UNIT 5 POSTPARTUM

HEALTH AND NURSING

CARE
TOPIC 5.1, 5.2, 5.3
 TOPIC 5.1 POSTPARTUM NURSING CARE

• REPRODUCTIVE AND OTHER SYSTEMIC CHANGES

• NURSING CARE THE FIRST 24 HOURS POSTPARTUM
• NURSING CARE FOLLOWING VAGINAL AND CAESAREAN
BIRTH
 UNIT 5 – POSTPARTUM
PHYSIOLOGIC CHANGES

REPRODUCTIVE CHANGES OTHER SYSTEMIC CHANGES:

- INVOLUTION • HORMONAL SYSTEM
• UTERUS • URINARY SYSTEM
• AFTER PAINS • CARDIOVASCULAR SYSTEM
• LOCHIA
• LACTATION
• CERVIX
• OVULATION & MENSTRUATION
• VAGINA
• PERINEUM
 WHAT IS INVOLUTION?
• UTERUS - 2 MAIN PROCESSES. WHAT ARE THEY?
• SEAL OFF SITE OF PLACENTAL IMPLANTATION TO PREVENT BLEEDING
• RETURN TO THE PRE-PREGNANCY STATE

• FUNDUS:
– LOCATION OF FUNDUS (1 HOUR POST-PARTUM AT LEVEL OF UMBILICUS)
– DECREASES BY APPROX. 1 FINGER BREADTH PER DAY (APPROX. 1 CM)
– BY DAY 9 OR 10 HAS RETURNED BACK INTO PELVIS AND CAN NO LONGER BE FELT
– BLADDER CAN DISPLACE UTERUS AND PREVENT INVOLUTION
– CONSISTENCY AFTER BIRTH (FIRM, BOGGY)
– TYPE OF BIRTH (VAGINAL, C/S)
• AFTERPAINS: INTERMITTENT CRAMPING
• FELT MORE BY WOMEN WITH BIGGER BABIES OR MULTIPARITY AS THE UTERUS
HAS TO WORK HARDER
DESCENT OF THE UTERINE FUNDUS
 A FULL BLADDER
DISPLACES THE UTERUS
 REPRODUCTIVE CHANGES CONTINUED

• CERVIX INITIALLY OPEN AND THEN CONTRACTS TO CLOSE; BY

END OF DAY 7 BE FIRM AND BACK TO NON-PREGNANT STATE
• VAGINA: TAKES 6 WEEKS TO RETURN TO APPROXIMATE PRE-
PREGNANCY STATE
• GOOD TIME TO PERFORM KEGEL EXERCISES; WILL HELP STRENGTHEN
AND TONE THE VAGINAL MUSCLES

• PERINEUM: CAN FEEL EDEMATOUS AND TENDER AFTER BIRTH

• INTERVENTIONS? ANALGESIC, ICE
 LOCHIA – LASTS 2 -6 WEEKS
• DISCHARGE FROM VAGINA IN THE POSTPARTUM PERIOD. GOES
THROUGH 3 PHASES.
• RUBRA: RED – MOSTLY BLOOD. LASTS FOR APPROX. 3 DAYS

• SEROSA: PINK – BLOOD AND MUCOUS. DAYS 3 – 10 APPROX.

• ALBA: MOSTLY MUCOUS – WHITISH OR COLORLESS. CAN LAST

UP TO 6 WEEKS.
 MORE PHYSIOLOGICAL CHANGES
• DIURESIS • LACTATION
• LET-DOWN REFLEX
• DIAPHORESIS & CHILLS
• LATCH-ON (LATCH)
• CARDIOVASCULAR
• ENGORGEMENT
• GASTROINTESTINAL SYSTEM
• ERECT NIPPLE
• INTEGUMENTARY SYSTEM • INVERTED NIPPLE
• WEIGHT LOSS • FLAT NIPPLE
• OVULATION/MENSTRUATION • COLOSTRUM
POST PARTUM ASSESSMENT- FIRST 24
HOURS
THE FIRST HOUR:
• FUNDUS/LOCHIA
• PERINEUM
• VITAL SIGNS
• IV
• FOLEY IF THERE IS ONE/ ASSESS BLADDER
• NUTRITION NEEDS (DRINK/FOOD)
• SHOWER
• NURSE BABY
 POSTPARTUM ASSESSMENT FIRST 24
HOURS
• HEALTH HISTORY
– IF THIS WAS NOT COMPLETED PRIOR TO ADMISSION FOR LABOR AND DELIVERY
– IT SHOULD INCLUDE INFORMATION REGARDING LABOR AND DELIVERY AS WELL
AS INFANT DATA

• PHYSICAL ASSESSMENT
– WE USE BUBBLE HER TO GUIDE OUR ASSESSMENT

• LABORATORY DATA
– HEMOGLOBIN USUALLY MEASURED FIRST 12-24 HOURS
– SYPHILIS SCREEN PRIOR TO DISCHARGE
PP ASSESSMENT – FOCUSSED ASSESSMENT
(FIRST 24 HOURS AND BEYOND)
• BUBBLE HER VITALS
• B - BREASTS
• U - UTERUS
• B - BLADDER
• B - BOWEL
• L - LOCHIA
• E - EPISIOTOMY(PERINEUM)
• H - HOMAN’S (PASSIVE STRETCH ONLY)
• E - EMOTIONAL
• R - REST AND ACTIVITY

• VITALS
• WE DO NOT DO HOMAN’S BUT THIS WAS PART OF
THE ACRONYM FOR THE FOCUSED ASSESSMENT
• IF YOUR PATIENT HAS HAD AN EPIDURAL OR
SPINAL, YOU WILL NEED TO CHECK THE SITE.
PALPATING THE FUNDUS AFTER
BIRTH
 POSTPARTUM CARE ROUTINE
• FIRST HOUR PP CHECKING EVERY 15 MIN.
• FREQUENCY OF ONGOING PP ASSESSMENT
• CHECK UNIT PROTOCOL
• COULD BE Q SHIFT IF STABLE
• COULD BE Q 4 HRLY IF NEW ADMISSION OR COMPLICATIONS

• SEE VAGINAL DELIVERY CARE MAP ON MOODLE

 POSTPARTUM AND OXYTOCIN

• SOME PATIENTS ARE ADMITTED TO POSTPARTUM AND

HAVE OXYTOCIN/SYNTOCINON RUNNING. DOCTOR’S
ORDERS MAY READ TO DISCONTINUE WHEN FUNDUS
AND LOCHIA SATISFACTORY.

• HOW DO YOU DEAL WITH THIS?

 POSTPARTUM CARE EDUCATION
• HOW MIGHT THE LOCHIA CHANGE IF THE CLIENT DOES
THE FOLLOWING:
• AMBULATES
• CLIMBS STAIRS
• BREAST FEEDS
• 24 HOURS FOLLOWING A CAESAREAN BIRTH
 POSTPARTUM CARE EDUCATION

• HOW WOULD YOU MANAGE YOUR PATIENT IF SHE IS

COMPLAINING OF PERINEAL PAIN? WHAT WOULD YOUR
ASSESSMENT INCLUDE?

• WHAT WOULD CARE OF THE PERINEAL AREA INVOLVE? WHAT

WOULD YOU TEACH YOUR PATIENT?
 POSTPARTUM CARE EDUCATION

• YOUR PATIENT IS CONCERNED ABOUT BECOMING CONSTIPATED.

WHAT TEACHING COULD YOU DO IN ORDER TO ASSIST HER IN
THIS?

• YOUR PATIENT WANTS TO KNOW WHEN HER “MILK” WILL COME

IN. WHAT DO YOU SAY? HOW MIGHT SHE FEEL THAT DAY?
 POSTPARTUM CARE EDUCATION
• THIRD AND FOURTH DEGREE TEARS:

• MOTHERS ARE PUT ON BOWEL ROUTINE TO FACILITATE A SOFT

BOWEL MOVEMENT. (CHECK UNIT PROTOCOL FOR THIS.)

• NO ENEMAS/SUPPOSITORIES – NOTHING SHOULD BE INSERTED IN

THROUGH THE ANAL SPHINCTER IN CASE THERE IS A DISRUPTION
OF THE SUTURES AND THEN SUBSEQUENT BLEEDING OR
INFECTION.
 POSTPARTUM CARE EDUCATION
• WHY ASSESS THE FUNDUS AND THE LOCHIA?
• WHAT IS THE FIRST THING YOU WOULD DO IF THE LOCHIA WAS
VERY HEAVY AND/OR THERE WERE CLOTS?
• WHAT WOULD YOU DO IF THE LOCHIA WAS HEAVY AND YOU
COULD PALPATE BLADDER?
• WHAT WOULD YOU DO IF THE FUNDUS WAS BOGGY/SOFT?
 NEW ADMISSION – C/SECTION
• USE THE ACRONYM REEDA TO DESCRIBE ASSESSMENT OF THE
INCISION. CAN ALSO USE THIS FOR ASSESSMENT OF
EPISIOTOMY SITE.
• R - REDNESS
• E - EDEMA
• E - ECHYMOSIS
• D - DISCHARGE
• A - APPROXIMATION
 NURSING CARE FOR CESAREAN
• TREAT AS POST-OP
• VITALS, IV, FOLEY, INCISION, LOCHIA, O2,
• PLUS “BUBBLE HER VITALS”

• IF YOUR PATIENT HAS HAD AN EPIDURAL OR SPINAL, YOU WILL

NEED TO CHECK THE SITE.