Postpartum Nursing Care Assessments

Postpartum Physiological Assessments and Nursing Care

• Assessment Frequency: Initial assessments are 15 minutes for the first hour, then 30 minutes for the next hour and 4 hours for the next 22 hours. Thereafter, assessments occur every shift.

• Hemorrhage Assessment: Regularly assess for hemorrhage, including potential complications like DIC, AFE, PE. Monitor vital signs (temperature, blood pressure, heart rate, respiratory rate, SpO2, pain). Evaluate lochia (color, amount, odor). Assess the fundus (position, height, tone - firm or boggy - and location). Perform a head-to-toe assessment (BUBBLE-HE, REEDA).

• Critical Findings (Hemorrhage): Purulent discharge (infection), bleeding >500 mL after vaginal birth (>1000 mL after C-section), boggy or deviated fundus, hypotension, tachycardia, tachypnea, dizziness, pale, cool, clammy skin.

• Critical Findings (Preeclampsia/Eclampsia, HELLP): Hypertension (above 160/100), headache, nausea, altered mental status/seizures, blurred vision, RUQ pain, edema, bleeding (internal and external petechiae, purpura). Observe for a sudden drop in oxygen saturation.

• Fundal Assessments and Management: A firm, midline fundus indicates proper involution. A boggy or deviated fundus indicates uterine atony (often requiring voiding, massage, oxytocin administration, and ongoing reassessment every 30 minutes).

• Primary vs. Secondary Postpartum Hemorrhage (PPH): Primary PPH occurs within the first 24 hours, usually due to uterine atony (a boggy, elevated, or displaced fundus). Secondary PPH happens after 24 hours, often resulting from retained placental fragments/tissue or subinvolution.

Postpartum Infections

• Breast Infection (Mastitis): Assess for redness, pain, warmth, fever, headache, and flu-like symptoms in the breast. Encourage breastfeeding, and apply warm compresses. Seek medical attention if pus is present (discard milk). Use antibiotics (e.g., Keflex) and pain relievers as directed.

• Metritis: Occurs more than 24 hours after delivery. Signs include odor, pain, and fever. Potential causes - retained tissue, stillbirth, intercourse/objects, STIs.

• Incision/Laceration Infection: Infection risk factors include C-sections, lacerations, poor wound care, underlying conditions like diabetes or immunocompromise, and obesity/hypertension.

• Urinary Tract Infections (UTIs): Causes include anesthesia, Foley catheters, vaginal births, urinary retention, and peri/hygiene issues. A complication, pyelonephritis (kidney infection), presents with flank pain.

Postpartum Complications and Psychological Disorders

• Disseminated Intravascular Coagulation (DIC): A serious complication linked to preeclampsia and HELLP syndrome.

• Anaphylaxis: Could pose a risk with sudden drops in oxygen saturation.

• Venous Thromboembolism (VTE) and Deep Vein Thrombosis (DVT): Potential complications related to blood clots.

• Postpartum Blues/Baby Blues: Transient emotional distress within the first few days/weeks postpartum, affecting ADLs.

• Postpartum Depression (MDD): A more serious and prolonged condition affecting ADLs within the first year postpartum. Symptoms include changes in sleep, appetite, weight, self-care, thoughts of self-harm or harming the baby. Seek immediate medical attention or ED visit.

• Postpartum Psychosis: Characterized by severe disruptions in thinking and mood, sometimes manifesting as mania. Requires immediate hospitalization to protect both the mother and infant.

• Paternal Postpartum Depression: May be related to low testosterone levels. Referral to a healthcare provider, therapy, or hormone replacement therapy is recommended.

Neonatal Assessment and Care

• Normal Neonatal Assessment: Assess tone (flexed), head (fontanels, symmetry, eyes/ears), chest (respirations and heart rate), abdomen, genitalia, back, limbs, and skin. Document color, lanugo, vernix, birthmarks, injuries, and vascular spots. Evaluate all reflexes carefully.

• Critical Neonatal Findings: Jaundice (within 24 hours is considered pathologic), pallor, cyanosis, hypotonia, seizures, bulging/sunken fontanels, respiratory distress, decreased bowel sounds, lack of meconium and/or urine production, abnormalities in vital signs, critical glucose levels.

• Respiratory Distress Syndrome (RDS), Bronchopulmonary Dysplasia (BPD), Patent Ductus Arteriosus (PDA), Retinopathy of Prematurity (ROP), Infections, Jaundice: Discuss these specific conditions, their causes, and potential treatments.

• Meconium Aspiration Syndrome: Recognize signs of stress and post-term births, suctioning, resuscitation, and provider assistance are required.

• Necrotizing Enterocolitis (NEC): A serious intestinal condition, especially in premature infants, often requiring surgical intervention and monitoring.

Discharge Teaching, Transition, and Loss

• Discharge Teaching: Explain the normal changes and abnormal findings related to postpartum recovery, lochia, involution, afterpains, RhoGAM, postpartum depression, and infection. Offer guidance on diet, exercise, sleep, smoking cessation, sexual activity, and contraception.

• Transition to Parenthood: Ensure the parent's needs are met before teaching infant care. Assess understanding and provide support and observation to facilitate bonding.

• Loss: Offer support and strategies for parents dealing with grief or loss in a healthy way, avoiding retraumatization.

Women's Health and Other Issues

• LGBTQIA+ Care: Assess and support inclusivity for LGBTQIA+ patients, using appropriate language and pronouns. Alter care as needed.

• Sexually Transmitted Infections (STIs): Educate regarding potential transmission methods and the importance of testing and reporting.

• Vaginitis: Differentiate between bacterial and yeast infections, and outline appropriate treatment using medications like Metronidazole (Flagyl) or Miconazole (Monistat).

• Cancer Screening: Guidance on cervical (PAP smear), breast (mammography), and endometrial screening.

• Surgical Procedures: Post-operative care for fibroid removal, hysterectomy, and fistula repair, to help with complications.

• PCOS, Menopause, and IPV: Discuss potential complications and treatment strategies. Increased awareness and support for patients facing possible IPV.

This quiz covers the essential physiological assessments and nursing care required during the postpartum period. Focus on the frequency of assessments, critical findings for hemorrhage, and monitoring parameters for conditions like preeclampsia. Evaluate your understanding of the key assessments necessary for ensuring maternal safety and well-being.