Postnatal Assessment: Signs, Symptoms, and Nursing Care PDF

Here is the transcription of the document in a structured markdown format. # POSTNATAL ASSESSMENT BY -TRIPTI ## INTRODUCTION Puerperium is the period following childbirth during which the body tissues, specially the pelvic organs revert back approximately to the pre-pregnant state both anatomical...

Here is the transcription of the document in a structured markdown format. # POSTNATAL ASSESSMENT BY -TRIPTI ## INTRODUCTION Puerperium is the period following childbirth during which the body tissues, specially the pelvic organs revert back approximately to the pre-pregnant state both anatomically and physiologically. ## DEFINITION **According to D. C. Dutta** Postnatal care includes systematic examination of the mother and baby and appropriate advice given to mother during post-partum period. **According to Nadine M. Jacobson** Postpartum care encompasses management of the mother, newborn, and infant during the postpartum period. The period usually is considered to be the first few days after delivery, but technically it includes the six week period after childbirth up to the mother's postpartum check-up with her health care provider. ## HISTORY TAKING * Identification data * Present obstetric history- nausea, vaginal bleeding, urin frequency. * Past obstetric history-no.of child, complication of previous preg, miscarriage * Family history * Medical / surgical history * Personal history * Menstrual history * Contraception * Psychological ## PHYSICAL EXAMINATION * General examination * Mental status * Skin condition * Head * Eyes * Ear * Nose * Mouth, pharynx and throat * Neck chest * Breast * Abdomen * Perineum, lochia, cervix, vagina, bladder, bowel * Extremities * Nails # POSTNATAL MANAGEMENT ### BUBBLEHE The nurse should follow an organised method when examining the post partum client, which provides a consistent, quality approach to nursing care. The acronyms, “BUBBLEHE” can serve a helpful reminder of the elements in a postpartum assessment. The image shows the acronym BUBBLEHE, with each letter representing an area of assessment: * BREAST * UTERUS * BLADDER * EMOTIONAL STATUS * BOWEL * EPISIOTOMY * HOMAN'S SIGN * LOCHIA ## BUBBLEHE Assessment * Breasts - Soft, filling, firm, Nipples * Uterus — consistency, position, height * Bladder - voiding pattern * Bowels - bowel sounds, hemorrhoids, * Lochia - type, amt, clots, odor * Episiotomy- laceration, bruising, swelling * Homan sign — present or not * Emotional status — bonding, blues ### Breast * On palpation after delivery, breast usually are enlarged, soft and warm and contain only small amount of colostrums. * The mother may experience breast engorgement, which may begin as a tingling sensation in her breast, 2-4 days after delivery * Milk is released through infant sucking, manual expression, or pumping * Analgesic given if breast pain occur. * Provide cabbage leaves to reduce pain &swelling. There is an illustration of two breasts, one labeled "Not Engorged" and the other "Engorged." * **Not Engorged:** The normal lactating breast is softer and mom is comfortable * **Engorged:** The engorged breast is full, hard and sore. The pressure can cause damage to the cells Illustration indicating what Breast Massage can help with: * Relieves Breast Tenderness * Improves Skin Tone * Increases Breast Milk Production * Relieves Engorgement * Unblocks Plugged Milk Glands There is an image of placing cabbage leaves inside a bra. ### Uterus * Size, Weight, location and firmness * Immediately after delivery, the uterus begins the process of involution or reduction in size. * The uterus weight about 100 g, measuring. * At the end of 6th week weighs 50-100g. * A bulky uterus may indicate the presence of blood clots or retained placental beats or also due to a full rectum.. * Tenderness of the uterus suggest infection. * Normally uterus should be contracted, hard and not painful if touched. the height of uterus should be measured * After the 1st postpartum day, the fundus involute 1-2 cm. Per day. ### Management of Bleeding * After delivery of the placenta 20 to 30 units of oxytocin often is added to the intravenous solution . * Or can administering oxytocin intra muscular 10 units . * Initiating early breast feeding or performing nipple stimulation is employed. * If remains boggy than despite massage and oxytocin administration or if bleeding continue than pharmacological agent start :- Methargin (0.25 mg)IM * Prostaglandin which can be given when methargin can not stop bleeding or contraindicated. ### Uterine pain * The key to effective relief from after birth pain is an empty bladder. * Once the bladder is empty, the woman may lie prone with a pillow under her lower abdomen , which keeps it contracted and thus eliminate after birth pain. * Analgesic can be effective. ### Bladder * In the immediate postpartum period, the bladder is congested, edematous and hypotonic from the effect of labour. * After delivery, the client should urinate within 4 hours, at least 300 ml, with completely emptying the bladder * After delivery within 24 hour cause diuresis up to 3000 ml per day occurs in the first 2 to 3 days. * Should be noted and informed to the physician * Straight catheterization must be done. ### Bowels * Following vaginal delivery, bowel movement normally occurs after 2 to 3 days. when gastric motility does not return by 2-3 days, constipation occur. * The client should be encouraged to drink should be 6 to 8 glasses of fluid daily, eat a high fiber diet (whole grains, legumes, vegetable and fruits) * Sitz bath * Enema may be given * Stool softener dulcolax, topical ointment etc. ### Lochia * When the bleeding is heavy, ensure that the source of bleeding, it may be laceration. * Saturation of vaginal pad with in 15- 30 min. * CBC may indicate 1.0 to 1.5 g/dl decrease in Hb level. There is an illustration of the different blood volumes on a sanitary pad. * **Scant:** <2.5-cm (1-inch) stain * **Light:** 2.5- to 10-cm (1- to 4-inch) stain * **Moderate:** 10- to 15-cm (4- to 6-inch) stain * **Heavy:** Saturated in 1 hour ### Episiotomy * An episiotomy is the surgical incision made to enlarge the vaginal opening for delivery of the baby's head. * Care of the vulva includes applying ice packs to the perineum for the first 24 hour. * Should not be applied to the directly to the skin, should be wrapped with an absorbent disposable type of covering * After the first 24 hour following delivery. a sitz bath with warm water may be used. * The client should be taught perineal hygiene. including daily wash with warm water and mild soap. * The perineum should be cleaned after each voiding. * Perineal pad frequently changes after each voiding, removing pad from front to back, and hand washing will help decrease the risk of infection. * To perform perineal exercises such as kegel exercise . There is an illustration titled "What is it?" describing Kegels and their benefits, including strengthening pelvic floor muscles, and preventing incontinence. Another image shows a woman performing Kegel exercises, with the title Kegels & Birth indicating the importance of kegels for preparation for birth. ### Homan's sign * Assessment of homan's sign must be done for all postpartum clients, to check for presence of thrombophlebitis. * Should be perform leg exercise, to teach the client to flex and extends the both leg and feet alternatively. * Keeping the leg uncrossed while seated. * Not flexing the leg at groin * Resting the leg without putting pressure on the back of the knees. * Wearing support hose and antiembolism stocking. * Padding pressure points during lithotomy position Images show the performance of the Homan's sign test and leg exercises. ### Emotional status * The immediate postpartum period is an emotional roller coaster, and almost any emotion may be observed. * They may also be exhausted and need sleep and rest to restore their bodies to health. * In this "taking in phase" mother wish to meet their own rest and nutritional needs before focusing their energy on newborns. * They want to relieve the experience by talking about the process of labour and delivery. ### Guidance and instruction in preparation for home care :- Following normal delivery, mothers are discharged on the 2nd and 3rd post partum day, the midwife must appraise the mother needs for instruction and guidance for the care of: * self * baby * self in relations to others ### SELF :- * Measure to improve her general health. * Perineal care * Breast care * Care of breast during breast engorgement * Postnatal exercises * Gradual return to day to day activities * Return for 6th week post partum check up. ### BABY :- * Breastfeeding * If being bottle feed; Care and preparation of bottles and nipples or container * Hold the baby during feeding * Baby bathing and dressing including care of genital area * Cord care * Prevention and treatment for diaper rash. * Checking babies temperature. * Recognizing baby's needs * Check-up and immunization for the baby. ### SELF IN RELATION TO OTHERS * Sibling and husband. * Family planning * Resumption of sexual intercourse after six weeks, ### Myths and fact related to postnatal diet 1. Myths:-recommendation of eating bland food like khichdi during postpartum period. Fact:- bland food like khichdi, rice etc are easily digested as well as the it provides immediate energy to the mother for day to day activities. 2. myths:-eating extra ghee(butter)helps recover faster, strengthens joints. fact:-a mother's baby already has enough fat reserves that it gathered during pregnancy. increase the intake of ghee will lead to weight gain in the postpartum period. instead of eating ghee laden dry fruits laddoos, drinking a glass of milk dry fruits in it. 3. Myths:- more the milk the mother drinks, more the milk she will make Fact:- there is no scientific evidence confirming the above claim. instead a balanced diet of rich in protein, minerals and vita. will help increase breast milk supply. 4. myth:-avoid eating spicy food. fact:- even though spicy food does affect the flavor of breast milk slightly; unless the baby seems uncomfortable or fussy after a feed, it's ok to eat spicy food. 5. Myth: drinking carom(ajwain) help to digest and speed up recovery. fact:-even though there is no scientific evidence in support of the claim, there is no harm, observed in having it. provided you have a nutritious diet along with this. 6. Myth: breastfeeding moms can't have their morning coffee. Fact: coffee contains caffeine, which if limited moderate amounts has been proven to be harmful, even though over dose of caffeine may cause related issues. 7. myth:Skip the "gassy "food like broccoli, cabbage etc. fact: cabbage, broccoli and many other vegetables are super foods and a mother needs all the super nutrients she can get as her body works to produce milk for the baby. 8. myth:breastfeeding moms require special vitamin supplements. Fact: the best source of nutrient for the baby mother is a varied. 9. myth: eating yogurt by nursing mother causes infant diarrhea indigestion and gas. Fact: yogurt is a known pro-biotic and source of calcium and it is condition like, diarrhea, indigestion and acidity Thank you