1. Health Assessment during Postpartum Period by Assoc. Prof. Dr. Susanha Yimyam Faculty of Nursing, CMU

2. History, Physical Examination (Observation, Palpation, Listening), Laboratory, Special Examination History, Physical Examination (Observation, Palpation, Listening), Laboratory, Special Examination 4 Dimensions : Physical, Psychological, Social and Spiritual dimensions 4 Dimensions : Physical, Psychological, Social and Spiritual dimensions 12 B 12 B Overview: Background, Body conditions, Body temp& Blood pressure Overview: Background, Body conditions, Body temp& Blood pressure Neck => Toe Neck => Toe Breast & Lactation, Belly & Uterus, Bladder, Bowel movement, Breast & Lactation, Belly & Uterus, Bladder, Bowel movement, Bleeding & Lochia, Buttom Blues Blues Baby Baby Bonding & Attachment Bonding & Attachment Princip le

3. 1. Backgroun d 1.1 Personal data age, education, occupation, income residence, culture, beliefs & value supporting persons & network in family & community 1.2 Pregnancy history Parity, childbearing, childrearing & complications 1.3 Current pregnancy & childbirth type & duration of labor medications during labor & complication

4. 1.6 Family’s health history 1.7 Culture, health beliefs & value Self-care & infant care 1. Background (cont.) 1.4 Postpartum data General health Maternal adaptation Ability of breastfeeding Supports from family & community 1.5 Laboratory & Special examinatio n

5. 2. Body conditions 2.1 General Appearance, Manner, Clean & Comfort Weakness, Lift up from bed Abilities for routine activities o fnormal life 2.2 Anemia Conjunctiva, Nail, Hb & Hct 2.3 Lower extremity Color edema Varicose vein 2.4 Sleep pattern 2.5 Foods & water 2.6 Readiness & demand to learn

6. 3. Body temperature & Blood pressure Body temperature 3.1 Body temperature 24 hours of after birth Body temperation = / > 38 C Infection Pulse 3.2 Pulse Blood pressure 3.3 Blood pressure 24 hours of after birth => Orthostatic hypotension => Postpartum Hemorrhage

7. 4. Breast & Lactation 4.1 Breasts Balance, Rash? Comfort, Breast engorgement? 4.2 Nipples Normal, Short, Invert, Crack ? Engorge areola ? Painful ? 4.3 Breast milk Milk production & lactation Quantity & Quality of breast milk

8. 5. Belly and Uterus 5.1 Abdomen Striae gravidarum, linea nigra Diastasis recti Rash, Scar 5.2 Uterus Contraction, Fundal height, Involution After (birth) pain

9. 6. Bladd er 6.1 Full bladder 6.2 Urine 6.3 Urination Painful during urination Frequency of urination Urinary incontinence Painful during urination Frequency of urination Urinary incontinence

10. 7.1 Characteristic & Quantity Lochia rubra Lochia rubra : 2-3 days after birth: darkled red, no blood clot Lochia serosa Lochia serosa : 4-9 days after birth: pink or brown Lochia alba Lochia alba : 10 days after birth: yellow or white/ cream 7. Bleeding & Lochia - Lochia: heavy & with blood clot Postpartum hemorrhage - Lochia rubra: through after birth retained a pieces of placenta/membranes - 3-4 after birth: bleeding/ lochia infection / Subinvolution - continued serosa & alba lochia endometritis 7.2 Quality (smell) : Normal: Normal: like menstruation Abnormal: Abnormal: foul lochia => infection bad smell => no enough perineum care

11. 8. Bottom 8.1 Perineum REEDA 8.1 Perineum : pain scale, healing of perineum Check signs of infection by using REEDA (Redness Edema Ecchymosis Discharge Approximation) 8.2 Genital organ V : Edema, Hematoma, & Varicose vein 8.3 Rectum Edema, Pain, Hemorrhange : Edema, Pain, Hemorrhange

12. 9.Bowel movement normal labor 2-3 after birth may constipation abnormal labor perhaps NPO should observe Bowl movement before start oral foods

13. 10.Blues : Emotional status : Maternal role adaptation : Acceptance of infant & Social support : Bonding & Attachment Maternal behavior 1. Taking-in phase (dependent phase) : Dependent within 1-2 days 2. Taking-hold phase (dependent- independenr phase) : Dependent & Independent within 10 days 3. Letting-go phase (independent phase) : Independent about Day 10 after birth

14. 11. Baby : Head & Face : Skin, Chest, Abdomen & Back : Genital organ, Rectum : Extremities & movement : Vital signs : Sucking & Urination

15. 12. Bonding Attachment between mother & baby - Attachment between mother & baby - Observation attachment behavior : touch, hug, talk : eye contact, hold, feeding Observation family adaptation - Observation family adaptation Sibling relationships - Sibling relationships