Postpartum Care

7:53:00 PM

Postpartum-Complications-Nursing Mnemonics. See more: http://www.nursebuff.com/nursing-mnemonics-obstetrics-and-newborn-care/:

Topic : Postpartum Care by Association of Professors of Gynecology and Obstetrics (APGO)

Postpartum Maternal Physical Assessment Summary- BUBBLE HE

Breasts:

inspect: size, symmetry, shape of breast and nipples taking note of erection, flatness, redness, bruising, open wounds, presence of mastitis and colostrum
palpate: fullness, soft or engorged, firmness and lumps
pain assessment

Uterus (Fundus):

palpate: firmness/bogginess, location of the fundus in relation to the abdomen, determine the location of the fundus in relation to the belly button to determine amount of fundal involution
inspect incision site
check policy: in some organizations, they may not assess fundal involution by palpation due to fear of dehiscence

Bladder:

void amount (~30ml/hr)
assess for distention, incontinence, urinary retention, urinary infection especially if the patient had a foley catheter

Bowel:

last bowel movement/flatus
assess for distention, abdominal pain

Lochia:

amount, color, odour
assess for postpartum hemorrhage

Persistent red lochia suggested delay involution that is usually associated with infections or retained piece of placenta tissue.
Offensive lochia, which may be accompanied by pyrexia and a tender uterus, suggests infections and should be treated with broad spectrum antibiotics.
Retained placental tissue is associated with increased red blood cell loss and blood clots, and this may be suspected if the placenta and membranes were incomplete at delivery. Management includes uses of antibiotics and evacuation of retained products under regional or general anaesthesia.

Episiotomy

level of laceration
number of stitches, redness, edema, bruisin, discharge, approximation of wound edges
assess perineal area

Homan’s Sign-for DVT

assess for pain with dorsiflexion
check policy: this is sometimes not done in organizations

Emotional State:

assess for signs and symptoms of postpartum depression and infant-maternal bonding

At my postpartum placement, one of the nurses gave us a very helpful handout on what to look for specifically in cesarean and vaginal deliveries postpartum. Again, the Disclaimer is that these were tips she found useful in assessing her patients, do not use this information to guide your practice, checking college standards and organizational regulations is imperative to good practice.

Vaginal Birth Assessment

VS: on admission; 2 hrs post 1st set of VS; 24hr postpartum or qshift; within 2hr of d/c
Urine Output: d/c foley when patient is walking; delay foley removal if there is swelling in labia
IV: d/c when patient is stable and no signs of postpartum hemorrhage

Cesarean Assessment

VS: on admission; 1hr post 1st set of vitals; q4hrs for the next 48 hrs; qshift until d/c; within 2hrs of d/c
Urine Output: d/c foley catheter 12 hrs post opt unless ordered; output for first 2 voids should match ~30ml/hr; if no void within 6-8 hrs post foley removal then do I/O catheter
IV: assess for complications such as infiltration, fluid overload; d/c 24hrs or when stable VS

Neonatal Physical Assessment

Check: GBS, Bloodtype, HepB, HIV and Rubella status of mother and baby
VS: on admission; qshift (if GBS+ive then q4h)
Head to Toe: on admission; qshift; the mother is a great resource wen you are doing vital assessments or when you are getting blood samples for the heel prick. Have the mother hold the baby skin-skin or breast feed the baby when you assess, they cry less and will make the assessment go faster.
Blood Work: GBS+ive babies need cbc and blood culture 4hrs after birth; bilirubine and newborn screen with heel prick is done after 24hrs for Vaginal births and 48hrs for Cesarean sections
Breastfeeding: skin-skin as much as possible; breask feed 12-3 hrs or when baby shows feeding cues.

Credit: Nurse Student Opinion