POSTPARTUM NURSING CARE

Diana Barrios RN, MSN Merritt College ADN Program Nursing 3A: Perinatal Nursing

EXPECTED OUTCOMES DURING THE POSTPARTAL PERIOD


The woman will:











Undergo a normal involution process with normal lochia discharge Remain comfortable and injury free Demonstrate normal bladder and bowel function Demonstrate knowledge of breast care Demonstrate knowledge of infant safety, infant care activities, and infant feeding Integrate the newborn into the family

POSTPARTUM ASSESSMENTS




Initial general assessment Body systems assessment Assessment specific to postpartum changes

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GENERAL ASSESSMENT








Enter the room quietly, speak quietly. Wash hands and provide for privacy. Inform patient before turning on lights. Note LOC, activity level, position, color, general demeanor. Take note of the total environment:
Safety/patient considerations
Note equipment and medical devices

BODY SYSTEMS ASSESSMENT






Vital signs Level of pain Neurological Pulmonary Cardiovascular








Musculoskeletal Gastrointestinal Genitourinary Integumentary Psychosocial

ASSESSMENT SPECIFIC TO POSTPARTUM ADAPTATION










Vital signs (q 4-8 hrs) Breasts/breastfeeding Uterus Lochia/perineum Bladder & bowel function Edema, Homan’s sign Bonding & attachment process Teaching/learning/referral needs assessment Refer to Table 14-1, page 397: Postpartum Assessment and Signs of Potential Complications

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VITAL SIGNS







Blood pressure: consistent with BP baseline during pregnancy, possible to have orthostatic hypotension for 48 hrs Pulse: 50-90 bpm Respirations: 16-24 breaths/min Temp: 97.1-100.4oF (36.2-38oC)

ASSESSMENT OF BREASTS & BREASTFEEDING









Begin by asking how feedings are going. Ask if patient feels lumps in breasts, or has redness, soreness, or blisters on nipples. Observe for signs that might indicate incorrect latch Breasts should be soft & non-tender; nipples everted

THE POSTPARTUM DECISION

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NURSING DIAGNOSES RELATED TO BREASTS & BREASTFEEDING











Pain r/t improper positioning, engorged breasts Ineffective breastfeeding r/t maternal discomfort, improper infant positioning Knowledge deficit r/t normal physiologic changes, breastfeeding Infection r/t improper breastfeeding techniques, improper breast care

ASSESSMENT OF THE UTERUS








Uterus midline, FF @ U/U following the first 12-24 hrs after birth Rising uterus, displaced to side  full bladder? Boggy uterus  subinvolution? Lochia: scant-moderate, rubra-serosa Perineal lacerations/episiotomy – wellapproximated, no signs of infection C/S dressing: CDI, REEDA Patient should be educated about normal and abnormal changes, what to report, and when to ask for help.

PAD COUNT: LOCHIA Scant: