postnatal assessment

2. INTRODUCTION
Puerperium is the period
following childbirth
during which the body
tissues, specially the pelvic
organs revert back
approximately to the pre-
pregnant state both
anatomically and
physiologically.

3. Accordingto D. C. Dutta
Postnatal care includes systematic examination of the
mother and baby and appropriate advice given to mother
during post-partum period.
Accordingto NadineM. Jacobson
Postpartum care encompasses management of
the mother, newborn, and infant during the
postpartum period. The period usually is
considered to be the first few days after delivery,
but technically it includes the six week period
after childbirth up to the mother’s postpartum
check-up with her health care provider.

4. HISTORYTAKING
Identification data
Present obstetric history- nausea,vaginal
bleeding,urin frequency.
Past obstetric history-no.of child,
complication of previous preg, miscarriage
Family history
Medical / surgical history
Personal history
Menstrual history
Contraception
psychological

5. General examination
Mental status
Skin condition
Head
Eyes
Ear
Nose
Mouth, pharynx and throat
Neck chest
Breast
Abdomen
Perineum , lochia , cervix , vagina , bladder
, bowel
Extremities
Nails

7. BUBBLEHE
The nurse should follow an organised
method when examining the post partum
client , which provides a consistent ,
quality approach to nursing care .The
acronyms , “BUBBLEHE” can serve a
helpful reminder of the elements in a
postpartum assessment .

8. BREAST UTERUS BLADDER
EMOTIONAL
STATUS
BOWEL
HOMAN’SSIGN EPISIOTOMY LOCHIA
BUBBLE
HE

9. BUBBLEHE Assessment
• Breasts — Soft, feeling, firm, Nipples
• Uterus — consistency, position, height
• Bladder — voiding pattern
• Bowels — bowel sounds, hemorrhoids,
• Lochia — type, amt, clots, odor (TACO)
• Episiotomy— laceration, bruising, swelling
• Homan sign — present or not
• Emotional status — bonding, blues

10. •Breast
•On palpation after delivery , breast
usually are enlarged , soft and warm and
contain only small amount of colostrums .
•The mother may be experience breast
engorgement , which may begin as a
tingling sensation in her breast , 2-4 days
after delivery
•Milk is released through infant sucking ,
manual expression , or pumping
•Analgesic given if breast pain occur .
•Provide cabbage leaves to reduce pain
&swelling.

14. •Uterus:-
•Size, Weight , location and firmness
•Immediately after delivery , the uterus begins the
process of involution or reduction in size.
•The uterus weight about 100 g , measuring.
•At the end of 6th week weighs 50-100g.
•A bulky uterus may indicate the presence of blood
clots or retained placental beats or also due to a full
rectum . ,
•Tenderness of the uterus suggest infection .
•Normally uterus should be contracted ,hard and not
painful if touched. the height of uterus should be
measured
•After the 1st postpartum day ,the fundus involute 1-2
cm. Per day.

15. •Management of Bleeding
•After delivery of the placenta 20 to 30 units of
oxytocin often is added to the intravenous solution .
•Or can administering oxytocin intra muscular 10
units .
•Initiating early breast feeding or performing nipple
stimulation is employed .
•If remains boggy than despite massage and oxytocin
administration or if bleeding continue than
pharmacological agent start :-
•Methargin (0.25 mg)IM
•Prostaglandin which can be given when methargin
can not stop bleeding or contraindicated .

16. Uterinepain
•The key to effective relief from
after birth pain is an empty bladder .
•Once the bladder is empty, the
woman may lie prone with a pillow
under her lower abdomen , which
keeps it contracted and thus
eliminate after birth pain .
•Analgesic can be effective .

17. •In the immediate postpartum period, the
bladder is congested , edematous and
hypotonic from the effect of labour .
•After delivery , the client should urinate
within 4 hours , at least 300 ml , with
completely emptying the bladder .
•After delivery within 24 hour cause diuresis
up to 3000 ml per day occurs in the first 2 to 3
days .
•Should be noted and informed to the physician
.
•Straight catheterization must be done .
Bladder

18. Bowels
•Following vaginal delivery , bowel movement
normally occurs after 2 to 3 days .when gastric
motility does not return by 2-3 days ,
constipation occur .
•The client should be encouraged to drink
should be 6to 8 glasses of fluid daily ,eat a high
fiber diet (whole grains , legumes , vegetable
and fruits )
•Sitz bath
•Enema may be given
•Stool softner dulcolax , topical ointment etc.

19. •Lochia
•when the bleeding is heavy, ensure that
the source of bleeding , it may be
laceration .
•Saturation of vaginal pad with in 15- 30
min then pph.
•CBC may indicate 1.0 to 1.5 g/dl
decrease in Hb level.

21. •Episiotomy
•An episiotomy is the surgical incision made to enlarge the
vaginal opening for delivery of the baby’s head .
•Care of the vulva includes applying ice packs to the perineum
for the first 24 hour.
•Should not be applied to the directly to the skin , should be
wrapped with an absorbent disposable type of covering .
•After the first 24 hour following delivery . a sitz bath with
warm water may be used .
•The client should be taught perineal hygiene . including daily
wash with warm water and mild soap.
•The perineum should be cleaned after each voiding .
•Perineal pad frequently changes after each voiding , removing
pad from front to back , and hand washing will help decrease
the risk of infection .
•To perform perineal exercises such as kegel exercise .

24. Homan’ssign
•Assessment of homan’s sign must be done for
all postpartum cliens,to check for presence of
thrombophlebitis .
•Should be perform leg exercise, to teach the
client to flex and extends the both leg and feet
alternatively .
•Keeping the leg uncrossed while seated.
•Not flexing the leg at groin .
•Resting the leg without putting pressure on the
back of the knees.
•Wearing support hose and antiembolism
stocking .
•Padding pressure points during lithotomy
position .

26. •Emotional status
•The immediate postpartum period is an
emotional roller coaster , and almost any
emotion may be observed .
•They may also be exhausted and need
sleep and rest to restore their bodies to
health .
•In this “taking in phase” mother wish to
meet their own rest and nutritional needs
before focusing their energy on newborns.
•They want to relieve the experience by
talking about the process of labour and
delivery.

27. Guidanceand instruction in preparationfor home
care :-
Following normal delivery,
mothers are discharged on the 2nd and 3rd
post partum day , the midwife must
appraise the mother needs for instruction
and guidance for the care of :-
•self
•baby
•self in relations to others

30. •Sibling and husband.
•Family planning
•Resumption of sexual intercourse
after six weeks,

31. Myths and fact related to postnatal diet
1. Myths:-recommendation of eating bland food like
khichdi during postpartum period.
Fact:- bland food like khichdi,rice etc are easily digested as
well as the it provides immediate energy to the mother for
day to day activities.
2. myths:-eating extra ghee(butter)helps recover faster,
strengthens joints.
fact:-a mother’s baby already has enough fat reserves that it
gathered during pregnancy. increase the intake of ghee will
lead to weight gain in the postpartum period. instead of
eating ghee laden dry fruits laddoos, drinking a glass of
milk dry fruits in it.

32. 3. Myths:- more the milk the mother drinks, more the
milk she will make
Fact:- there is no scientific evidence confirming the above
claim. instead a balanced diet of rich in protein, minerals
and vita. will help increase breast milk supply.
4. myth:-avoid eating spicy food.
fact:- even though spicy food does affect the flavor of
breast milk slightly; unless the baby seems uncomfortable
or fussy after a feed, it’s ok to eat spicy food.
5. Myth: drinking carom(ajwain) help to digest and speed
up recovery.
fact:-even though there is no scientific evidence in support
of the claim, there is no harm, observed in having it.
provided you have a nutritious diet along with this.

33. 6.Myth: breastfeeding moms can’t have their
morning coffee.
Fact: coffee contains caffeine, which if limited
moderate amounts has been proven to be harmful,
even though over dose of caffeine may cause related
issues.
7.myth:Skip the “gassy "food like broccoli,
cabbage etc.
fact: cabbage, broccoli and many other vegetables
are super foods and a mother needs all the super
nutrients she can get as her body works to produce
milk for the baby.

34. 8.myth:breastfeeding moms require
special vitamin supplements.
Fact: the best source of nutrient for the baby
mother is a varied.
9.myth: eating yogurt by nursing mother
causes infant diarrhea indigestion and gas.
Fact: yogurt is a known pro-biotic and source
of calcium and it is condition like, diarrhea,
indigestion and acidity