Postnatal care Flashcards
Describe the star day?
The day of birth where you do observations on mum and do the baby check
What do you do on day 1?
Observations, mum and baby check
What do you do on day 2?
Observations, mum and baby check
What do you do on day 3?
Baby’s weight if breastfed
What do you do on day 5?
Mum and baby check, baby weight and new born blood spot is offered
What do you do on day 10?
Mum and baby check, baby weight, hand over to health visitor is all okay
Why is emotional and psychological wellbeing important?
Midwives role is to provide support. Birth debrief important. Consider; baby blues, sociological aspects, culture aspects. Don’t forget the partner!
Maternal vital signs pulse range
(60) 70 - 80 (100) bpm
what can pulse that is out-with the normal range indicate?
stress, pain, infection, haemorrhage
Maternal vital signs blood pressure range
(140) 100/60 (90) mmHg
What can blood pressure outwith the normal range indicate?
stress, (increase)
haemorrhage (decrease)
Maternal vital signs temperature range
35.8- 37.3
What can a raised temp mean?
infection
Maternal vital signs respiratory rate
12- 20 times a min
What can an increased respiration rate indicate?
pain, increase
anaemia (shortness increase)
infection increase
What should you be doing in a postnatal visit looking at the breasts?
Ask how breasts feel: soft, full, painful, nipple pain, bleeding
Full milk supply usually arrives by 3 days postnatal (same time as baby blues)
Offer advice and support regarding common breast problems: bleeding, engorgement, mastitis, thrush
What should you expect from the uterus post natal?
Gradual reduction in size of uterus until no longer palpable
After pains
What is lochia?
Blood produces immediately after birth
As involution continues, stale blood, lanugo, vernix, decidua exit
The shade and density individual to women
Assessment should include asking is lochia is more or less, lighter or darker, any clots, any nasty smells, how often she changes her pad
Perineal assessment
injury to the perineum affects most women
can have long term social, physchological and physical health consequences
pain/discomfort can disrupt breastfeeding
physical examination only if indicated or requested
To alleviate pain or discomfort, oral analgesia , localised cooling (icepacks)
Cesarean section wound assessment
ask mum how it feels
check the wound is healing, clean and dry?
Redness inflammation, seeping, bruising
may need to remove dressing and stitches
What should you be vigilant for in wounds?
fever, raised temperature, shivering, pain, offensive blood loss, heavy blood loss
bladder and bowels
Minor changes to bladder and bowel habits resolve with first few days
Give reassurance about first bowel movement
urinary and bowel symptoms such as incontinence should be investigated
What should you be vigilant for in bladder and bowels?
Burning, stinging, frequency in urination, raised temp,
UTI might need treated
Legs
ask about comfort of the legs, especially the calf
Observe any oedema to the legs- an be normal as the body gets rid of extra-circulating fluid
encourage mobility
raise legs
vigilant legs
any unilateral (one sided) called oedema
stiffness/ pain or red raised area
breathless ness
could be a blood clot in the legs deep vein thrombosis (DVT) or pulmonary embolism (PE)
Record keeping
Clear, accurate records of observations should be documented
key tool in safeguarding the health and wellbeing of mother and baby
Health promotion in post natal care
pelvic floor exercised for long term health
exercise
contraception
relationship building with baby
What is looked at in the first examination after birth -24 hours
skin head face neck chest and abdomen anus genitalia limbs, hands and feet spine
What does the detailed examination of a new born entail?
NIPE
Neonatal and infant physical examination
Performed by paediatrician or trained midwife with 72 hours after birth
looking for signs of congenital heart disease, cataracts, dysplasia of the hips and undescended testes
Heart, eyes, hips, genitalia, neurological reflexes
What is in the daily examination of the new born?
baby appears well good muscle tone clear skin cries lustily feeds well keeps warm sleeps wet and dirty nappies
Breathing in baby
Diaphragm, chest and abdomen rise and fall is synchrony
Explain to parents babies breathing is erratic, shallow and irregular with brief 10-15 second period of apnoea
RR 30-60 in one minute normal, check RR by placing hand on abdomen
Breathe through nose
Temp in baby
babies find it difficult to maintain their temperature as they adapt to inter uterine life
Observe temperature by placing a hand on the abdomen or using thermometer 36.5-37.5
Discuss with parents optimal room temp of 18-21
clothing appropriate to temp
Skin baby
babys skin should be insoected for rashes, seotic spots, excoriation (damage)
colour of the skin, normal for ethnicity, no yellowing
seborrhoeic dermatitis (cradle cap) erythema toxicum (e-tox) Necrotising umbilical stump Milia (milk spots) Vernix
wet and dirty nappies
breastfeeding babies may only pass urine once a day for the first few days
babies that are well will pass stool every day
stools will change in colour
What other things could you mention in a postnatal visit?
postnatal support groups breastfeeding support groups safe sleeping -reduce risks of SIDS child safety- smoking, car seat safety, pets in house, keeping calm when baby is crying child protection- raise concerns
