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Postpartum Nursing Care Postpartum Lochia

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Postpartum Nursing Care Postpartum  Lochia Powered By Docstoc
					      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




                                                    1
                                                        1
 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             Musculoskeletal
 Level of pain           Gastrointestinal
 Neurological            Genitourinary
 Pulmonary               Integumentary
 Cardiovascular          Psychosocial




   ALTA BATES’ MATERNAL FLOWSHEET




                                                  2
                                                      2
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




           VITAL SIGNS
SBP 90-140, DBP 50-90 (compare to
baseline values)
Pulse 60-100 bpm
RR 10-24 breaths/min




    ASSESSMENT OF
BREASTS & BREASTFEEDING

                           Breasts soft & non-tender;
                           nipples everted
                           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
                           LATCH score




                                                        3
                                                            3
       THE POSTPARTUM DECISION




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 or below 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 – well-
 approximated, 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.




                                                         4
                                                             4
  PAD COUNT: LOCHIA
   Scant: 1-inch stain on pad in 1 hour
   Light/small: 4 inches in 1 hour
   Moderate: 6 inches in 1 hour
   Heavy/large: Pad saturated in 1 hour
   Excessive: Pad saturated in 15 min
   Can estimate blood loss by weighing
   pads
     500 mL = 1 lb. or 454 g




     LOCHIA AMOUNTS




ASSESSMENT OF BOWEL &
  BLADDER FUNCTION
Void without difficulty/pain, urine may be blood-
tinged from lochia
Possible diagnosis: Urinary retention or constipation
r/t post childbirth discomfort or tissue trauma
Expected outcome: Return to normal bowel and
bladder habits, void at least 240mL in 8 hrs, bowel
movement in 3 days without pain.
Nursing interventions: Assist to the bathroom. Use
measures to encourage voiding (privacy). Measure
1st 2 voids after SVD or Foley catheter removed.
Encourage use of peribottle with warm water, fluids,
fiber, frequent ambulation, stool softeners; teach
effects of pain medication.




                                                        5
                                                            5
ASSESSMENT OF EDEMA &
    HOMAN’S SIGN
Assess legs for presence and degree of
edema; may have dependent edema in feet
and legs (facial and hand edema may
indicate preeclampsia)
Assess for Homan’s sign (thromboembolism);
should be negative
Obtain lab values: 8-hr post-delivery
hemogram, urinalysis/C&S, blood type/Rh
status




CHECKING HOMAN’S SIGN




SUMMARY OF POSTPARTUM
  ASSESSMENT & CARE
Box 16-1, page 468: Postpartum
Assessment
Care Path: 24-Hour Vaginal Birth without
Complications, page 470-471




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Description: Postpartum Nursing Care Postpartum Lochia