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Post partum care

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Post partum care

  1. 1. Nursing Care in the Postpartum Period
  2. 2. Postdelivery Assessment • Greatest risk for postpartum complications is during the first 24 hours after delivery • Identification of potential problems; immediate intervention; reassessment
  3. 3. • Assessment includes: – Condition of uterus – Amount of bleeding – Bladder & voiding – Vital Signs – Perineum
  4. 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. 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. 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. 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. 8. Vital Signs • Elevated Temperature – Normal finding for first 24 hours – Sign of Dehydration – Sign of Infection • Bradycardia – Normal Finding
  9. 9. • Tachycardia – Infection – Hemorrhage – Pain – Anxiety • Lowered Blood Pressure – Orthostatic Hypotension – Shock
  10. 10. • Elevated Blood Pressure – Pregnancy-induced Hypertension
  11. 11. Breasts • Soft, firm, can be lumpy • Secretion of Colostrum • Engorgement • Assessment of: – Breasts – Nipples
  12. 12. Uterus • Process of Involution • Height – First Day = at Umbilicus – Decreases 1 FB per Day • Consistency – Firm, Round, Smooth; Not “Boggy” • Location – Midline
  13. 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. 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. 15. Lochia • Amount – Estimate of Drainage – Number of Pads • Color – Rubra – Serosa – Alba
  16. 16. Episiotomy • Assessment for: – Hematomas – Ecchymosis – Edema – Erythema – Intact Suture Line – Signs of Infection
  17. 17. Homan’s Sign • Assessment for Thrombophlebitis – Swelling – Reddness – Warmth – Pain • Unilateral Findings • C/S Mother at Higher Risk
  18. 18. Emotional Status • Can have Mood Swings • Observing Bonding Behavior & Ability to give Infant Care – Rubin’s Phases – En face – Engrossment
  19. 19. Patient Post Epidural • Assessment of Lower Extremities for: – Sensation – Movement • Remains on Bedrest
  20. 20. Post C/S • Additional Assessment: – Incision – Fluid Intake – Bladder & Bowel – Ambulation/Orthostatic Hypotention – Thrombophlebitis
  21. 21. Documentation of Findings • Assessment Checklist Form • Graphic Sheet • Narrative Notes – Admission – Daily
  22. 22. Nursing Diagnoses • Throughout the chapter • NCP
  23. 23. Interventions • Prevention of Complications • Reduce Discomfort • ADL – Nutrition – Rest & Sleep – Ambulation – Bathing – Kegel Exercises
  24. 24. Predischarge • Rubella Vaccine – Titer – Hypersensitivity to eggs – Administration of Vaccine – Patient Teaching • Rho Immune Globulin – Criteria – Administration of Rhogam
  25. 25. Discharge • Instructions for Mother & Infant Care • Next Appointment • Referrals

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