Postnatal Examination Flashcards
- How would you approach this episode of care? Max 5
- Introduce self
- Explain what going to do
- Ask about general health-open question-verbal & non verbal cues
- Consent
- Check patient name & DOB against notes-check bands
- No contraindication-dealing acutely unwell
- What is the purpose of postnatal care? Max 5
- Promote and maintain maternal wellbeing
- Detect deviations from normal-report to appropriate person
- Promote attachment bonding- ensure and encourage
- Provide support and education
- How would you prepare space for examination? Max 2.5
- Warm - close windows, blinds etc
- Private - close curtains etc
- Happy with who is in room.
- How would you prepare self and what equipment would you require? Max 7.5
- Wash hands - WHO 5 moments of hand hygience and 7 steps of hand washing. - sanitiser if visibly clean - prevent cross infection
- Put on PPE - gloves, apron
- Get equipment ready
-thermometer
- stethoscope
- sphygmomanometer
- notes
- mews chart
- fob watch
- check bands
6a) demonstrate examination- start with health and well-being. 11.5 max
- Ask open questions!
-how you feeling/ getting on?
-ask questions about her mood- she may feel baby blues at this stage and give advice on how to manage that.
-advice on how to contact someone for help and support if low mood.
-give advice on signs and symptoms of perinatal mental health. - Ask about sleeping pattern
-provide reassurance depending on what she tells me
-give advice about trying to make sure that she sleeps when she can- adapt to interrupted sleep she will probably be feeling now.
- sleep when baby sleeps and don’t get overwhelmed by housework etc - Advice on managing fatigue
-eating well
-resting/relaxing - Advice on safe use of medication she may be taking and supplements
- analgesia she maybe taking for tear etc.
5 Worsening advice
- signs of infection
-headaches/migraines- sign of hypertension or pre-eclampsia.
6b) Observations
-what will be taken and why? Max 6.5
- Going to take observations - important in PN period
-should be taken inline with local guidance for example take one everyday for the 1st three days
-temp - normal between 36 and 38 degrees
-pulse - radial pulse - count for 1 min - rate, rhythm and regularity - 60-100 bpm
-respirations - keep holding hand while counting - no respiratory effort - ribs rising both sides - 12 to 18 bpm.
-b/p - compare with previous b/p antenatally - looking for signs of pre-eclampsia
Document all on mews chart - pass on if not normal.
6c) how would you assess oral intake?
Why is this important? Max 3.5
- Ask if eating and drinking?
Advise on small/frequent meals.
Drink plenty of fluids- increase renal recovery
Advise on high fibre diet - reduce constipation and tear recovery.
Foods rich in iron.
6d) support on chosen method of feeding. 3 max
- ask how feeding/ how it’s going
- Ask if she feels it is going well/different positions
- Ask if she requires any guidance or advice - recommend any books/websites/classes which might be helpful.
- Ask if she would like you to watch her feed and feedback on it.
6e) observations of breasts. Max 8
- Ask open questions
- how does her breasts feel?
- pain or engorgement or mastitis give advice if needed.
- ask about nipples - cracked, sore or bleeding and advice on care for her nipples.
-be sensitive around different skin tones.
-encourage feeding in different positions to help empty breasts-avoid mastitis.
Make sure breast are same colour and no inflammation or hot tender areas.
Tell about bad positioning how can affect breasts.
Tell to buzz if assistance required.
6f) routine abdo palpitation isn’t always necessary but how would demonstrate if needed? Max 5
- Side of hand- downwards top of fundus
-umbilicus-down round firm and central (been to toilet)
- no tenderness
- cover over /privacy dignity
-let patient expose self
6g) how would assess lochia?
What advice would you give around prevention and signs of infection? Max 17
- Ask open questions
- how’s bleeding
- amount
-colour - rubra (dark red) serosa ( pinkish brown) alba (white/yellow)10-14 days
-smell
-clots (size)
-odour
-look at pad
-worsening-heavy,offensive or pass concerning clots. - Wash hands before and after pad change and toilet
- Not tampons for 6 weeks
- Change pads regularly
- Report changes
- Avoid perfumed products
- Look out for infection - fever, chills, temperatures
- abdominal, pelvic or perineal pain.
Demonstrate or discuss how would inspect perineum? Max 1.5
- Gain consent
- On side- leg straight other bent and roll
- On back - heels to bum - let knees flop
- Expose perineum-poor healing, infection or any concerns.
- Maintain privacy and dignity.
6i) how would inspect legs? Max 7
- Looks for excessive odema
Ask about tender/hot areas
Compare legs together
Ask about headaches or breathlessness
Discuss DVTs - signs and symptoms
Encourage mobilisation for circulation
Consent
Pass on anything to midwife
6j) elimination?
Bowel function? Max 6
Ask questions about output
Going regularly?
Do you have control? No incontinence
Have bowels opened? Support suture line and relaxing pelvis floor-scared-sensitive
Feel normal?
Pelvis floor exercises
Pass on any concerns to midwife
Refer to physio if needed.
- Overall approach to care? Max 4
- Systematic - head to toe
- Private maintained dignity
- Compassionate care
- Give opportunity for questions
