SEMINAR
ON
POSTNATAL ASSESSMENT
Submitted to, Mrs. Nethravathi Assistant Professor OBG Dept. KIN, Banglore-4
Submitted by, Ms. Mamatha B.V st
1 Year MSc.(N), OBG
KIN, Banglore-4
POSTNATAL ASSESSMENT
INTRODUCTION The postpartum period, which lasts for approximately 6 weeks following delivery, is a time of rapid physical and emotional changes. The number of changes that occur and the magnitude of these changes make the postpartum period a potentially dangerous time. Providing care to new mothers is normally a pleasant experience, but it is also a challenging responsibility.
AIMS:
Demonstrate understanding of the normal and expected postpartum changes.
Conduct thorough assessments to identify signs and symptoms of problems before they become serious complications.
Initiate appropriate interventions when problems do occur.
Prevent problems by teaching the woman appropriate ways to care for herself and her newborn.
EQUIPMENTS: SL. ARTICLES NO. A trolley consists of, 1.
2. 3.
TPR tray BP apparatus and stethoscope
To check temperature, pulse and Respiration. To check blood pressure.
A sterile bin with, 2 gauze piece 1 spatula 1 right hand autoclaved gloves/paper gloves Inch tape
To check milk secretion. To observe tongue. To observe vagina and lochia. To check fundal height
4.
PURPOSES
5.
Torch
6. 7.
Weighing machine
To observe eyes, ears, nose, mouth and genitalia. To check weight of the mother.
Kidney dish
To collect waste.
ASSESSMENT
Before beginning postpartum assessment, the nurse should review the woman’s records to determine physical or psychosocial problems that may have been identified during labour or delivery. This review will enable the nurse to pay special attention to those areas most at risk. Physiologic stability is assessed by monitoring vital signs, assessing the contraction of the uterus, determining the amount and type of lochia and assessing the tissues of the perineum. Postpartum assessment is performed according to institutional policy. In most facilities this includes assessments every hour until 4 hours after delivery and then at 4-8 hours intervals until discharge. PROCEDURE:
Explain the procedure to the woman completely and clearly.
Ask mother to empty the bladder.
Provide privacy and assemble articles at bedside.
Check anthropometric measurements.
General appearance – Looks dull/good/fair.
Check vital signs including temperature, pulse, respiration and blood pressure.
Head to foot examination.
Postpartum assessments: BUBBLE HE should be checked carefully to know the deviation from normal and prevent complications.
B – Breast
U – Uterus
B – Bowels
B – Bladder
L – Lochia
E – Episiotomy
H – Homan’s Sign
E – Emotional status
HEAD TO FOOT EXAMINATION: HEAD: Scalp – Dandruff/ lies
Hair distribution Colour of hair Ay surgical scars FACE: Fore head is normal / any abnormality EYES: Eyebrows and eyelashes
Reaction to light Discharges/haemorrhage/any other Visual acquity EARS: Lowset ears/any other abnormalities.
Discharges/wax NOSE: Deviated nasal septum/any other abnormalities
Discharges / epistaxis MOUTH: Colour of the lips and tongue
Dental carries/any other abnormalities
Thyroid/lymph node enlargement CHEST: INSPECTION
Symmetrical/non symmetrical in chest movements Breast; Symmetry of breast Primary and secondary areola development Montgomery’s tubercles
Nipples erected/cracked PALPATION Clockwise and anticlockwise palpation to check the lumps or nodules in Breasts and for breast engorgement. Colostrums secretion in both the breast. PERCUSSION Check for pleural effusion AUSCULTATION Respiratory sounds normal/abnormal Usually no breast changes are evident immediately following delivery. The breast should be soft, with the nipples erect and free of any sign of redness or other irritation. A thin yellow serous fluid may be visible on the breast. ABDOMEN: INSPECTION
Size and shape of the abdomen Surgical scar previous/present Umbilicus dimpled or flattened
Striae gravidae/linea albicans PALPATION Fundal height Centralization of the uterus Diastesis of recti Any other abnormalities/enlargement of organs PERCUSSION Accumulation of fluid AUSCULTATION Bowel sounds UTERUS:
Examine the fundus by placing one hand above the symphysis pubis to support the lower uterine segment and using the side of the other hand to locate the fundus. And measure the fundal height with inch tape. Here, the fundal height decreases 1.25cm daily to get beyond the symphysis pubis and become a pelvic organ at 6weeks of puerperial period.
Immediately after delivey the fundus should be firm and in the midline at approximately the level of the umbilicus.
Following delivery the uterine muscle must remain in a state of contraction to prevent hemorrhage. If the uterus is not contracting adequately, the nurse can support the lower uterine segment and use gentle massage to increase contraction of the uterine muscle fibres.
BOWELS:
Most women do not have the urge to defecate for a few days following delivery, although some may do so. Loss of abdominal tone contributes to Problems with constipation following child birth. Fear of pain or tissue damage during the first
defecation after delivery is also common. The nurse Should identify specific concerns so that any potential problems can be addressed. BLADDER:
The urinary bladder should be assessed for the presence of distention. When the bladder becomes distended , inspection and palpation will reveal a bulge directly above the symphysis pubis. A distended bladder is dangerous following delivery because it will interfere with normal contraction of the uterus. The woman should void within 4-6 hours following delivery. This time is monitored closely. The volume of the initial voiding is typically measures and documented. Subsequent voiding should be measured if incomplete emptying of the b ladder is suspected. Any signs or symptoms of infection, such as pain or burning with urination should be documented and reported. GENITALIA: Inspect for vulval oedema, hematoma and lacerations. LOCHIA – The amount and characteristics of the lochia are assessed each time the
fundus is checked. Immediately after delivery this drainage is red and contains blood, small clots and tissue fragments.
In case of uterine atony increases blood loss. So, general condition should be checked by monitoring vital signs.
The amount of lochia described as scant, light, moderate or heavy. This is determined by assessing how rapidly perineal pads are saturated. The nurse must be careful to look underneath the woman’s buttocks and back
to make sure that the drainage is not missing the pad and pooling in the bed linens.
For the first 1-2 hours following delivery the flow is expected to be moderate, with one or two pads being saturated in an hour. A heavier rate of flow than this is considered excessive.
The nurse should maintains careful records of the number of pads saturated in an hour inorder to determine overall blood loss.
When more detailed assessment is needed, the pads can be weighed to determine blood loss more precisely. One gram of weight is approximately equivalent to 1ml of blood.
Less than expected flow should also be viewed with caution to determine that the uterus is contracting and clots are not forming within the uterus or vaginal canal.
The amount of lochia diminishes gradually over time. Lochia changes colour and consistency as healing of the endometrium takesplace.
EPISIOTOMY:
The woman should be positioned in lithotomy position and good room light or flash light is needed to visualize the stitches/suture line adequately. REEDA should be observed,
R – Redness
E – Edema
E – Ecchymosis
D – Discharges
A – Approximation of suture line
RECTUM: Inspect for hemorroids. EXTREMITIES:
Any congenital abnormalities syndactyly/polydactyl
Capillary refill
HOMAN’S Sign;
Problems related to venous stasis generally begin during the last few months of pregnancy when the enlarged uterus restricts the return of blood to the heart. These problems are further aggravated by pressure on the femoral veins during bearing down and use of stirrups during delivery. Impaired venous return increases the risk of thrombus formation.
The nurse inspects both the legs for any signs of superficial or deep vein thrombosis (DVT) formation, such as pain in the calf muscle, warmth, redness or swelling.
Both the legs are checked for the presence of Homan’s sign, which is an indicator of venous thrombosis. With the woman lying in the supine position, the nurse supports the knee of one leg while dorsiflexing the foot. Homan’s sign is considered positive when the woman reports pain, not just
a stretching sensation in the calf. EMOTIONAL STATUS: Relationship with the newborn and family dynamics:
The early postpartum period is the ideal time for bonding between mother and newborn. The immediate family should have the opportunity to spend time with each other and the newborn while their emotions and level of excitement are high. The nurse should provide privacy and encourage the family to interact with a minimum amount of interruption. And the rooming-in or bonding should be developed between mother and the baby. Self care ability: The nurse must assess the woman’s ability to care for herself and h er newborn.
Documentation of procedure and informing the deviations from normal to the physiciens.
Education to the mother regarding personal hygiene, postnatal diet, postnatal exercise,breast feeding techniques, immunization schedule and care of the newborn.
Replace the articles.
CONCLUSION:
The postpartum period is a time of major adjustments. With short hospital stays the nurse must work efficiently and effectively to complete all of the necessary assessments, teaching and other interventions that the new mother requires.
BIBLIOGRAPHY:
1. Gloria Hoffmann Wold; “Contemporary maternity nursing”, Mosby publications, Philadelphia,1997,page no.258-264. 2. B.T Basavantappa;”Text book of midwifery and Reproductive health nursing”, Jaypee publications, Newdelhi ,2006,page no. 381-397.
