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Nursing Care in the Postpartum Period Nursing Care in the Postpartum Period

Postdelivery Assessment • Greatest risk for postpartum complications is during the first 24 hours Postdelivery Assessment • Greatest risk for postpartum complications is during the first 24 hours after delivery • Identification of potential problems; immediate intervention; reassessment

 • Assessment includes: – Condition of uterus – Amount of bleeding – Bladder • Assessment includes: – Condition of uterus – Amount of bleeding – Bladder & voiding – Vital Signs – Perineum

 • Fundus = Palpated to assess firm & well contracted • Bleeding = • Fundus = Palpated to assess firm & well contracted • Bleeding = Assess drainage on pad • Pulse & Bp = Assess cardiovascular function • Perineum = Assess for signs of hematoma, lacerations, & edema

 • Assessments are q 15 minutes for the first hour post delivery • • Assessments are q 15 minutes for the first hour post delivery • Temperature is taken at the end of first hour • Transferred to Postpartum Unit when stable

Admission to Postpartum Unit • Report between L&D Nurse & PP Nurse • Preparations Admission to Postpartum Unit • Report between L&D Nurse & PP Nurse • Preparations made for receiving the Mother such as: – Room Ready – IV Pole – Admission Assessment – Vital Signs Equipment

Assessment • Assessment is immediately upon arrival to the PP Unit – Complete Assessment Assessment • Assessment is immediately upon arrival to the PP Unit – Complete Assessment – BUBBLE HE & VS included • Reassessment q Hour x 4 Hours – Uterus, Lochia, Bladder, Bp & Pulse – Abnormal Findings

Vital Signs • Elevated Temperature – Normal finding for first 24 hours – Sign Vital Signs • Elevated Temperature – Normal finding for first 24 hours – Sign of Dehydration – Sign of Infection • Bradycardia – Normal Finding

 • Tachycardia – Infection – Hemorrhage – Pain – Anxiety • Lowered Blood • Tachycardia – Infection – Hemorrhage – Pain – Anxiety • Lowered Blood Pressure – Orthostatic Hypotension – Shock

 • Elevated Blood Pressure – Pregnancy-induced Hypertension • Elevated Blood Pressure – Pregnancy-induced Hypertension

Breasts • • Soft, firm, can be lumpy Secretion of Colostrum Engorgement Assessment of: Breasts • • Soft, firm, can be lumpy Secretion of Colostrum Engorgement Assessment of: – Breasts – Nipples

Uterus • Process of Involution • Height – First Day = at Umbilicus – Uterus • Process of Involution • Height – First Day = at Umbilicus – Decreases 1 FB per Day • Consistency – Firm, Round, Smooth; Not “Boggy” • Location – Midline

Bladder • Often times will be catheterized in L&D post delivery • Assess for Bladder • Often times will be catheterized in L&D post delivery • Assess for Bladder Distention: – Uterine Atony – UTI • Recatheterize in 6 hours if not voided (Dr. ) • Measure Urine Output

Bowel • • Assessment for Bowel Sounds Complaints of Gas Pains Usually has Stool Bowel • • Assessment for Bowel Sounds Complaints of Gas Pains Usually has Stool 2 -3 days post delivery May need medication for gas pains, laxatives, stool softeners, enemas

Lochia • Amount – Estimate of Drainage – Number of Pads • Color – Lochia • Amount – Estimate of Drainage – Number of Pads • Color – Rubra – Serosa – Alba

Episiotomy • Assessment for: – Hematomas – Ecchymosis – Edema – Erythema – Intact Episiotomy • Assessment for: – Hematomas – Ecchymosis – Edema – Erythema – Intact Suture Line – Signs of Infection

Homan’s Sign • Assessment for Thrombophlebitis – Swelling – Reddness – Warmth – Pain Homan’s Sign • Assessment for Thrombophlebitis – Swelling – Reddness – Warmth – Pain • Unilateral Findings • C/S Mother at Higher Risk

Emotional Status • Can have Mood Swings • Observing Bonding Behavior & Ability to Emotional Status • Can have Mood Swings • Observing Bonding Behavior & Ability to give Infant Care – Rubin’s Phases – En face – Engrossment

Patient Post Epidural • Assessment of Lower Extremities for: – Sensation – Movement • Patient Post Epidural • Assessment of Lower Extremities for: – Sensation – Movement • Remains on Bedrest

Post C/S • Additional Assessment: – Incision – Fluid Intake – Bladder & Bowel Post C/S • Additional Assessment: – Incision – Fluid Intake – Bladder & Bowel – Ambulation/Orthostatic Hypotention – Thrombophlebitis

Documentation of Findings • Assessment Checklist Form • Graphic Sheet • Narrative Notes – Documentation of Findings • Assessment Checklist Form • Graphic Sheet • Narrative Notes – Admission – Daily

Nursing Diagnoses • Throughout the chapter • NCP Nursing Diagnoses • Throughout the chapter • NCP

Interventions • Prevention of Complications • Reduce Discomfort • ADL – Nutrition – Rest Interventions • Prevention of Complications • Reduce Discomfort • ADL – Nutrition – Rest & Sleep – Ambulation – Bathing – Kegel Exercises

Predischarge • Rubella Vaccine – Titer – Hypersensitivity to eggs – Administration of Vaccine Predischarge • Rubella Vaccine – Titer – Hypersensitivity to eggs – Administration of Vaccine – Patient Teaching • Rho Immune Globulin – Criteria – Administration of Rhogam

Discharge • Instructions for Mother & Infant Care • Next Appointment • Referrals Discharge • Instructions for Mother & Infant Care • Next Appointment • Referrals