Postpartum Assessment Flashcards
Describe Maternal Physiological Changes
-Postpartum period is interval between birth and return of reproductive organs to their nonpregnant state
-Referred to 4th
trimester of pregnancy
-Traditionally lasts 6
wks, although this
varies among women
List the Goals of Postpartum Care
-Assist and support recovery -Educate mom about self- care -Educate mom/supports about infant care -Monitor for signs/risks of --Postpartum Hemorrhage (PPH) -Monitor for signs/risk of infection
What do I need to know about a postpartum patient?
-Infant status and feeding
-GBS (Group B-strep)
status
-Rh status
-Risk for PPH
Assessments: Vital Signs
- Pulse
- Blood pressure
- Respirations
- Temperature
Assessment: PAIN
-Subjective pain score
-Resolution of epidural
analgesia
Assessment: BUBBLLEE
Breast Uterus Bladder Bowel Lochia Legs Episiotomy/laceration or C/S birth incision Emotional
Assessment: BREAST
Soft
Tenderness
Localized redness
Filling/Full/Engorged
Is mom pumping?
What type of support does she require?
Nipples
-status (intact)
-signs of breakdown (redness,
cracking)
-tenderness, bruising
-inverted or flat
Colostrum/milk present
Breast Assessment: Day 1 and 2 & 3 and4
Day 1 and 2: -Little if any change in - breast tissue in first 24 hours -Tingling sensation -Secrete colostrum
Day 3-4: -“milk coming in” -Begin to secrete “true” milk-bluish white in colour -Breasts may feel warm, firm tender -Engorgement – due to lymph and venous stasis so breasts feel full, tender and uncomfortable
Breast Assessment - ENGORGEMENT
-breasts become firm, tender, swollen, and hot, and appear shiny and red -tenderness and swelling may extend into the axilla -areolae then become firm and the nipples may flatten, making it difficult for the newborn to latch on -Temporary condition that usually resolves in 24 hours
Breast Assessment- HEALTH TEACHING
-Frequent feedings
-Ice packs are
recommended in a
rotation of 15 to 20
minutes on, 45 minutes
off between feedings; ice
packs should cover both
breasts. Large bags of
frozen peas or corn make
easy packs and can be
refrozen between uses
-Fresh raw cabbage
leaves placed over the
breasts in between
feedings may help reduce
the swelling and
discomfort
-Anti-inflammatory
medications-Ibuprofen for
pain and swelling
-Stand in warm shower to
start milk flow to manually
express to soften around
areola
Assessment of Uterus (Fundus)
***Fundus should always be “firm”
Fundus is measured in relation to the umbilicus
Assessment of the fundus is best in supine position and with an empty bladder
Assessment of Uterus
Measured in finger breadths or centimeters
At delivery the fundus is slightly above or at the level of the umbilicus
Involution occurs at ≈ 1 cm per day (1 fingerbreadth)
Assessment of Fundus
Degree of firmness:
Support the lower uterine segment with non-dominant hand and palpate the uterine fundus for firmness
Described as:
-firm
-soft
-boggy
***Vigorous massage can potentiate uterine atony
Bladder Assessment includes:
Assess urinary output and first void
Assess location of fundus:
Midline or deviated to the right
Full bladder displaces the uterus up and laterally to the right risk that uterus does not contract normallyPPH
Normal pregnancy is associated with increase in extracellular fluid
Bladder has increased capacity and decreased tone
Leads to over-distension of the bladder and increased risk for:
Retention of residual urine
Urinary Tract Infection (UTI)
Postpartum Hemorrhage (PPH)
Signs of a Distended Bladder
-Fundus above umbilicus
-Fundus deviated to one
side (usually right)
-Bulge of bladder above
symphysis
-Excessive lochia
-Tenderness over bladder
area
-Frequent voidings (less
than 150 cc)
***When did the patient last void?
Bladder Assessment - Signs of Infection
***Signs of infection
-Infrequent/insufficient
voiding
-Discomfort/burning on
urination/foul-smelling urine
-Health Teaching:
-Void frequently; pericare
after each void and BM; ++
drinking.
-Change pads frequently
Bowel Assessment includes:
Assess for: -Passing flatus -First bowel movement -Hemorrhoids -Bowel sounds (all 4 quadrants)
What is Lochia and what does the Lochia assessment include?
Lochia is uterine blood flow and is normal after birth from the placental site.
Assessment includes:
-Amount
-Type
-Presence and size of
clots
-OdourDescribe Rubra, Serosa, and Alba Lochia
Rubra: dark red discharge and may contain blood clots (From day 1 to day 3 or 4)
Serosa: lochia is thinner & is pink or brown discharge (from day 3 or 4 to and can last 22 to 27 days, although typically after day 10 turns to alba)
Alba: yellowish white discharge (persist 4 to 8 weeks after delivery).
What is a concern if lochia rubra lasts longer than 3 or 4 days?
Describe Lochia Odour and health teaching.
Odour: normal- “musky” scent
Abnormal- Foul smelling
Health Teaching:
- Pericare
- Frequent pad changes
- Frequent urination
- Increased fluid intake
- Increased activity
Leg Assessment includes:
Assessment : -Over all symmetry -Presence of pain (especially with ambulation) -Swelling -Temperature -Presence of any raised reddened areas (especially on the posterior calf) -Presence of varicosities ***Assessing for signs of Deep Vein Thrombosis (DVT)
Health Teaching: -Increased activity early post delivery (especially after C/S) -Analgesia -Support stockings -Decrease risk factors (ie. Smoking)
Assessment for Episiotomy/Laceration/Perineum includes?
-Assess in side- lying position -Assess pain -Assess for REEDA Redness Edema Ecchymosis Discharge Approx. of edges
**Increased pain may indicate infection, hematoma, hemorrhoids
PERI CARE includes?
-Cleaning
-Wash hands b/f
after cleansing perineum/changing pads.
-Wash perineum with mild
soap and warm water at
least once daily.
-Cleanse from symphysis
pubis to anal area.
-Apply peripad from front
to back, protecting inner
surface of pad from
contamination.
-Wrap soiled pad and place
in covered waste
container.
-Change pad with each
void or defecation
-Assess amount and
character of lochia with
each pad change
-Ice Pack (for First 24
Hours)
-Squeeze Bottle (Peri
Bottle)
-Sitz Bath
-Analgesics for pain and
swelling (ie. ibuprofen)
Emotional Status- 3 stages of postpartum include?
3 Stages of Postpartum
1. “Taking In Phase” patient is focused on self, the delivery, ingestion of food, and resting more.
- “Taking Hold Phase” patient is now focused on her health and her baby. This is the phase where the best health teaching is established.
- “Letting Go Phase” patient now is ready to re-engage with her previous relationships. Increased socialization is now occurring.
