Postnatal Care AL ASSESSMENT © Lochia responsibilities of nurse in postnatal settings are to assess postnatal patients, py significant findings. Postnatal nurses are essentially searching for findings fet untreated or unattended, Thus, itis imperative for nurses to distingu ea clear understanding of the nursing care necessary to promote patient's provide care and teaching and if necessary that might lead to negative outcomes for ish between normal and abnormal findings health and well-being, ITION period is usually considered to be the first few days after delivery, but technically it includes the 6 weeks period after until the body has returned back to near prepregnant state (reproductive organs revert back to their normal position), DSES pw about the normal physiological changes in the body in the postnatal period pw about the normal psychological changes in the immediate postnatal period for potential medical problems after delivery E out the involution of various organs in mother hing postnatal mother regarding care of herself and baby 5s the emotional status of the mother. ne Patient to the examination room quietly. meticulously. the privacy of patient using screen and sheet to cover her. patient should be kept in mind. _ copie ‘bladder within 30 minutes before abdominal palpation. ‘clothes enough to allow access to the abdomen. [Articles to record-Pen (Red, Blue and Black ‘Treatment chart Cotton swabs ser “Tray for perineal examin: Weighing machine Screen equired quireClinical Nursing Procedures ‘Tray containing te follwing articles Bray 4 Watchand tore © Kidney tray and paper bag © Sterile pad in a wrappet + Cotton swabs 1.Stethoscope 7 2.Thermometer | Blue tray 3. Cotton swabs 4. BP apparatus 7. Sanitizer Figure 1: Tray containing articles for postnatal examination STEPS OF PROCEDURE PREPROCEDURAL STEPS Explain procedure to mother. Promote compliance Assemble the articles atthe right side of the patient. To ‘Wash your hands wel before doing assessment. To pre ‘ prevent inconvenience during procedure + Ask mother to empty the bla vent infection INTRAPROCEDURAL STEPS,Obstetric and Gynecological Nursing gattsamion'on paysical Framination and built. 100.4°F during first 24 hours after delivery consid © 104°F check the following for posible netong st Encourage is my and abdomen) * eh (oul odor oflochia may indicate infection) ; + pands (Tenderness indicates infection) {signs of urinary tract infection F carraion may be Stiga 6 bazaar tage Daceased pulse rate (as lw a8 50) is considered normal during first postpartum week. Dareased BP and/or narrowed pulse pressure are signs of shock, Orhesatic hypotension is common during the early postpartum period. The patient should rise slowly from lying or sting to prevent “blackouts” or falls. Asess BP every hour if patient has been pre-eclamptc. in detecting any deviation from the normal physiological changes. toFoot Examination fo following: Infction, cleanliness, pediculosis, etc. {era and conjunctiva for pallor, and jaundice, signs of infection. Hsing abnormality, discharge, wax accumulation ischarge, (Deviated nasal septum) DNS, epistaxis. Cracked lp, chests dental caries and hygiene, gum swelling o bleeding and coated tounge. metry, shape and lymph adenopathy. {cuamination: Symmetry, shape, primary and s pecially nipples engorgement, adequacy or inadequacy of extremities: Check for any bony deformity, capillary refill. ities: Homans sign, edema, bony deformity and varicose veins ese nd bladder: Constipation, incontinence, retention of urine and signs of wrinary tract infection (UTD). area: Bleeding, discharge, infection, hemorrhoids and hygiene. ‘ny complication in the immediate postnatal period. econdary areola tubercles, inverted or flat nipples and colostrum, Hygiene breast milk member the necessary components ofthe postnatal assessment aue> jereursog‘+ Palpation: Gently palpate each breast it have been emptied at last feel any nodule in the breast, the duct may not n Stoke dowrgard toward the nipple then get remove the miemanualy : ‘Take this opportunity to explain the process of milk production, what to do about engorgement, how to perf seexamination and the questions that she may have about breastfeeding ‘Check for any tenderness, firmness and fullness Check for engorgement of breast, i.e tender, painful and heavy Breast: Soft, engorged, fullness, swelling, redness and tenderness a8 Nipples: Inverted, erected, cracked, bleeding, bruised and presence of colostrum and mi Colostrums: Yellowish fluid rich in antibodies and high in proteins : Engorgement: Occurs by day 3 or 4 due to vasoconstriction as milk production begins : Lactation: Ceases within a week if breastfeeding is never begun or is stopped Help in detection of breast complication that will create dificlty in breastfeeding. Abdomen ‘+ Position the woman for examination + Place a pillow under her head and upper shoulders Have her arms by her sides Expose her abdomen from below the breasts to the symphysis pubis Promotes relaxation of abdominal muscles, Inspection: Perform the following inspection: Shape of abdomen, linea nigra, striae gravidarum and previous surgery scar Afierthe delivery of baby, the uterus (myometrial muscle) is well contracted and retracted with alternate h softening and comes at the level ofthe umbilicus, After 10-14 days the uterus well Become a pelvic orean The ues measures about 20» 127.5 em ength breath ad thickness) a term and welghteaboot £00 6 weeks it returns to pre gravid sate 7.5 x 5x 2.5 em and weight about 60 g Enables visualization of the whole abdomen. Clinical assessment of involution: The clinical assessment is done by noting the height of fundus of the uterus in relat Bladder must be emptied asthe full bladder and bowel may raise the em oe ‘The uterus is to be centralized and with a measuring tape the fundal height is measured above the symp Following delivery the fundus ie bout 13.5 em above the symphysis eee 1g irst 24 hours, the levels remain constant, ther i 24 hours, so that at the end of second week the uterus seep is steady decrease in height _* Subinvolution ofthe uterus occurs when the uterus ie i novreplaga and this mostly due to: ‘not completely contracted and retracted which_gefor requent emptying of bladder sie {rom front to back after voiding and defecating. old wipe aso ‘n should be encouraged. Fe etention of urine Reabtourinate: rative thatthe first three voiding should be measured and it should be at least 150 ce. ent small voiding with or without pain and burning may indicate infection or retention. feruso contract and retract properly and prevent the atonicity of the uterus, fe woman daily about bowel movements, she must not become constipated. towels have not functioned by the second postpartum day, the doctor may start her on mild laxative. fate for the bowel movement. " rage mother to drink extra fluids, oer select fruits and vegetables from her menu, fiber and fluid intake to prevent constipation sage early ambulation for prevention of constipation. Itis the vaginal discharge for the first fortnight during puerperium (Fig. 2) and reaction: Ithas got a peculiar, fishy smell Its reaction is alkaline tending to become more acidic toward the end or: Lochia rubra: (1-4 days), red Lochia serosa: (5-9 days), yellowish and pink and pale brownish Lochia alba: (10-15 days), pale white . Blood, shreds of fetal membranes and deciduas, vernix caseosa, lanugo, meconium Lochia serosa: Less RBC but more leucocytes, wound exduate, mucus from the cervix Lochia alba: Plenty of decidual cells, eucocytes, mucus, fatty and granular epithelial cells 3: The average amount of discharge forthe first 5~6 days is estimated to be 250 ml | Moderate Heavy 0 [sx ‘amount | amount Saturated j Less than 6 inch stain on peripad within + hour TRseasing pospartum lochie .ssubinvolution or retained bits of placenta bladder distention does occur, a pouch over the bladder area is observed/felt upon palpation and mother ustally gives important information about the abnormal puerperal state. The | i é i 4 e429 jereursogClinical Nursing Procedures Tae episiotomy thoroughly using flashlight if necessary, for better visibility. © Use the acronym REEDA to guide assessment R - Redness E - Edema E - Ecchymosis D - Discharge from episiotomy ) A - Approximation of suture line (edges of episiotomy) eae as br babonibiaraad provide stz bath an local analgeste medication as adviced by doctor ‘* Reassure the woman and answer to her question that she may have regarding pain, cleanliness and coitus, ‘© Unusual perineal discomfort may be a symptom of impending infection or hematoma. Homan'’s sign * Make the woman lie on her back. ‘+ Press down gently on the patients knee (legs extended flat on bed) ask her to dorsiflex her foot. ‘+ Pain or tenderness in the calf muscles i a positive sign of Homan sign and indication of thrombophlebitis, * To assess for deep vein thrombosis (DVT), the lower extremity should be examined for the presence of red, ‘edematous are: '* Degree of edema in feet and legs should be checked. Provides a sign for detection of deep vein thrombosis, Emotional status ‘* Emotions are an essential element of the postpartum assessment. * Postpartum patients typically exhibit symptoms of the “baby blues” or “ 1m blues” demon irritability and sometimes insomnia, a pee ‘The postpartum blues are caused by a multitud le of factors including hormonal (c ‘maternal role exhaustion and maternal role adjustment, ime This is a normal part of the postpartum experiences. However, Be sh : Givea comfortable positon tothe patient. “ke all the articles to the utility room, ng and reporting the findings should be don, ngs should be done| | | : Clinical Nursing Procedures 4.2 ANTENATAL EXERCISES KEY TERMS + Abdominal exercise * Deep breathing «Pelvic floor exercise INTRODUCTION Exercise during pregnancy is of utmost importance for the nae exercises done during pregnancy. It not only relieves Pregnany intranatal and postnatal period. Antenatal exercises help to de backache, constipation and insomnia. of both the mother and the baby. Antenatal exec Tated ailments but it also helps to cope during pa good posture and relieve minor discomfort DEFINITION “These are systematic exercises to help the pregnant woman adapt to the physical changes in her body during pregnancy tone up the muscles that will be stretched or stressed during pregnancy. PURPOSES To tone the pelvic floor muscles. ‘To reduce lower back stress from the added weight of pregnancy and strengthen upper back ‘To reduce problems related to sluggish circulation such as leg cramps, varicose veins and edema. To increase endurance and muscle control for labor and birth. Strengthen pelvic floor muscles. Strengthen the diaphragm and improve oxygenation of the blood. To speed up return of muscle strength after delivery. ARTICLES MatiDari to do laying exercises comfortably. © Chair to sit ina comfortable position. STEPS OF PROCEDURE PREPROCEDURAL STEPS _ Educate the woman to start exercises slowly and rhythmically. Figure 1: Practice dee? ®Obstetric and Gynecological Nursing nostril breathing (Fig. 2) he purposes of alternate nostril breathing. .d body and reduces anxiety. .o mother and fetus. ation. » the following procedures lung completely. d take a deep breath through the other nostril has much air as possible. Hold for a few seconds h the same nostril. ‘ss with the other nostril closed. ths are to be taken. 3: Abdominal breathing (Fig. 3) = : The following are the purposes of abdominal breathing: Figure 2: Alternate nostril exercise strengthens the deep transverse abdominal muscles, which are main breathing ort of spine. (Anulom-Vilom pranayam) its backache in future. mother to do the following procedures: fortably or kneel on all fours. inand out normally. p the lower part of abdomen below the umbilicus while continuing to breathe ly. 1¢ muscles in the drawn-in position for 10 seconds. up to 10 times exercises (Figs 4A and B) ollowing are the purposes of foot and leg exercise: p improve venous circulation. to prevent swollen ankles and re mother to do the following procedures: legs hanging down or lie down. knees and ankles relaxed. pd and stretch your ankles for 30~ make imaginary circles with your knees for a count of four and then relax fl straighten knees. is exercise before getting up f duce the incidence of varicose veins. Figure 3: Abdominal breathing 45 seconds atleast 12 times. feet, Circle both feet at the ankles at east 20 times in each direction, Repeat 12 times. com resting lst thing at night and several times during day. enn ne TagenraneClinical Nursing Procedures Kegel’s Exercise (Pelvic floor Exercise) (Figs5and 6) the purposes of Kegel’ exercise: forthe stretching during delivery Purposes: Following ar yr muscles fo and vagina and urinary stress incontinence in postnaa Pei ‘© This exercise wll prepare the pelvic floo This helps to prevent problem like prolapsed of uterus Instruct the mother do the following procedures: ‘© Sit, stand or half lie with legs slightly apart Close and draw up around the anal passage as t i {Then draw up around the vagina and urethra as if to stop th hough preventing a bowel action. ¢ flow of urine in mid stream. Hold for 10 seconds, breathe normally and then relax. Repeat up to 10 times. ‘One should aim to do 8-10 sets of 10 contractions eacl Jn per day for maximum benefit, |_| Keger's exercises: Contract your pelvic floor muscles for 3 seconds then relax for3 seconds. Do this 10-15 times several times a day. Athoug here while ying own, these exercises can also be done dung of daly activities, such a8 sing in a meeting, whie stopped ny ala trafic light of when talking on the phone “—_ \ Introital ) |}, margin mang | (eb) _ Figures SA andB: (A) Before Kegesexerce (8) During Kege'’s exercise Pelvic Tilting (Fig. 7) Purposes ‘This exercise will prepare the pelvic Sor stretching during deter Sabian + This exercise wll prevent back ‘abdominal and back muscles. This " ps oes Prevent problems like prolapse of werus na and urary tes ino Instruct, ea the pain f oe pers Procedures: pillows, knees bent and ete aoa” Pain by strengthening mitinence in © Place one hand under tre abdomen mT the back and other ontop of nee, == ‘Tighten the abdominal musc 7 Pelvic titing exercise ‘¢ Breathe normally, hold les and buttocks and pr. : hold for 10 secon Press the smal - ids and relax of th, Gently repeat up to ; 1 bac eee otc et tow cass ander scde, haul lerneath hanexorcise (F181) paling we ee pumone® Of knee rolling ii pevent and minimizes leg cramp save mother 10 40 the following p I ineback with knees bent and feet flat. Hepat shoukders dows flat, lower both the knees BI elf, return them to center and then othe right: ina rhythmical manner the range of moveme procedures and gradually ngexercise (Fig. 9) wing arethe purposes of hip up drawing foffaot siretches the calf muscles and relieves cramp: smother to do the following procedures: intheack ith eet nce bent andthe right ke rag hel ofthe straight leg down as far as possible the leg straight, shorten again by pulling up from the the right knee bent and left one straight. (Figs 108 and 8) Ving are the purposes of Ts muscle, circulation. joints pliable Tower back pain, and strengthen the hip, thigh lor press exercise: h and to do the following procedures: and place the soles of feet together. 7 Boss. igure 9: Hip erneath knees.Clinical Nursing Procedures hands. Inhale and press knees down against ‘While doing this, push hands against knees. + Hold this pressure for a count of five. POSTPROCEDURAL STEPS id i Ith personnel, if she has dizziness, blurry vision, § Seana ielicerGra meaner er Lae ane of fetal movement during or after e Baan mt ‘benefits of exercise during pregnancy like improving sleep, reducing swelling or b Balpeies cate ena aateay cee providing endorphins that can make her feel happier and more and helping to get her shape back faster after delivery. Activities that put the mother at a high risk of injury should b Pend ‘+ Educate the woman to start exercises slowly and rhythmically. * Begin exercise fora few minutes and gradually increase the time, Exercise should be done in moderation and mm exercise should be done 30 or more minutes daily. * Avoid doing exercises immediately after meals, ++ Exercises must be done regularly. * Avoid doing exercises during a hot or humid weather. ‘Stop doing exercises that cause fatigue. Ltd., Delhi; 2004. pp. 7 ivingstone; 2009. pp. 3 : 1975. pp. 75-81. © “Non. Thomson Delmar Learning; 2007 infofru.com/health/pregnancy/ex