Postnatal examination Flashcards
Explain how you would approach this episode of care
Introduce yourself
Ask how blessing is doing- ask open ended questions about her health and wellbeing
Look for her verbal and non verbal indications
Ensure there are no counter indicatio for doing Exam- pain or unwell
Explain procedure and gain concent
Make sure case notes match person-name, age and check her band
What is the purpose of postnatal care
Maintain and promote maternal health and wellbeing
Detect deviations from the normal and escalate concerns to appropriate person
Give blessing info in bonding and attachment
Health and parenting advice- give her confidence
How would you prepare the space for postnatal exam
Warm, privacy ad dignity- close door, curtains and put a do not disturb sign up if possible
How would you prepare yourself and equipment needed
Wash Hands- who 5 moments and 7 steps of hand hygiene
PPH- aprons and gloves
Equipment- watch(pulse) sphygmomanometer, stethoscope, thermometer, case notes
Use doll- how would you preform exam
Open ended questions- How she’s feeling overnight and through day ( health and mood- baby blues) Give advice if mood isn’t getting better- Contact numbers
Ask about sleeping patterns- sleeps when she can (when baby is sleeping)
give advice on fatigue- sleeping, resting and relaxation
Safe use of medication- give advice on pain relief for second degree tear- if worsening give advice on infection, headaches ( sign of hypertension or preeclampsia)
Difference between postural headache- alleviated when in supine position and feet raised adn migraines
Demonstrate what observations you would take and why
Take observations- inline with local guild lines but should be at least done once everyday for the first 3 days postnatal - temperature( normal range 36- 38)BP (Compare to antenatal be and check for deviations- preeclampsia) pulse ( count for 1min- between 60-100), resps ( no effort, ribs rising on both sides- 12-18)
Record on MEWS chart- one red or two yellow if concerns
How would you assess oral intake and why is it important
Ask blessing if she’s drinking- how much and what she’s had
Advice to continue to good volumes as it helps with recovery and repair
Helps avoid constipation
Food rich in fibre - small frequent meals
Demonstrate your approach to feeding form and methods as part of postnatal exam
Support with choosing design method- Breastfeeding
Ask open ended question on how its been going- management
Ask fro her to alert midwife so we can assess her feeding and attachment - Can give hint and tips
Assets Based approach- consider her knowledge already and add to what she knows
Observation of breast- How would you undertake this
Ask blessing if we can asses her breast- sensitive to different people colouring of breast and what inflammation looks like in different skin tones
Open ended questions - pain, discomfort, tenderness
Inspect one breast at a time to look for inflammation
Give advice on worsening symptoms- infection (Mastitis- genially massage breast onwards nipple while breastfeeding, continue to feed from breast, if not working report and get treatments)
Demonstrate how you would palpate blessing fundus
Ask for consent- privacy and dignity- lower cover only to where is necessary and ask blessing to expose herself
Start with the umbilicus- side of hand, generally palpating towards until feeling the fundus, expect to feel around 2 down from umbilicus (use to being on second day)
Round, hard and firm fundus and shouldn’t be tender to touch or towards left or right
Insure blessing has been to toilet- full bladder can cause more discomfort and harder to palpate and can cause deviations
How would you asses blessings lochia- advice around prevention and monitoring in case of signs of infection
Ask blessing about her volumes of lochia- any clots or odour
Tell about the normal volumes and colour changes- starts at rubra ( red) subosa ( lighter and pinky) alba ( white and can be around 10 days)
Ask to look at pad - blessings is normal
use sanitary towels and not tampons for first few weeks postnatal to avoid any sort of infections- changing every time going to toilet ( wash hands before and after to reduce chance of infection)
No scented products but wash frequently
If any deviations fro normal and signs of infection- contact numbers
Discuss how you would inspect the perineum
Look at suture lines- ether by lying blessing round to side and lift leg or from front lifting knees up
Ensure keeping privacy and dignity roll bed sheets up as far as needed
Looking for signs of poor heeling, infection or other concerns
Blessings will be normal however advice to keep on top of medication and keep sight dry and clean
Demonstrate inspection of blessings legs
Looking for signs of oedema or varicose versions or deep vein thrombosis
Any pain or discomfort in limbs
No tenderness and compare legs
Small amount of oedema is normal as kidneys are going back to non pregnant state- circulation system is slower
Encourage movement outwith and in bed
Cover blessing back up
Bowel function?
No leakage of urine- when sneezing or coughing or just small trickles when moving
Any complication le us know
Give advice on pelvic floor exercises and ensure she continues to do these
Ask if bowels have moved- not expected on day two postnatal
Ask around fecal incontinence or fecal fluid
Normal today
overall approach to the care episode
Systematic approach- logical head to toe
Maintained privacy and dignity throughout
Been companionate
Listened and answered questions
Offered opportunity fro dialogue
