Nursing Care in the Postpartum Period

1. Nursing Care in the Postpartum Period Presented By Chris Hicks

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