postnatal assessment.pptx

postnatal assessment

1. KING GEORGE’S MEDICAL UNIVERSITY KGMU COLLEGE OF NURSING TOPIC : POSTNATAL ASSESSMENT SUBJECT : OBSTETRICS AND GYNAECOLOGY PRESENTED BY – MS. SUSHMITA YADAV M.SC.(N) 1 ST YEAR

2. INTRODUCTION 25-02-2023 POSTNATAL ASSESSMENT[KGMUCON] 2 Systematic examination of mother and baby Begins with 4 th stage and extends throughout postnatal period

3. PURPOSES OF POSTNATAL ASSESSMENT 25-02-2023 POSTNATAL ASSESSMENT[KGMUCON] 3 Promote physical and emotional well being Restore health status of the mother Prevent infections and complications

4. PERIOD OF POSTNATAL ASSESSMENT 25-02-2023 POSTNATAL ASSESSMENT[KGMUCON] 4 Immediate : 24 hours after delivery Late : up to 6 weeks Early : up to 7 days

5. POSTNATAL ASSESSMENT PROCEDURE HISTORY COLLECTION Review antenatal, labor, delivery history Receive any previous delivery report Determine educational needs Consider religious and cultural factors Assess for language barriers 25-02-2023 POSTNATAL ASSESSMENT[KGMUCON] 5

6. HISTORY COLLECTION(CONT…) 6. Family profile : Support person No. of children Occupation Educational status Socioeconomic status 7. Pregnancy history: Para Gravida EDD ( expected date of delivery) Any pregnancy complications 25-02-2023 POSTNATAL ASSESSMENT[KGMUCON] 6

7. HISTORY COLLECTION(CONT…) 8. Delivery history Date and time of delivery Duration of labor Type of delivery Labor complications 9. Baby condition Birth weight Sex Any difficulty at birth Breastfeeding Congenital anomalies 25-02-2023 POSTNATAL ASSESSMENT[KGMUCON] 7

8. 2. PREPARATION OF ARTICLES ARTICLES PURPOSES Handwashing Maintain aseptic technique Draw sheet To cover the bed A pair of gloves Maintain aseptic technique Mask Personal protection and prevent cross infection Weighing machine Measure weight of mother Bp apparatus Measure blood pressure of mother Measuring tape Maintain SFH ( symphysio fundal height ) 25-02-2023 POSTNATAL ASSESSMENT[KGMUCON] 8

9. PREPARATION OF ARTICLE (CONT…) ARTICLES PURPOSES Sanitary pad To apply for vaginal discharge Cotton swabs To clean area for vaginal discharge TPR tray To measure vitals Perineal examination tray If required 25-02-2023 POSTNATAL ASSESSMENT[KGMUCON] 9

10. 3. PREPARATION OF PATIENT AND ENVIRONMENT 25-02-2023 POSTNATAL ASSESSMENT[KGMUCON] 10 Maintain privacy Provide comfort Room should be warm Explain procedure to patient

11. IMMEDIATE POSTNATAL ASSESSMENT 25-02-2023 POSTNATAL ASSESSMENT[KGMUCON] 11 The 1 st hour after delivery of placenta is a critical period

12. 1. Assessment Assess maternal history of etiologic of previous postpartum hemorrhage. Assess blood loss Evaluate presence of blood clots Note number of pads saturated in 1 hour Assess for vital signs – temperature, pulse, blood pressure, respirations Assess for intake and output chart 25-02-2023 POSTNATAL ASSESSMENT[KGMUCON] 12

13. 2. INSPECT 25-02-2023 POSTNATAL ASSESSMENT[KGMUCON] 13 THE INTACTNESS OF PERINEAL REPAIR Episiotomy wound inspection for assessment of wound infection

14. 3. PALPATE Steps of procedure Rationale Assess location and firmness of the fundus and fundal height. Soon after delivery fundus will be at the level of umbilicus The bladder distention and catheterize if needed Distended bladder prevent uterine involution 25-02-2023 POSTNATAL ASSESSMENT[KGMUCON] 14

15. 4. BONDING 25-02-2023 POSTNATAL ASSESSMENT[KGMUCON] 15 Help With Colostrum Feeding Of Baby Soon After Birth

16. EARLY POSTPARTUM ASSESSMENT 25-02-2023 POSTNATAL ASSESSMENT[KGMUCON] 16 When mother is shifted to postnatal ward

17. 1. RECORD VITAL SIGNS Postnatal Normal Vital Signs Are: Temperature - 100°F Pulse – 56 beats/min Respiration – 16 breath/min Blood pressure – 110/65 mmHg 25-02-2023 POSTNATAL ASSESSMENT[KGMUCON] 17

18. 2. HEIGHT AND WEIGHT MEASUREMENT 25-02-2023 POSTNATAL ASSESSMENT[KGMUCON] 18 Generally , 5-6 kg weight loss after delivery Further 2-3 kg during puparium

19. 3. GENERAL PHYSICAL EXAMINATION General Appearance – Nourishment : Well Nourished / Undernourished Body Build : Thin / Obese / Healthy Healthy / Unhealthy Activity : Active / Dull / Tired 25-02-2023 POSTNATAL ASSESSMENT[KGMUCON] 19

20. GENERAL PHYSICAL EXAMINATION ( CONT…) Mental Status- Consciousness : Conscious, Delirious Talking Incoherently Look : Anxious / Worried / Depressed Body Posture : Lordosis / Kyphosis / Scoliosis Movement : Any Limb 25-02-2023 POSTNATAL ASSESSMENT[KGMUCON] 20

21. GENERAL PHYSICAL EXAMINATION ( CONT…) Skin Condition – Color : Pallor / Jaundice / Cyanosis / Flushing Texture : Moist / Dry Skin Turgor : Hydrated / Dehydrated Temperature : Warmth / Cold / Clammy Lesions : Macula / Papules / Vesicles / Wpunds Presence Of : Spider Nevi, Palmar Erythema, Superficial Varicosities Hyperpigmentation Of : Areola Nevi, Line Nigra, Chloasma 25-02-2023 POSTNATAL ASSESSMENT[KGMUCON] 21

22. 4. HEAD AND FACE Scalp : check for cleanliness, condition of hair , dandruff , pedicle Face : pale/ flushed / fatigue / pain / fear / anxiety 25-02-2023 POSTNATAL ASSESSMENT[KGMUCON] 22

23. Eyes : Eyelids – edema/ lesions Eyeballs- sunken/ protruded Conjunctiva – pale/ red/ purulent discharge/ Sclera –jaundiced Cornea or iris –irregularities and abrasion Pupils –dilated/ constricted/ reaction to light Vision –normal/ myopia / hyperopia 25-02-2023 POSTNATAL ASSESSMENT[KGMUCON] 23

24. HEAD AND FACE(CONT..) Ears : External ear –any discharge/ cerumen Tympanic membrane –perforations / lesions/ bulging Hearing –hearing acuity Nose: External nares –crusts/discharges Nostrils –inflammation of mucous membrane/ septal deviation 25-02-2023 POSTNATAL ASSESSMENT[KGMUCON] 24

25. HEAD AND FACE(CONT..) Mouth And Pharynx: Lips –Redness, Swelling, Crusts Odor Of The Mouth –Angular Stomatitis, Foul Smelling Teeth –Discoloration And Dental Caries Mucous Membrane –Ulceration And Bleeding, Swelling, Pus Formation Tongue –Pale, Dry Lesions, Sores, Tongue Tie 25-02-2023 POSTNATAL ASSESSMENT[KGMUCON] 25

26. 5. NECK Lymph Node: Enlarged , Palpable Thyroid Gland : Enlarged Range Of Motion : Flexion, Extension, And Rotation 25-02-2023 POSTNATAL ASSESSMENT[KGMUCON] 26

27. 6. CHEST AND THORAX Shape , Symmetry, Of Expansion, Posture Breath Sound : Wheezing, Rales, Crepitation, Pleural Rubs And Stridor Heart Sound : Size And Location, Murmurs 25-02-2023 POSTNATAL ASSESSMENT[KGMUCON] 27

28. BUBBLEHE 25-02-2023 POSTNATAL ASSESSMENT[KGMUCON] 28 B- Breasts H –Homan Sign E –Episiotomy L –Lochia B –Bowels B -Bladder U -Uterus E –Emotional Status

29. BREAST EXAMINATION : INSPECTION Size Shape Firmness Redness Symmetry 25-02-2023 POSTNATAL ASSESSMENT[KGMUCON] 29 Engorgement Areola –primary and secondary areola Nipples –check for cracks, redness, fissure, flat, inverted or erect Evaluate for mastitis Lumps and axillaries veins can be prominent

30. BREAST EXAMINATION: PALPATION Feel any nodules, lumps in breast Breast engorgement, warmth and ancillary lymph nodes Allow mother to assess her own breasts by doing self –breast examination 25-02-2023 POSTNATAL ASSESSMENT[KGMUCON] 30

31. NURSING INTERVENTION Lactating Mother : Supportive bra Correct position Correct latch –on technique Warm showers Expose to air Non Lactating : Avoid stimulation Wear support bra 24 hours Ice packs or cabbage leaves Mild analgesic for discomfort 25-02-2023 POSTNATAL ASSESSMENT[KGMUCON] 31

32. UTERUS EXAMINATION : INSPECTION Presence of scar or wound on abdomen Size, shape of the uterus Umbilicus –dimple hernia, protruded or not Lactation immediately after birth Consistency –firm / boggy 25-02-2023 POSTNATAL ASSESSMENT[KGMUCON] 32

33. ON OBSERVATION – Presence of striae albicans, striae gravidarum Midline or deviated uterus to the left or right : if deviated , usually sign of full bladder 25-02-2023 POSTNATAL ASSESSMENT[KGMUCON] 33

34. Cont… 25-02-2023 POSTNATAL ASSESSMENT[KGMUCON] 34 Boggy Fundus – Uterine Atony Bulky Uterus – Presence Of Clots/ Retained Product Of Conception Tenderness –Indicates Infection

35. UTERINE EXAMINATION : PALPATE UTERINE INVOLUTION( MEASURE FUNDAL HEIGHT ) 25-02-2023 POSTNATAL ASSESSMENT[KGMUCON] 35 Explain the mother about abdominal palpation Empty bladder Provide position : supine with legs extended

36. 25-02-2023 POSTNATAL ASSESSMENT[KGMUCON] 36 By 10 th -14 th days , uterus becomes a pelvic organ Measure the fundal height by inch tape which indicates uterine involution Palpate fundus with finger breaths from symphysis pubis towards umbilicus and locate fundus

37. CLINICAL MEASUREMENT OF SYMPHYSIOFUNDAL HEIGHT (SFH) Following delivery : fundus lies 13.5cm above symphysis pubis Within 24 hours : no change in fundal height After 24 hours : fundal height decreases by 1 cm to 1.25 cm End of 2 nd week : uterus become pelvic organ 6 th week : complete involution of uterus 25-02-2023 POSTNATAL ASSESSMENT[KGMUCON] 37

38. BLADDER Spontaneous void : 6-8 hours Postpartum diuresis : first 24 hours Encourage frequent voiding : every 4-6 hours Monitor intake and output for 24 hours Early ambulation Void within 4 hours after birth Catheterize if unable to void 25-02-2023 POSTNATAL ASSESSMENT[KGMUCON] 38

39. BOWEL Assess for presence of bowel sound. Spontaneous bowel movements occur on 2nd to 3rd postpartum day. Assess for gastric motility. NURSING INTERVENTION: Increase fiber in diet 6-8 glasses of water or juice Stool softener Laxative Sitz bath for discomfort Medications for hemorrhoids 25-02-2023 POSTNATAL ASSESSMENT[KGMUCON] 39

40. LOCHIA DISCHARGE 25-02-2023 POSTNATAL ASSESSMENT[KGMUCON] 40

41. ASSESS FOR LOCHIA Note the character, colors, amount, odor of lochia. Count the number of perineal pads that are saturated in each 8 hours period. Nursing intervention: Teach mother and family members about perineal care for maintaining the perineal hygiene. 25-02-2023 POSTNATAL ASSESSMENT[KGMUCON] 41

42. Provide sitz baths or dry heat as per hospital protocol. Sit in the tub on the towel for 15 to 20 minutes. If the water starts getting cool, then let some water out and add new warm water. 25-02-2023 POSTNATAL ASSESSMENT[KGMUCON] 42

43. Educate the mother for following sign and symptoms to be informed to health care provider immediately: Heavy bleeding that soaks more than 1 pad per hour for 3 hours. Blood clots or bright red blood after the 4th day Bad ordor of lochia (fishy smell) Any lochia during the first 2 weeks Bad cramps and heavy bleeding Fever over 100.4" F Severe pain in lower abdomen 25-02-2023 POSTNATAL ASSESSMENT[KGMUCON] 43

44. EPISIOTOMY ASSESSMENT: Inspect perineum, vulva and anus daily If perineal wound is present inspect, it daily frank bleeding and signs of infection If perineal wound is present, it has to be inspected for infection. PERINEAL AREA ASSESSMENT: Pull the labia from front to back . Check the episiotomy or areas of vaginal tearing Look for hematoma formation-a collection of blood in between tissue Look for hemorrhoids (developed during pregnancy or during labor from the pushing process)/anal varicosities. 25-02-2023 POSTNATAL ASSESSMENT[KGMUCON] 44

45. REEDA ASSESSMENT: R: Redness E: Edema E: Ecchymosis D: Discharge A: Approximation/closeness of skin edges. 25-02-2023 POSTNATAL ASSESSMENT[KGMUCON] 45

46. HOMANS' SIGNS: EXTREMITIES Inspect the legs/extremities for signs of thromboembolism and assess Homans' sign. Homans' signs assessment: Make the patient lie on supine position in bed. Keep the sole of the patient's foot on non- dominant hand. The calf is flexed at a 90°angle. Manipulates the foot in a dorsiflexion movement . If pain is felt in the calf, the Homans' sign is said to be positive. Homans' sign is positive that indicates deep vein thrombosis. Do the procedure on both legs. 25-02-2023 POSTNATAL ASSESSMENT[KGMUCON] 46

47. EMOTIONAL STATUS: Assess emotional risks and evaluate the interaction and care skills of the mother and family with the infant. Assess about emotional well-being, family and social support and their usual coping strategies of mother for dealing with day-to-day matters. Mother may need support and education regarding the care of new baby. At 10-14 days after birth, assess the woman's psychological well-being for postnatal depression. Encourage women and their families/partners to tell their health care professional about any changes in mood, emotional state and behavior that are outside of the woman's normal pattern. 25-02-2023 POSTNATAL ASSESSMENT[KGMUCON] 47

48. LATE POSTNATAL ASSESSMENT Assess following history of mother who came for follow-up and postnatal check up: Postnatal complications- urinary tract infections, breast engorgement or any other problems. Physical symptoms, such as bleeding on occasion, having any abdominal discomfort, vaginal or perineal pain, urinary tract infections, breast engorgement or any other problems. 25-02-2023 POSTNATAL ASSESSMENT[KGMUCON] 48

49. Physical symptoms, such as still Bleeding on occasion, having any abdominal discomfort, vaginal aur perineal pain, urinary or anal incontinence or breast pain. Emotional status of mother. If she is feeling overwhelmed, anxious, or depressed. Breastfeeding status-exclusive breastfeeding or any breastfeeding problems. 25-02-2023 POSTNATAL ASSESSMENT[KGMUCON] 49

50. SUMMARY Postnatal care includes systematic examination of mother and baby and appropriate advice given to the mother during postpartum period. Over 5,36000 women die annually from complications during pregnancy, child birth or the postpartum period. Nearly all of this death occur in developing countries where fertility rates are higher and a women’s life time risk of dying during pregnancy or child birth. Almost all 95% of this maternal death occurred in Africa and Asia. The burden of maternal complications and deaths is also highest in the first few days of delivery. 25-02-2023 POSTNATAL ASSESSMENT[KGMUCON] 50

51. RECAPITALIZATION: What is postnatal period? Explain bubblehe . ASSIGNMENT: Write role of nurse during postnatal assessment by 28 /02/2023. 25-02-2023 POSTNATAL ASSESSMENT[KGMUCON] 51

52. BIBLIOGRAPHY Book refrences : Swain Dharitri , Obstetrics Nursing Procedure Manual. 2 nd ed. New Delhi: Jaypee Brothers Medical Publishers;2023. Sharma JB, Midwifery And Gynaecological Nursing. 1 st ed. New Delhi: Aviachal Publishing Company;2018. Internet refrences : https://www.slideshare.net/ImranNurManik/postnatal-care-manik https://www.slideshare.net/TriptiGoarya/postnatal-assessment-249381381 https://www.slideshare.net/sakshirana18/postnatal-assessment-147054988 25-02-2023 POSTNATAL ASSESSMENT[KGMUCON] 52