&-POINT POSTPARTUM ASSESSMENT WORKSHEET INSTRUCTIONS ‘SPECIAL POINTS TO NOTE 7. Breast ‘A Gently palpate each breast ‘What's the contour? B. Ifyou feet nodules in the breast, the ducts may not have BL Are the breast ful firm, tender, shiny? been emptied at last . C. Are the veins distended? ©. Stroke downward towards the nipple, then gently release D. Is the skin warm? the mik by manual. E. Does the patient complain of sore nipples? D. If nodules remain, notity the doctor. F. Are breasts s0 engorged that she requires pain E, Take this opportunity to explain the process of milk ‘medication? production, what to do about engorgement, how to perform seit breast examinations, and answer any questions she may have about breastfeeding. Tierus. A B. & Palpate the uterus Have the patient feel her uterus as you explain the process of involution W uterus not ivoluting property, check fr infection, fibroids and lack of tone. ‘Uterus should the fim decrease approximately one finger breadth below B. Unsatisfactory involution may result i the bladder ‘ot completely empty ‘&_Bladder ‘A. Inspect and palpate the bladder simulaneously while ‘Bladder distention should not be present after checking the height of the fundus. recent emptying. B. An orderfrom the physician is necessary catherization B._ When bladder distention does occur, a pouch over may be done. An order for culture and sensitivity test the bladder area is observed, felt upon palpation; since definitive treatment may be required. ‘mother usually fee's need to urinate. ©. Talk to mother about proper perineal care, Explain that CC. Itis imperative thatthe frst three post-partum she should wipe from front to back attr voiding and \oidings be measured and should be at least delecating. 150ce, Frequent small voidings with or without pain ‘and burning may indicate infection of retention. “&_ Bowel Function "A. Question patient daily about bowel movements. ‘® Patient cannot go home unless ahe has a bowel B. She must not become constipated. If her bowels have movement ‘ot functioned by the second postpartum day, the doctor may start her on a mild laxative 5 Lochia ‘A. Inform the mother about what changes ’A._ Notify the doctor ifthe Tochia looks abnormal in to ‘she should expect in the lochia and when it should ‘color or contains clots or other small ones. cease. . Tell the mother when her next menstrual period will probably begin and when she can resume sexual relations, 1D. Discuss family planning at this time, 6. Episiotomy ‘A. Inspect episiotomy thoroughly using flashlight ‘Check episiotomy for proper wound healing, necessary. for better visibility. Infection, inflammation and suture sloughing. Check rectal area. If hemorthoids are present, the doctor ‘may want to start on sitz bath and local analgesic medication. Reassure patient and answer questions she may have regarding pain, cleanliness, and coitus. BB. Is the surrounding skin warm to touch? C. Does the patient complain of discomfort? Notify the .Doctorif any occur z Homan’s Sign A ‘Press down ganlly on the patient's knoe (lags extended flat on bed) ask her to flex her foot ‘K. Pain of tondomess in tho calli a positive Homan's sign and indication of Thrombophlebitis. Physician should be notitied immediately. Emotional Status: a 8 ‘Throughout the physical assesement, notice and evaluate the mother's emotional status. Explain to the mother and to her family that she may cry easily lor a while and that her emotions may shift from high fo low. The changes are normal and are probably caused by the tremendous hormonal changes occurring in her body and by her realization of new responsibilities that accompany each childs birth. NOTE: Bo sure that the mother has emptied her bladder and that she is lying in supine postion ona fat bed Betore beginning assessment. ‘K._Doas the paient appear dependent or independent? Is she elated or despondent? 8. What does she say about family? C. Are there other nonverbal responses? Created by Ana Corona, FNP-C