Jolene K. Bethune, RN, MSN
<ul><li>At the completion of this presentation, you will be able to: </li></ul><ul><li>Perform postpartum checks according...
<ul><li>Hand-washing station. </li></ul><ul><li>Gloves. </li></ul><ul><li>Oral glass, electronic or tympanic thermometer. ...
<ul><li>Conductive jelly. </li></ul><ul><li>Watch with sweep second hand. </li></ul><ul><li>Sphygmomanometer with assorted...
<ul><li>Frequency of postpartum checks according to protocol: </li></ul><ul><li>First hour: every 15 minutes </li></ul><ul...
<ul><li>Wash hands and explain the procedure to the patient </li></ul><ul><li>To make sure the client is as comfortable as...
<ul><li>Raise the head of the bed </li></ul><ul><li>Ask the patient lower her gown so that her breasts can be examined </l...
<ul><li>The fundus should be palpated until the 10 th  day postpartum. </li></ul><ul><li>Since patients are usually discha...
<ul><li>Using the ring finger as a fulcrum, roll the hand back and forth gently and note the fundus in relationship to the...
<ul><li>During fundal palpation </li></ul><ul><li>Bladder palpability </li></ul><ul><li>Bladder distention could displace ...
<ul><li>Voiding pattern and amounts voided: </li></ul><ul><li>Is it at least 30ml/hr? </li></ul><ul><li>Distention: </li><...
<ul><li>Bowel movements: </li></ul><ul><li>When was her last BM? </li></ul><ul><li>Normal, diarrhea or constipation? </li>...
<ul><li>Detach the peripad from the front to the back to minimize the risk of contaminating the vagina with rectal dischar...
<ul><li>Instruct the client to assume a side-lying (Sims) position.  </li></ul><ul><li>If a laceration or episiotomy repai...
<ul><li>Homan’s sign (calf pain from passive dorsiflexion of foot) </li></ul><ul><li>Redness, tenderness or warmth </li></ul>
<ul><li>Bradshaw, M. J., & Lowenstein, A. J. (2007).  Innovative teaching strategies in nursing  (4 ed.). Sudbury, MA: Jon...
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Monitoring Postpartum Recovery Pp Inservice

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Monitoring Postpartum Recovery Pp Inservice

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

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