Monitoring Postpartum Recovery<br />Jolene K. Bethune, RN, MSN<br />
At the completion of this presentation, you will be able to:<br />Perform postpartum checks according to protocol<br />Mon...
You will need:<br />Hand-washing station.<br />Gloves.<br />Oral glass, electronic or tympanic thermometer.<br />Stethosco...
Conductive jelly.<br />Watch with sweep second hand.<br />Sphygmomanometer with assorted cuffs; or continuous non-invasive...
Postpartum Check<br />Frequency of postpartum checks according to protocol:<br />First hour: every 15 minutes<br />Second ...
Vital Signs and Blood Pressure<br />Wash hands and explain the procedure to the patient<br />To make sure the client is as...
Inspect and Palpate the Breasts<br />Raise the head of the bed<br />Ask the patient lower her gown so that her breasts can...
Palpate the Fundus<br />The fundus should be palpated until the 10th day postpartum.<br /> Since patients are usually disc...
Palpate the Fundus<br />Using the ring finger as a fulcrum, roll the hand back and forth gently and note the fundus in rel...
Palpate the Bladder<br />During fundal palpation<br />Bladder palpability<br />Bladder distention could displace the uteru...
Monitor Urinary Output<br />Voiding pattern and amounts voided:<br />Is it at least 30ml/hr?<br />Distention:<br />Is a di...
Monitor Bowel Activity<br />Bowel movements:<br />When was her last BM?<br />Normal, diarrhea or constipation?<br />Hemorr...
Monitor Lochia<br />Detach the peripad from the front to the back to minimize the risk of contaminating the vagina with re...
Instruct the client to assume a side-lying (Sims) position.  <br />If a laceration or episiotomy repair is present, instru...
Monitor Extremities for Thrombophlebits<br />Homan’s sign (calf pain from passive dorsiflexion of foot)<br />Redness, tend...
References <br />Bradshaw, M. J., & Lowenstein, A. J. (2007). Innovative teaching strategies in nursing (4 ed.). Sudbury, ...
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Monitoring Postpartum Recovery Pp Inservice

  1. 1. Monitoring Postpartum Recovery<br />Jolene K. Bethune, RN, MSN<br />
  2. 2. At the completion of this presentation, you will be able to:<br />Perform postpartum checks according to protocol<br />Monitor vital signs and blood pressure<br />Inspect and palpate the breasts<br />Palpate the fundus and bladder<br />Monitor urinary output<br />Monitor bowel activity<br />Monitor lochia<br />Inspect the perineum<br />Monitor extremities for thrombophlebitis<br />Objectives<br />
  3. 3. You will need:<br />Hand-washing station.<br />Gloves.<br />Oral glass, electronic or tympanic thermometer.<br />Stethoscope.<br />Doppler ultrasound stethoscope or probe.<br />
  4. 4. Conductive jelly.<br />Watch with sweep second hand.<br />Sphygmomanometer with assorted cuffs; or continuous non-invasive blood pressure monitoring device.<br />Maternity pads.<br />
  5. 5. Postpartum Check<br />Frequency of postpartum checks according to protocol:<br />First hour: every 15 minutes<br />Second hour: every 30 minutes<br />First 24 hours: every four hours<br />After 24 hours: every 8 hours<br />
  6. 6. Vital Signs and Blood Pressure<br />Wash hands and explain the procedure to the patient<br />To make sure the client is as comfortable as possible, make sure the patient has voided.<br />Take vital signs and make sure they are within normal limits when compared to the baseline. <br />Take vital signs before hands-on procedures; the discomfort of palpating the fundus could reflect in an elevated blood pressure or pulse.<br />
  7. 7. Inspect and Palpate the Breasts<br />Raise the head of the bed<br />Ask the patient lower her gown so that her breasts can be examined<br />Visually inspect and palpate each breast noting:<br />Soft, filling or firm<br />Engorged, reddened, or painful<br />Nipples: erectility, possible cracks and redness<br />
  8. 8. Palpate the Fundus<br />The fundus should be palpated until the 10th day postpartum.<br /> Since patients are usually discharged sooner, patients should be instructed in self-examination so that she can be alert to sudden changes in the uterus. <br />Lower the head of the bed so that the abdomen will be relaxed. <br />Position the ring finger directly over the umbilicus so that the small finger is the closest to the client’s head. <br />
  9. 9. Palpate the Fundus<br />Using the ring finger as a fulcrum, roll the hand back and forth gently and note the fundus in relationship to the umbilicus. Note:<br />Fundal consistency and tone<br />Fundal position – in relationship to the midline. Displacement to the left or right could be caused by a distended bladder.<br />Fundal height – measured in finger breadths from the umbilicus. <br />
  10. 10. Palpate the Bladder<br />During fundal palpation<br />Bladder palpability<br />Bladder distention could displace the uterus<br />Impeding involution<br />Impeding the control of bleeding.<br />
  11. 11. Monitor Urinary Output<br />Voiding pattern and amounts voided:<br />Is it at least 30ml/hr?<br />Distention:<br />Is a distended bladder displacing the uterus?<br />Pain:<br />Is voiding painful, burning or itching?<br />S/S of what?<br />
  12. 12. Monitor Bowel Activity<br />Bowel movements:<br />When was her last BM?<br />Normal, diarrhea or constipation?<br />Hemorrhoids:<br />Are there hemorrhoids present?<br />Is there active bleeding<br />Bowel sounds: auscultate all four quadrants:<br />Especially C/S patients; why?<br />Normo-, hyper- or hypoactive?<br />
  13. 13. Monitor Lochia<br />Detach the peripad from the front to the back to minimize the risk of contaminating the vagina with rectal discharge. Note:<br />Type and amount – rubra (dark and red); serosa (serous or brown)<br />Four to eight saturated pads per 24 hours is normal. <br />Presence of odor – could indicate infection<br />Presents of clots – could indicate retained placental tissue or inadequate uterine contraction. <br />
  14. 14. Instruct the client to assume a side-lying (Sims) position. <br />If a laceration or episiotomy repair is present, instruct the client to flex the top leg to minimize the strain on the repair. <br />Gently separate the buttocks and inspect the perineum for:<br />Episiotomy, lacerations and hemorrhoids<br />Bruising, hematoma, edema, discharge, approximation<br />Inspect the Perinuem<br />
  15. 15. Monitor Extremities for Thrombophlebits<br />Homan’s sign (calf pain from passive dorsiflexion of foot)<br />Redness, tenderness or warmth<br />
  16. 16. References <br />Bradshaw, M. J., & Lowenstein, A. J. (2007). Innovative teaching strategies in nursing (4 ed.). Sudbury, MA: Jones and Bartlett Publishers.<br />Mattson, S., & Smith, J. E. (Eds.). (2004). Core curriculum for maternal-newborn nursing (3 ed.). St. Louis, MO: Elsevier-Saunders.<br />McEwen, M., & Wills, E. M. (2007). Theoretical Basis for Nursing (2 ed.). Philadelphia, Pennsylvania: Lippincott Williams & Wilkins.<br />National League for Nursing Accrediting Commission. (2008). 2008 Edition NLNAC Accreditation Manual. New York City. NY: Author.<br />Simpson, K. R., & Creehan, P. A. (2008). Perinatal nursing (3 ed.). Philadelphia, PA: Association of Women’s Health, Obstetric and Neonatal Nurses.<br />Smith, S. F., Duell, D. J., & Martin, B. C. (2000). Clinical nursing skills: basic to advanced skills (5 ed.). Upper Saddle River, NJ: Prentice-Hall, Inc..<br />Swearingen, P. L., & Howard, C. A. (Eds.). (1996). Photo atlas of nursing procedures (3 ed.). Menlo Park, CA: Addison-Wesley Nursing.<br />Wendt, A., Kenny, L., & Stasko, J. (Eds.). (2008). 2008 Detailed test plan for the NCLEX-PN examination-Item writer/item reviewer/nurse educator version. Chicago, IL: National Council of States Boards of Nursing.<br />

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