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Nursing Care in the Postpartum Period
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Postdelivery Assessment
Greatest risk for postpartum complications is during the first 24 hours after delivery Identification of potential problems; immediate intervention; reassessment
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Assessment includes: Condition of uterus Amount of bleeding
Bladder & voiding Vital Signs Perineum
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Fundus = Palpated to assess firm & well contracted
Bleeding = Assess drainage on pad Pulse & Bp = Assess cardiovascular function Perineum = Assess for signs of hematoma, lacerations, & edema
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Assessments are q 15 minutes for the first hour post delivery
Temperature is taken at the end of first hour Transferred to Postpartum Unit when stable
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Admission to Postpartum Unit
Report between L&D Nurse & PP Nurse Preparations made for receiving the Mother such as: Room Ready IV Pole Admission Assessment Vital Signs Equipment
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Assessment Assessment is immediately upon arrival to the PP Unit
Complete Assessment BUBBLE HE & VS included Reassessment q Hour x 4 Hours Uterus, Lochia, Bladder, Bp & Pulse Abnormal Findings
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Vital Signs Elevated Temperature Bradycardia
Normal finding for first 24 hours Sign of Dehydration Sign of Infection Bradycardia Normal Finding
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Lowered Blood Pressure
Tachycardia Infection Hemorrhage Pain Anxiety Lowered Blood Pressure Orthostatic Hypotension Shock
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Elevated Blood Pressure
Pregnancy-induced Hypertension
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Breasts Soft, firm, can be lumpy Secretion of Colostrum Engorgement
Assessment of: Breasts Nipples
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Uterus Process of Involution Height Consistency Location
First Day = at Umbilicus Decreases 1 FB per Day Consistency Firm, Round, Smooth; Not “Boggy” Location Midline
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Bladder Often times will be catheterized in L&D post delivery
Assess for Bladder Distention: Uterine Atony UTI Recatheterize in 6 hours if not voided (Dr.) Measure Urine Output
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Bowel Assessment for Bowel Sounds Complaints of Gas Pains
Usually has Stool 2-3 days post delivery May need medication for gas pains, laxatives, stool softeners, enemas
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Lochia Amount Color Estimate of Drainage Number of Pads Rubra Serosa
Alba
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Episiotomy Assessment for: Hematomas Ecchymosis Edema Erythema
Intact Suture Line Signs of Infection
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Homan’s Sign Assessment for Thrombophlebitis Unilateral Findings
Swelling Reddness Warmth Pain Unilateral Findings C/S Mother at Higher Risk
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Emotional Status Can have Mood Swings
Observing Bonding Behavior & Ability to give Infant Care Rubin’s Phases En face Engrossment
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Patient Post Epidural Assessment of Lower Extremities for:
Sensation Movement Remains on Bedrest
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Post C/S Additional Assessment: Incision Fluid Intake Bladder & Bowel
Ambulation/Orthostatic Hypotention Thrombophlebitis
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Documentation of Findings
Assessment Checklist Form Graphic Sheet Narrative Notes Admission Daily
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Nursing Diagnoses Throughout the chapter NCP
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Interventions Prevention of Complications Reduce Discomfort ADL
Nutrition Rest & Sleep Ambulation Bathing Kegel Exercises
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Predischarge Rubella Vaccine Rho Immune Globulin Titer
Hypersensitivity to eggs Administration of Vaccine Patient Teaching Rho Immune Globulin Criteria Administration of Rhogam
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Discharge Instructions for Mother & Infant Care Next Appointment
Referrals
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