Postpartum Assessment and Care PDF

The Dreaded Page 1 Postpartum Assessment Postpartum Points Assessment and Care...

The Dreaded Page 1 Postpartum Assessment Postpartum Points Assessment and Care Rebecca M. Thomas, RN-DNP, WHNP-BC Family-centered maternity care is vital in the postpartum period. The postpartum period begins after delivery, extending to 3 months after birth. BUBBLEEE!!! Unlike many units, the approach to care is “wellness-oriented”. Most women Every student dreads their and babies are generally healthy, remaining in the hospital for 1-2 days for a first postpartum vaginal birth and 2-3 days for a cesarean birth. It is during this time that both assessment. Knowing what evaluation of needs and patient education are an essential part of the nurse’s to look for will put your role. This includes involving the whole family in care of their new member. (Perry, Hockenberry, Lowdermilk, & Wilson, 2014) mind at ease! Breasts: Looking at Lochia… Consistency (soft, firm, Color- RUBRA-dark red (1-3 days) SEROSA-pink (4- filling, full, engorged) 10 days) ALBA-yellow/white (10 days to 6 wks.) Nipples (intact, cracked/bleeding, Odor- fleshy (normal); foul (sign of infection) erect, inverted) Consistency- clots present? How large? How many? Uterus: Position (midline?) Amount- scant/small, medium/mod, large/heavy* Height (U,-1,-2,-3…) *Soaking more than 1 pad an hour is TOO MUCH! Consistency (firm, boggy) Bowels: Postpartum PAIN Breast vs. Bottle: The Great Bowel sounds x4 When our patients are in pain, many Debate! BM or passing gas of us want to jump straight to Extensive evidence exists concerning Hemorrhoids medication to solve the problem. the health benefits of breastfeeding, Bladder: While NSAIDs, narcotics, and topical for both mom and baby. This Distended? Voiding? analgesics are certainly helpful, there includes, but is not limited to: Foley? Infant are many forms of non-pharmacologic Enhanced immune system Signs of UTI pain management the nurse can Fewer digestive issues Lochia: employ (independent interventions): Lowered rates of obesity Color, amount, odor Ice (perineal pain, edema) Mother consistency- clots? Sitz baths (epis/lacs) Decreased postpartum bleeding Episiotomy/Laceration: Repositioning (uterine or Reduced risk of GYN cancers Degree? Repair? perineal pain) Unique bonding experience REEDA However, it is important to support Education (splinting, hot Extremities: your patient in the choice that best showers, ambulation) suits their personal and family needs, Edema (pitting?) whether breast or bottle feeding. DTRs Remember… Patients who are bottle feeding need Signs of DVT Every postpartum assessment begins to be taught methods of lactation Emotions: with a good, basic med-surg suppression!! Bonding/Attachment assessment (vitals, heart, lungs, and Wear supportive bra or binding Baby Blues vs. PPD abdomen). Apply ice packs or cabbage leaves No stimulation of breasts  Page 2 Postpartum Points Assessment and Care Rebecca M. Thomas, RN-DNP, WHNP-BC Help! My patient is bleeding to death! ATTENTION: The Importance of VOIDING & AMBULATION Postpartum hemorrhage is Two of the most neglected, yet most essential, areas of postpartum care defined as a loss of 500ml > are voiding and ambulation. It is assumed that because patients on an blood after vaginal birth, obstetrics unit are generally young and healthy, they do not need assistance or 1000ml> after cesarean, or a encouragement. Remember, when patients are tired, in pain, or busy with a 10% change in hematocrit new little one, they are unlikely to void and ambulate as often as they should. from baseline. Symptoms Why are these so important? include persistent significant Voiding: An over-distended bladder can cause uterine atony, leading to bleeding (perineal pad soaked excessive bleeding. The patient should void within 6-8 hours after birth. Key within 15 minutes), point to remember: a uterus that is displaced from midline and often weakness/dizziness, anxiety, accompanies increased bleeding signals FULL BLADDER. ashen or cool/ clammy skin, Ambulation: Early ambulation is associated with reduced incidence of DVT, increased heart rate, and promotes the return of strength, and decreases pain by stretching muscles and decreased blood pressure. promoting gas movement. Key point to remember: Early postpartum, women Nursing Considerations may feel dizzy. Offer standby assistance until the patient is able to demonstrate the ability to ambulate on their own (Perry, et. al, 2014). Interventions for PPH, when performed quickly and Don’t Forget PERICARE! Patient Education Corner efficiently, can save a life. Always call for help, and have A major factor in the prevention of someone call the healthcare infection and promotion of comfort Postpartum Discharge Teaching provider. Most units have is good pericare. Whether it is Be culturally competent when standing orders for PPH. encouraging your patients to providing education to your These typically include the perform self-care, or assisting patients following: them after c-section, consider the Pericare, pain management, following: nutrition, lifting, exercise, family FUNDAL MASSAGE planning, and resumption of sexual Elevate legs or place Pads should be changed activity should be reviewed patient in Trendelenburg frequently When to call your doctor… Start large bore IV Use a squeeze bottle with o Fever of 100.4 or greater Administer bolus of LR or warm water to rinse after void o Soaking more than 1 pad NS and pat gently front to back per hour or foul odor Apply oxygen by non- Encourage patient to wash o Chest pain, SOB, or rebreather at 8-10 L/min hands! swelling/redness in Give uterotonic extremity medications as ordered References: o Severe headache, changes in Give blood as ordered Perry, S., Hockenberry, M., Lowdermilk, D., & vision Insert Foley catheter as Wilson, D. (2014). Maternal Child Nursing Care. o Sad, tearful, or disinterested needed (5th ed). Mosby-Elsevier: St Louis, MO. in infant care, thoughts of (Perry, et. al, 2014) hurting oneself or baby