Postpartum Assessment Quiz

NURS 2543 Health of Families & Social Groups

• Course is about nursing care of the family during postpartum.
• Instructor is Krissy Jordan, RN, MSCN, PhD Candidate.
• Course is part of York University.

Learning Objectives

• Understand components of a systematic postpartum assessment and post-partum nursing care.
• Learn criteria and teaching plan for postpartum discharge.

Postpartum Physical Assessments

• Vital signs, including temperature, pulse, respirations, blood pressure.
• Breath sounds.
• Rectal area assessment.

Vital Signs

• Normal Findings: Temperature (36.2-38°C), Pulse (60-100 beats/min), Respirations (12-24 breaths/min), Blood pressure consistent with baseline (120/80 mmHg), clear breath sounds.
• Signs of Complications: Temperature ≥ 38°C after 24 hours (possible infection), Tachycardia (possible hemorrhage), Bradypnea/Tachypnea (possible complications), Hypertension/Hypotension (possible complications), Crackles (possible fluid overload).

Breasts & Nipples

• Breasts: Size, Shape, Firmness, Redness and Heat, Symmetry.
• Nipples: Size, Shape, Integrity, Tenderness.
• Normal Findings (Breasts): Day 1-2: Soft, Days 2-3: Filling, Days 3-5: Full, softens with breastfeeding. Skin intact, no soreness reported.
• Potential Complications (Breasts): Firmness, heat, pain (possible engorgement), Redness, heat, pain, fever, body aches (potential mastitis).

Uterus

• Fundus: Firm or soft, boggy; higher than expected level.
• Fundal Height: In relation to umbilicus; First 24 hours at level of umbilicus; involutes 1-2cm/day.
• Documentation: "1/U = 1 finger above the umbilicus," "@ U" = At umbilicus," U/1 = 1 finger below the umbilicus".
• Location: Midline or deviated to the left or right (deviating usually indicates a full bladder).

Nursing Considerations for Maintaining Uterine Tone

• Stimulation through gentle fundal massage.
• Boggy fundus may indicate uterine atony (increased risk of postpartum hemorrhage (PPH)).
• Nursing Actions: Perform uterine massage, encourage patient to void, utilize uterotonic medications (Oxytocin), and contact a medical professional (likely MRP).

Bladder

• Establish a voiding schedule to prevent bladder distention and urinary stasis.
• Encourage urination prior to breastfeeding.
• Normal findings: Able to void spontaneously within 8 hours, no bladder distension, able to empty bladder completely, no dysuria (painful urination), diuresis begins within 12 hours after birth.

Nursing Interventions in Preventing Bladder Distinction

• Empty the bladder as soon as possible, assist/ambulate the patient to promote voiding, use pain medications for discomfort during voiding, use a peri-bottle after voiding for hygiene, and comfort, use intermittent urinary catheters if necessary (if patient doesn't void within 6-8 hours of delivery), and encourage Kegel exercises.

Bowels

• Passing flatus: Soon after vaginal birth.
• Bowel movements: Within 2-3 days.
• Active bowel sounds: All four quadrants (especially for C-section).
• Nursing care: Measures to avoid constipation, ambulation or rocking to stimulate bowel movement, increase fiber and fluid intake, and use stool softeners as needed.

Lochia

• Color: Rubra (dark red; birth to 3-4 days), Serosa (brownish red or pink; day 4 to 2-4 weeks), Alba (yellowish white; after 10-14 days)
• Odor: "No odour" or "foul"
• Amount: Scant, Moderate, Heavy
• Presence of clots: Cherry, peach, or plum or golf size.

Legs

• Peripheral edema may be present.
• Observe for redness, tenderness, pain, venous thromboembolism (VTE).
• Observe for varicosities.

Episiotomy/Laceration or CS Birth Incision

• Perineal area assessment: Check for episiotomy or vaginal tearing, hematoma formation, and hemorrhoids.
• Use REEDA scale to grade severity of perineal trauma associated with episiotomy or lacerations.
• Normal findings: Minimal edema, episiotomy or laceration edges approximated, C-section incision: Dressing clean and dry, suture line intact.
• Abnormal findings: Pronounced edema, bruising or hematoma, redness, warmth, and drainage, possible infection.
• C-section incision: Redness, edema, warmth, drainage - potential infection.

Nursing Interventions (Episiotomy, Lacerations & Hemorrhoids)

• Cleansing (front-to-back, post-void and stool, at least 4 times daily), ice pack (first 24 hours), squeeze bottle (peri-bottle), and Sitz baths (X2/day for 20 minutes), and topical applications.

Emotional Status

• Caregiving of self and baby is an indicator of emotional status.
• Note patient's response to health teaching, affect, eye contact, and interests in newborn and adjustment to postpartum.
• If concerned, discuss with a medical professional (likely MRP) the need for referral to a Social Worker.
• Psychological assessment: Use Edinburgh Postnatal Depression Scale (EPDS), Patient Health Questionnaire (PHQ-9), and 7-item Generalized Anxiety Disorder scale (GAD-7).
• Emotional conditions: Postpartum blues, Postpartum depression, and Postpartum psychosis.

Signs of Postpartum Blues, Depression, or Psychosis

• Baby blues: Sad, anxious, overwhelmed feelings, crying spells, loss of appetite, difficulty sleeping (lasting more than 2 weeks).
• Postpartum depression: Persistent symptoms of baby blues, thoughts of self-harm or harm to baby, loss of interest in baby, hallucinations, confusion, rapid mood swings.
• Postpartum psychosis: Any symptoms of psychosis should be reported immediately, including worsening symptoms, inability to function, or thoughts of harming self or baby

Postpartum Blues

• Affects 50-80% of new mothers, typically begins within days of birth, and peaks around day 5, resolving by day 10.
• Associated symptoms include: Emotional lability, easy crying, sadness, anxiety, fatigue, restlessness, insomnia, anger, mild depression.
• Management: Reassurance and support; encourage self-care activities (sleep, relaxation, outings). Social support is beneficial; consider community resources and childcare.

Postpartum Hemorrhage (PPH)

• Leading cause of maternal death worldwide.
• Risk for all patients post-birth.
• Definition: Loss of ≥500 mL blood after vaginal birth, ≥1,000 mL after C-section.
• Types: Primary (occurs within 24 hours of birth), Secondary (occurs >24 hours to 12 weeks post-birth).
• Risk Factors/Causes: Uterine atony, trauma, retained tissue, thrombocytopenia.
• Management: Immediate assessment & intervention for bleeding control (massage fundus), oxytocic medications, surgical intervention if needed.
• Prevention: Early recognition and prompt treatment to reduce maternal mortality.

Hypovolemic Shock

• Signs and Symptoms: Rapid bleeding, weakness, lightheadedness, nausea/seeing stars, anxiety, reluctance to hold baby, ashen/grey skin, cool/clammy, increased pulse/respirations, decreased urine output, and declining BP.
• Immediate Actions: Notify provider, uterine intervention (massage), oxygen (8-10 L/min), position (tilt/elevate legs 30°), IV support, further measures (blood transfusion, urinary catheter, prepare for surgery).

Breastfeeding

• Promotion: Early initiation (skin-to-skin contact and breastfeeding within 1-2 hours after birth), health benefits, support (assess latch, education on cue-based feeding), and community resources.
• Suppression: Indications (not breastfeeding/infant loss), use of supportive bra, avoidance of stimulation, management of breast engorgement.

Health Promotion for Future Pregnancies

• Rubella vaccination (administer MMR vaccine if non-immune, given postpartum, safe for breastfeeding), prevention of Rh isoimmunization (standard dosage, antepartum prevention @26-28 weeks gestation, and within 72 hours if positive).

Postpartum Self-Care: Key Essentials

• Nutrition: Balanced diet & hydration, additional iron may be needed for low hemoglobin levels.
• Exercise: Gentle walking and stretching, gradually increase activity, kegel exercises for bladder control.
• Medications: NSAIDs or stool softeners, clearly defined dosage, timing, and side effects given at discharge.
• Family Planning: Contraception options, consider non-hormonal and lactation-safe methods.

Postpartum Warning Signs

• Physical signs: Heavy bleeding (soaking more than 1 pad/hour or passing large clots), severe abdominal pain, fever, severe headache, leg swelling/pain, wound infection, painful urination.
• Psychological signs: Postpartum depression/anxiety, suicidal thoughts, and breastfeeding concerns/difficulties.

Postpartum Follow-up After Discharge

• Routine checkups: Mother (6-week visit, or 2 weeks for C-section/complications), newborn (3-5 days after birth or 48-72 hours).
• Home visits: Community health nurses assess mother, baby, and environment and provide education to support breastfeeding.
• Telephone follow-up: Postpartum calls for health checks, teaching, and support, Outcomes: Better breastfeeding, reduced depression, higher satisfaction
• Warm Lines/Consultation Services: Non-crisis support for feeding, crying, etc.
• Support groups: Peer connections.
• Community Resources: Referrals to local/national services tailored to family needs.

Summary, Education/Anticipatory Guidance

• Specific patient education points (breastfeeding, newborn feeding, normal physiological changes, voiding/bowel patterns, self-care, pain management, recognizing symptoms needing follow-up).
• Review of discharge medication and community resources.
• Discussion of postpartum blues/perinatal depression.
• Information on family planning and sex education/concerns.
• Information on who the primary health care provider is and contact information.
• Includes information on rubella status, MMR vaccination dates, rh immune globulin, and other relevant tests/procedures.

Test your knowledge on the normal parameters and potential complications during postpartum assessments. This quiz covers vital signs, breast firmness, and other key indicators relevant to postpartum care. Perfect for nursing students and healthcare professionals.