Postpartum Assessment PDF

Routine Postpartum Assessment TABLE OF CONTENTS DEFINITION OF POSTPARTUM BUBBLELE ASSESSMENT HEALTH EDUCATION OPEN DISCUSSION WHAT IS POSTPARTUM? Postpartum (or postnatal) refers to the period after childbirth. Most often, the postpartum period is the...

Routine Postpartum Assessment TABLE OF CONTENTS DEFINITION OF POSTPARTUM BUBBLELE ASSESSMENT HEALTH EDUCATION OPEN DISCUSSION WHAT IS POSTPARTUM? Postpartum (or postnatal) refers to the period after childbirth. Most often, the postpartum period is the first six to eight weeks after delivery, or until your body returns to its pre-pregnancy state. However, the symptoms and changes during the postpartum period can last far beyond eight weeks. Major body and life changes are happening simultaneously during the postpartum period. Some changes are physical, and hormones cause some other changes. The bottom line is, giving birth is a major physical and emotional challenge. Being a caregiver and adjusting to life with an infant during the postpartum period is also incredibly demanding. BREASTS UTERUS BOWEL FUNCTION BLADDER LOCHIA EPISIOTOMY/PERINEUM LOWER EXTREMETIES EMOTIONS BREASTS The breasts are assessed for: Signs of engorgement, including fullness, around postpartum days 3 and 4 Hot, red, painful, and edematous areas, which could indicate mastitis Nipple condition and latch-on technique of mothers who are breastfeeding BREASTS Engorgement-- usually occurs 2-3 days postpartum. Palpate both breasts for engorgement/filling. Minimize palpation for bottle-feeding mother to avoid stimulation. Check nipples for pressure sores, cracks, or fissures. Evaluate whether nipples are everted, flat, or inverted. BREASTS Teach mom to: Apply warm packs or K-pad 15-20 minutes pre-nursing Try a warm shower before nursing Ice bags and/or binders for non- nursing moms Wear a supportive bra 24 hours a day for the first few days postpartum. Clean the breasts thoroughly with warm water and cloth before and after feedings UTERUS The uterus is assessed for: By approximately one hour post delivery, the fundus is firm and at the level of the umbilicus. The fundus continues to descend into the pelvis at the rate of approximately 1 cm or finger-breadth per day and should be nonpalpable by 14 days postpartum. In addition, patients are assessed for uterine cramping and treated for pain as needed. UTERUS The fundus is palpated for the following: Height-- Record finger widths above or below the umbilicus. e.g. Fundus 2/U (2 fingerbreadths above the umbilicus) Fundus U/2 (2 fingerbreadths below the umbilicus Fundus descends 1 fingerbreadth each day UTERUS The fundus is palpated for the following: Position-- Fundus should be midline near the umbilicus A full bladder may push the fundus to the R or L of the umbilicus and cause the pt’s flow to be heavier UTERUS The fundus is palpated for the following: Tone-- Fundus should remain firm If uterus becomes boggy gently massage the uterus to help the muscles to contract BOWEL The bowel is assessed for: Bowel sounds Return of bowel function Flatus Color and consistency of stool Prescribed stool softeners or laxatives BOWEL Assess for presence of BS q shift; palpate abdomen for distension Administer daily stool softeners per doctor’s order Avoid use of enemas and or suppositories for pts with a 3rd or 4th degree laceration. If needed, use with caution. Best for pt to have BM before discharge Often sent home with stool softeners & encouraged to eat fiber & exercise BLADDER The bladder is assessed for: Return of urination, which should occur within six to eight hours of delivery For approximately 8 hours after delivery, amount of urine at each void. Signs and symptoms of a urinary tract infection (UTI) The bladder should be nonpalpable above the symphysis pubis Patients are encouraged to drink adequate fluid each day and to report signs and symptoms of a urinary tract infection, including frequency, urgency, dysuria, and hematuria. LOCHIA Lochia is the vaginal discharge you have after a vaginal delivery. It has a stale, musty odor like menstrual discharge and it consists of blood, mucus, uterine tissue and other materials from your uterus. Lochia is heavy at first but gradually subsides to a lighter flow until it goes away. This can last for a few weeks. Lochia is a normal part of the postpartum healing process and doesn’t usually cause complications. LOCHIA RUBRA 1st stage of lochia, expect: Dark or bright red blood Flows like a heavy period Mild, period-like cramping Small clots are normal From birth until 3-4 days postpartum Lasts 3-4 days LOCHIA SEROSA 2nd stage of lochia, expect: Pinkish brown discharge that’s less bloody and more watery Moderate flow Little to no clots Lasts 4-12 days LOCHIA ALBA 3rd stage of lochia, expect: Yellowish-white discharge Little to no blood Light flow or spotting No clots Lasts from 12 days to 6 weeks LOCHIA Saturating one pad in less than an hour, a constant trickle of lochia, or the presence of large (i.e., golf-ball sized) blood clots is indicative of more serious complications and should be investigated immediately. A significant amount of lochia despite a firm fundus may indicate a laceration in the birth canal, which should be addressed immediately. PERINEUM (EPISIOTOMY) The acronym REEDA is often used to assess an episiotomy or laceration of the perineum. REEDA stands for: Redness Edema Ecchymosis Discharge Approximation PERINEUM (EPISIOTOMY) Redness is considered normal with episiotomies and lacerations; however, if there is significant pain present, further assessment is necessary. The use of ice packs during the immediate postpartum period is generally indicated. There should be an absence of discharge from the episiotomy or laceration, and the wound edges should be well approximated. Perineal pain must be assessed and treated. Kegel exercises LOWER EXTREMETIES Deep Vein Thrombosis (DVT) -A deep vein thrombosis (DVT) is a blood clot that forms in a deep vein of the leg, calf or pelvis. Women have a higher risk for DVT during pregnancy, delivery, and for about 6 to 8 weeks after giving birth. This is because pregnancy raises the pressure in the veins in your legs and pelvis. EMOTIONS Emotions are an essential element of the postpartum assessment. Postpartum women typically exhibit symptoms of the “baby blues” or “postpartum blues,” demonstrated by tearfulness, irritability, and sometimes insomnia. The postpartum blues are caused by a multitude of factors, including hormonal fluctuations, physical exhaustion, and maternal role adjustment. POSTPARTUM BLUES A common transient, self-limited, mild depression that usually begins in the first week following childbirth and usually lasts no longer than 2 weeks. It does not usually affect the woman’s ability to care for her infant. ETIOLOGY: Cause is unknown. However, emotional letdown, discomfort, fatigue, anxiety and feelings of unattractiveness may contribute. POSTPARTUM BLUES SIGNS AND SYMPTOMS Insomnia Irritability Fatigue Tearfulness Mood stability Anxiety POSTPARTUM BLUES NURSING CONSIDERATIONS Acknowledge feelings and offer support. Explain that what the woman is experiencing is normal. Reassure her that the feeling will abate in less than 2 weeks. Encourage rest and time for herself. Distinguish between blues and postpartum depression or psychosis POSTPARTUM DEPRESSION Previous PPD or depression during pregnancy Hormonal fluctuations Medical problems: preexisting diabetes mellitus, anemia, or thyroid dysfunction during or after pregnancy History of depression, mental illness, or alcoholism Immaturity or low self-esteem Anger or ambivalence about pregnancy Feelings of isolation, lack of support Birth of an infant with illness or anomalies POSTPARTUM DEPRESSION Loss of interest in the surroundings Loss of usual emotional response toward her family Intense feelings of unworthiness, guilt and shame Generalized fatigue, irritability, difficulty concentrating Panic attacks and obsessive thoughts Caring for the infants in a loving manner but without feeling of pleasure or love. POSTPARTUM DEPRESSION NURSING CONSIDERATIONS Assess women for depression during pregnancy and after birth Recommend that the woman acknowledge her feelings and insist that others acknowledge them also. Emphasize the need for continued communication with the partner Explain the importance of adequate rest and sleep POSTPARTUM DEPRESSION THERAPEUTIC MANAGEMENT Encourage continued contact with other adults. Help the mother increase sensitivity to infant cues Include family members in discussions Help her identify and contact appropriate support groups. POSTPARTUM PSYCHOSIS Is a rare condition occurring within 3 months of childbirth. A history of previous postpartum psychosis or bipolar disorder increases the risk. POSTPARTUM PSYCHOSIS SIGNS AND SYMPTOMS Sleep disturbance Confusion, agitation, irritability Hallucinations, delusions and the risk that the mother may kill herself or the infant. Tearfulness, preoccupations of guilt Feelings of worthlessness, lack of appetite Delusions about the infant being dead or defective are common POSTPARTUM PSYCHOSIS THERAPEUTIC MANAGEMENT Hospitalization Supportive psychotherapy Antipsychotic or antidepressant drugs Woman must be assessed for suicide potential WRITE AN ORIGINAL STATEMENT OR INSPIRING QUOTE — Include a credit or citation