or suppositories for pts with a 3rd or 4th degree
laceration. If needed, use with caution.
4. First BM usually occurs on or after 2nd postpartum day.
5. Best for patient to have BM before discharge but may not happen.
6. Often sent home with stool softener
7. Causes of Constipation
A. Decrease muscle abdominal muscle tone
B. Lack of food and fluids during labor
C. Pre delivery enema
D. Dehydration
E. Perineal pain caused by episiotomy or rectal lacerations.

PATIENT EDUCATION?
LOCHIA
1. Assess peri-pad daily for color, amount, type, and for
any foul odor including number of pads consumed per shift.
2. Observe for constant trickle of bright red lochia.
3. Instruct patient to notify nurse if she passes clots. Note size and
number.
4. Lochia should progress from rubra to serosa to alba.
5. Notify the doctor for any excessive bleeding

Patient Education
1. After discharge, patients should report any abnormal progressions of
lochia, excessive bleeding, foul-smelling lochia, or large blood clots to
their physician immediately. Patients are instructed to avoid sexual
activity until lochial flow has ceased.
2. Teach patient about Peri-Care:
-- Instruct pt to fill peri-bottle with warm water and rinse stitches area
after each voiding or BM
--Wipe from front to back, patting gently
--Change peripads after each voiding
--Encourage use of sitz bath 24 hrs postpartum per Doctor’s order for 20
min bid-tid especially if pt had a 3rd or 4th degree laceration
On the basis of the US National Guideline provided by the Maternal
Health Office:

•“Scant hemorrhage is blood and Lochia around 10 ml or less or a bloody

pad less than 5 cm
•“Light hemorrhage is blood and Lochia of 10 – 25 ml or a bloody pad less
than 10 cm
•“Moderate hemorrhage is blood and Lochia to 25 – 50 ml or bloody pad
less than 15 cm
•“Heavy/Profuse hemorrhage is blood and Lochia of 50 – 80 ml or one pad
that becomes bloody in two hours
•“Excessive hemorrhage is when one pad becomes bloody in 15 minutes
or blood accumulates under the parturient. Clots larger than a lemon or a
large amount of blood suddenly are indicators of excessive bleeding.
EPISIOTOMY
1. Assess using REEDA every shift
--R=redness
--E-edema
--E=ecchymosis
--D=discharge
--A=approximation
2. Position in lateral Sim’s position with upper knee bent.
Gently lift the buttucks to view perineum. Flashlight may
be helpful.
3. Assess for pain and other discomfort
4. Observe for signs and symptoms of infection and
inflammation- (presence of discharges,
5. Assess for presence of hemorrhoids.
6. Notify the doctor for any complication

Patient’s Education
• Teach patient how to perform Kaegels exercise and use hot
sitz bath if not contraindicated.
HOMAN’S Sign
1. Assess daily for redness, painful, nodular edematous or
warm areas, discolorations, or leg varicosities and
notify Doctor.
2. Assess Homan’s Sign q shift? How?
3. Assess peripheral pulses and capillary refill
4. Women are more prone to thrombophlebitis post-
partum related to hypercoagulability of the blood.

Patient Education?
Emotional Status

3 Normal Phases
1. “Taking In”
➢ immediately after delivery till up to 2 days postpartum
needs: rest and sleep , self-focus, relives events of Labor
and Delivery

2. “Taking Hold”
➢ preoccupied with the present and usually encompasses
days 2 - 5 postpartum :interested in self-care, optimal time
for teaching, focus on caring for baby

3. “Letting Go”
➢ reestablishes relationships with others with outward focus

**Postpartum Blues”-- a normal temporary state related to

hormonal changes, role redefinition, fatigue, or pain. Pt may “cry
for no reason”.
Diastasis Recti
➢ a separation of the rectus abdominis muscles, may occur with
pregnancy, especially in women with poor abdominal muscle tone.

1. Following the uterine assessment, examine the abdomen for Diastasis

Recti by asking the mother to lift her head and place her chin on her
chest. While mother maintains that position, the nurse should begin to
palpate at the level of the umbilicus for a separation in the muscle.
Strive to measure both a length and a width and record on assessment,
if indicated, as Diastasis: 2 cm X 8 cm.

Patient Education
Teach mother importance of exercise to regain muscle tone, in order to
have strong abdominal support for future pregnancies. Reassure mom
that diastasis recti do respond well to exercise.