Postpartum Physiological Assessments

Postpartum Physiological Assessments and Nursing Care

• Assessment Frequency: Initial 15 minutes for 1 hour, then 30 minutes for 1 hour, 4 hours for 22 hours, then every shift.

• Hemorrhage Assessments: Include vital signs (temperature, blood pressure, heart rate, respiratory rate, SpO2, pain), lochia assessment (color, amount, odor), and fundus evaluation (void, supine position, height, tone, location). Critical findings include purulent discharge, bleeding exceeding 500 ml (vaginal birth) or 1000 ml (C-section), boggy or deviated fundus, and preeclampsia/eclampsia, HELLP (DIC) symptoms.

• Hemorrhage Management: A firm, midline fundus indicates good uterine involution. Primary PPH (first 24 hours) can be caused by uterine atony (boggy, elevated, deviated fundus) or lacerations/hematomas. Secondary PPH (after 24 hours) often involves retained placental fragments. Treatment includes voiding, fundus massage, oxytocin, and frequent reassessment.

• Postpartum Infection: Assess for breast mastitis (redness, pain, warmth, fever) and other infections like metritis (retained tissue, odor, pain, fever) or wound infections (incisions, lacerations). Treatment depends on the infection, including antibiotics (e.g., Keflex), pain relievers, and supportive care. UTI symptoms should be monitored, including pyelonephritis (kidney pain).

• Other Postpartum Complications: Consider DIC, anaphylaxis, VTE/DVT/PE as possible complications requiring prompt evaluation.

Psychological Disorders

• Postpartum Blues: Characterized by symptoms typically appearing within a few days or first two weeks after childbirth, individuals maintain adequate self-care and ADLs.

• Postpartum Depression (PPD): A more severe condition occurring within the first year postpartum. Individuals may experience changes in appetite, sleep, weight, and self-care, and are unable to perform all ADLs. Psychosis, self-harm, and/or baby harm may be involved.

• Postpartum Psychosis: This is a critical condition (can present as early as day 3) requiring immediate admission and supervision due to risk of self-harm, harm to baby, or inability to perform ADLs.

• Paternal Postpartum Depression: May exist and related to potential low testosterone; necessitates a provider visit, therapy, or hormone replacement medication.

Discharge Teaching

• Normal vs. Abnormal Findings: Postpartum teaching includes expected lochia patterns (rubra, alba, serosa), uterine involution, and afterpains. Rh-negative mothers should receive RhoGAM.

• Recognizing Symptoms of PPD: Educating on recognizing and reporting symptoms of postpartum depression.

• Addressing Complications: Provide education on the risks of PPH, infection, preeclampsia/HELLP/eclampsia, and the importance of appropriate nutritional, lifestyle and activity guidance.

Neonatal Assessment

• Assessment Guidelines: Evaluate the newborn's tone (flexed), head (fontanels, structures), chest (respirations, pulse), abdomen, genitalia, back, limbs, skin (color, lanugo, vernix), and reflexes. Acrocyanosis is normal in some newborns.

• Critical Findings: Pathological jaundice (within first 24 hours), pallor or cyanosis; hypotonia or seizures; bulging/sunken fontanels; breathing abnormalities (see-saw, retractions), tachycardia/bradycardia, tachypnea/bradynea, distension, poor bowel/urinary habits, unusual stools, abnormal vital signs (temperature, heart rate, respiratory rate, SpO2), rapid glucose response (<15 seconds critical) are all cause for immediate attention.

• Common Disorders: Address potential neonatal conditions including RDS/BPD,PDA,ROP, GBS infections, jaundice, PKU, NEC, and meconium aspiration syndrome.

Neonatal Teaching

• Abusive Head Trauma: Teach safe baby-care strategies, promote support systems for parents, and emphasize seeking professional help if needed.

• Circumcision and Cord Care: Provide guidelines for preventing infection, pain management, and wound monitoring. Establish routine cord care protocols.

• SIDS Prevention: Educate on safe sleep practices and environmental risk factors.

• Bathing, Diapering, Feeding: Teach hygiene techniques, safe environment, and appropriate feeding methods.

• Other topics: Address LGBTQIA+, STI screening, vaginal infections (bacterial/yeast), cancer screenings (cervical, breast, endometrial), surgeries (e.g., hysterectomy, fibroids, fistulas) , PCOS, menopause, and IPV.

This quiz focuses on the important aspects of postpartum physiological assessments and nursing care. It covers assessment frequencies, hemorrhage evaluations, and management techniques crucial for postpartum care. Understanding these elements is essential for ensuring patient safety and effective recovery.