1. Nursing Care in the Postpartum Period

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 Bradycardia
Normal finding for first 24 hours
Sign of Dehydration
Sign of Infection
Bradycardia
Normal Finding

9. Lowered Blood Pressure
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 Consistency Location
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 Color Estimate of Drainage Number of Pads Rubra Serosa
Alba

16. Episiotomy Assessment for: Hematomas Ecchymosis Edema Erythema
Intact Suture Line
Signs of Infection

17. Homan’s Sign Assessment for Thrombophlebitis Unilateral Findings
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 Rho Immune Globulin 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