Postnatal Nursing Care

POSTNATAL NURSING CARE a. Physical examination 1) General Condition. Assess the mother's general condition, whether she feels tired or whether she is fresh. This will affect the mother's acceptance of the baby as well as the mother's ability to breastfeed and care for the baby. 2) First hour. Postnatal crisis, carefully assess bleeding by palpating the uterine fundus frequently (15 minute intervals), inspecting the perineum for visible bleeding and evaluating vital signs. 3) Assess temperature, pulse, respiration and blood pressure every 4-8 hours during the first postpartum day. Note in particular: a) Increased temperature which can be caused by dehydration, onset of lactation or leukocytosis b) Hypotension with a fast and weak pulse (>100x/minute) which can indicate bleeding and shock. c) Orthostatic hypotension due to cardiovascular readjustment to pre-pregnancy state. d) Increased blood pressure. e) An increased pulse indicates bleeding. 4) Head and Face a) Eyes Anemic conjunctiva indicates anemia due to bleeding during delivery. b) Nose Ask the mother if she has a cold or a history of sinusitis. Infections in postpartum mothers can increase energy requirements. c) Ears Assess hearing in the right and left ear, whether there is a history of otitis media, cleanliness of the earlobe or ear canal. d) Mouth and Teeth Ask the mother if she has stomatitis or cavities. Cavities can become a port de entree for microorgasms and they can circulate systemically. 5) Neck Assess for enlarged lymph nodes under the ear and enlarged thyroid gland. Enlarged lymph nodes indicate infection, supported by other signs such as hyperthermia, pain, swelling. 6) Breasts a) General Impression Gently hold the breast and assess whether it is symmetrical between right and left, hard, tender and warm. Assess whether there is a breast milk dam (breast engorgement) which causes pain to the mother or a mass, by palpation. Mastitis can even be found with signs of redness, swelling, heat, pain. b) Nipples Assess whether breast milk or colustrum has come out by squeezing the mother's nipple. Also assess nipple cleanliness. Assess the nipples for cracks, fissures and bleeding. c) Breastfeeding Assessment The criteria for evaluating how to breastfeed are the relationship between mother and baby, how the baby breastfeeds, position when breastfeeding, let-down, condition of the nipple, baby's response and mother's response. 7) Abdomen a) Circumstances Assess whether there are striae and linea alba. Assess the condition of the abdomen, whether it is soft or hard. A firm abdomen indicates good uterine contractions so that bleeding can be minimized. A soft abdomen indicates otherwise and can be massaged to stimulate contractions. b) Diastasis of the rectus abdominis Rectus abdominis diastasis is a stretch in the rectus abdominis muscle due to an enlarged uterus. If palpated, this stretch resembles a gap extending from the xiphoid process to the umbilicus so that its length and width can be measured. This diastasis cannot reunite like before pregnancy but can be approached by motivating the mother to do postpartum exercises.The way to check for rectus abdominis diastasis is to ask the mother to sleep on her back without a pillow and raise her head, without propping it up. Then palpate the abdomen from below the xiphoid process to the umbilicus then measure the length and width of the diastasis. c) Uterine fundus Palpate the uterine fundus from the umbilicus downwards. Determine the height of the uterine fundus (example: 1 finger above the center, 2 fingers above the center, etc.), the position of the fundus, whether central or lateral. The lateral position is usually encouraged by a full bladder. Contractions also need to be checked, weak contractions or a soft feeling in the stomach indicates that uterine contractions are less than optimal, thus allowing bleeding to occur.Assess the uterine fundus daily, namely its strength and location, ensuring that the client empties the bladder before palpation is performed. -The uterus does not progressively decrease in size or return to the lower pelvis. -The uterus remains loose or contracts poorly -Persistent back pain or pelvic pain -Heavy vaginal bleeding d) Bladder Assess by palpation the urine content in the bladder. A round and soft bladder indicates that a lot of urine has been retained and in this case it can interfere with uterine involution, so it must be removed.Assess the level of bladder distension frequently in the first 8 hours after delivery, measure urine output, urinate in small quantities and urinate frequently in succession indicating urinary disorders.