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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 after delivery Identification of potential problems; immediate intervention; reassessment. Assessment includes: Condition of uterus Amount of bleeding

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Nursing Care in the Postpartum Period

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  1. Nursing Care in the Postpartum Period

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

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

  4. 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

  5. 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

  6. 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

  7. 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

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

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

  10. Elevated Blood Pressure • Pregnancy-induced Hypertension

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

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

  13. 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

  14. 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

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

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

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

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

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

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

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

  22. Nursing Diagnoses • Throughout the chapter • NCP

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

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

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

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