POSTNATAL ASSESSMENT

Postnatal care (PNC) for the mother should respond to her special needs, starting within an hour after the delivery of the placenta and extending through the following six weeks. The care includes the prevention, early detection and treatment of complications, and the provision of counselling on breastfeeding, birth spacing, immunization and maternal nutrition. To standardise the PNC service, you are advised to use the screening, counselling and postnatal care cards. These cards ensure that you have covered all the essential steps in every home visit.
this ppt is beneficial for nursing and obstetric and gynaecology students.

1. POSTNATAL ASSESSMENT BY –TRIPTI GOARYA

2. INTRODUCTION Puerperium is the period following childbirth during which the body tissues, specially the pelvic organs revert back approximately to the pre-pregnant state both anatomically and physiologically.

3. DEFINITION According to D. C. Dutta Postnatal care includes systematic examination of the mother and baby and appropriate advice given to mother during post-partum period. According to Nadine M. Jacobson Postpartum care encompasses management of the mother, newborn, and infant during the postpartum period. The period usually is considered to be the first few days after delivery, but technically it includes the six week period after childbirth up to the mother’s postpartum check-up with her health care provider.

4. HISTORY TAKING Identification data Present obstetric history- nausea,vaginal bleeding,urin frequency. Past obstetric history - no.of child, complication of previous preg , miscarriage Family history Medical / surgical history Personal history Menstrual history Contraception psychological

5. PHYSICAL EXAMINATION General examination Mental status Skin condition Head Eyes Ear Nose Mouth, pharynx and throat Neck chest Breast Abdomen Perineum , lochia , cervix , vagina , bladder , bowel Extremities Nails

6. POSTNATAL MANAGEMENT

7. BUBBLEHE The nurse should follow an organised method when examining the post partum client , which provides a consistent , quality approach to nursing care .The acronyms , “BUBBLEHE” can serve a helpful reminder of the elements in a postpartum assessment .  

8. BREAST UTERUS BLADDER EMOTIONAL STATUS BOWEL HOMAN’S SIGN EPISIOTOMY LOCHIA BUBBLEHE

9. BUBBLEHE Assessment • Breasts — Soft, filling, firm, Nipples • Uterus — consistency, position, height • Bladder — voiding pattern • Bowels — bowel sounds, hemorrhoids, • Lochia — type, amt, clots, odor • Episiotomy— laceration, bruising, swelling • Homan sign — present or not • Emotional status — bonding, blues

10. Breast On palpation after delivery , breast usually are enlarged , soft and warm and contain only small amount of colostrums . The mother may be experience breast engorgement , which may begin as a tingling sensation in her breast , 2-4 days after delivery Milk is released through infant sucking , manual expression , or pumping Analgesic given if breast pain occur . Provide cabbage leaves to reduce pain &swelling.

11. Uterus :- Size, Weight , location and firmness Immediately after delivery , the uterus begins the process of involution or reduction in size. The uterus weight about 100 g , measuring. At the end of 6 th week weighs 50-100g. A bulky uterus may indicate the presence of blood clots or retained placental beats or also due to a full rectum . , Tenderness of the uterus suggest infection . Normally uterus should be contracted ,hard and not painful if touched. the height of uterus should be measured After the 1 st postpartum day ,the fundus involute 1-2 cm. Per day.

12. Management of Bleeding After delivery of the placenta 20 to 30 units of oxytocin often is added to the intravenous solution . Or can administering oxytocin intra muscular 10 units . Initiating early breast feeding or performing nipple stimulation is employed . If remains boggy than despite massage and oxytocin administration or if bleeding continue than pharmacological agent start :- Methargin (0.25 mg)IM Prostaglandin which can be given when methargin can not stop bleeding or contraindicated .

13. Uterine pain The key to effective relief from after birth pain is an empty bladder . Once the bladder is empty, the woman may lie prone with a pillow under her lower abdomen , which keeps it contracted and thus eliminate after birth pain . Analgesic can be effective .

14. In the immediate postpartum period, the bladder is congested , edematous and hypotonic from the effect of labour . After delivery , the client should urinate within 4 hours , at least 300 ml , with completely emptying the bladder . After delivery within 24 hour cause diuresis up to 3000 ml per day occurs in the first 2 to 3 days . Should be noted and informed to the physician . Straight catheterization must be done . Bladder

15. Bowels Following vaginal delivery , bowel movement normally occurs after 2 to 3 days .when gastric motility does not return by 2-3 days , constipation occur . The client should be encouraged to drink should be 6to 8 glasses of fluid daily ,eat a high fiber diet (whole grains , legumes , vegetable and fruits ) Sitz bath Enema may be given Stool softner dulcolax , topical ointment etc.

16. Lochia when the bleeding is heavy, ensure that the source of bleeding , it may be laceration . Saturation of vaginal pad with in 15- 30 min . CBC may indicate 1.0 to 1.5 g/dl decrease in Hb level.

17. Episiotomy An episiotomy is the surgical incision made to enlarge the vaginal opening for delivery of the baby’s head . Care of the vulva includes applying ice packs to the perineum for the first 24 hour. Should not be applied to the directly to the skin , should be wrapped with an absorbent disposable type of covering . After the first 24 hour following delivery . a sitz bath with warm water may be used . The client should be taught perineal hygiene . including daily wash with warm water and mild soap. The perineum should be cleaned after each voiding . Perineal pad frequently changes after each voiding , removing pad from front to back , and hand washing will help decrease the risk of infection . To perform perineal exercises such as kegel exercise .

18. Homan’s sign Assessment of homan’s sign must be done for all postpartum cliens,to check for presence of thrombophlebitis . Should be perform leg exercise, to teach the client to flex and extends the both leg and feet alternatively . Keeping the leg uncrossed while seated. Not flexing the leg at groin . Resting the leg without putting pressure on the back of the knees. Wearing support hose and antiembolism stocking . Padding pressure points during lithotomy position .

19. Emotional status The immediate postpartum period is an emotional roller coaster , and almost any emotion may be observed . They may also be exhausted and need sleep and rest to restore their bodies to health . In this “taking in phase” mother wish to meet their own rest and nutritional needs before focusing their energy on newborns. They want to relieve the experience by talking about the process of labour and delivery.

20. Guidance and instruction in preparation for home care :- Following normal delivery, mothers are discharged on the 2 nd and 3 rd post partum day , the midwife must appraise the mother needs for instruction and guidance for the care of :- self baby self in relations to others

21. SELF :- Measure to improve her general health . Perineal care Breast care Care of breast during breast engorgement Postnatal exercises Gradual return to day to day activities Return for 6 th week post partum check up .

22. BABY :- Breastfeeding If being bottle feed;Care and preparation of bottles and nipples or container Hold the baby during feeding Baby bathing and dressing including care of genital area Cord care Prevention and treatment for diaper rash . Checking babies temperature . Recognizing baby’s needs Check-up and immunization for the baby.

23. SELF IN RELATION TO OTHERS Sibling and husband. Family planning Resumption of sexual intercourse after six weeks,

24. Myths and fact related to postnatal diet Myths:-recommendation of eating bland food like khichdi during postpartum period. Fact:- bland food like khichdi,rice etc are easily digested as well as the it provides immediate energy to the mother for day to day activities. myths:-eating extra ghee(butter)helps recover faster, strengthens joints. fact:-a mother’s baby already has enough fat reserves that it gathered during pregnancy. increase the intake of ghee will lead to weight gain in the postpartum period. instead of eating ghee laden dry fruits laddoos , drinking a glass of milk dry fruits in it.

25. 3. Myths:- more the milk the mother drinks, more the milk she will make Fact:- there is no scientific evidence confirming the above claim. instead a balanced diet of rich in protein, minerals and vita. will help increase breast milk supply. myth:-avoid eating spicy food. fact:- even though spicy food does affect the flavor of breast milk slightly; unless the baby seems uncomfortable or fussy after a feed, it’s ok to eat spicy food. Myth: drinking carom( ajwain ) help to digest and speed up recovery. fact:- even though there is no scientific evidence in support of the claim, there is no harm, observed in having it. provided you have a nutritious diet along with this.

26. 6.Myth: breastfeeding moms can’t have their morning coffee. Fact: coffee contains caffeine, which if limited moderate amounts has been proven to be harmful, even though over dose of caffeine may cause related issues. 7.myth:Skip the “gassy "food like broccoli, cabbage etc. fact : cabbage, broccoli and many other vegetables are super foods and a mother needs all the super nutrients she can get as her body works to produce milk for the baby.

27. 8.myth:breastfeeding moms require special vitamin supplements . Fact: the best source of nutrient for the baby mother is a varied. 9.myth: eating yogurt by nursing mother causes infant diarrhea indigestion and gas. Fact: yogurt is a known pro-biotic and source of calcium and it is condition like, diarrhea, indigestion and acidity