The document provides guidance on conducting a postnatal examination. The exam involves assessing vital signs, the breasts, abdomen, bladder, bowels, and lochia. Key things to check include temperature, pulse, blood pressure, skin, breasts for lumps or discharge, the uterus for size and tenderness, bladder fullness, bowel sounds, and character of lochia including color, odor, and amount. The exam aims to monitor the health of the mother and newborn and identify any issues requiring further care.
BREAST CARE (PRECEDURE)
PRESENTED BY – M. MANJOT KAUR GILL
DEFINITION
Breast care is the process of cleaning the breast of mother that helps in maintaining hygiene and prevent from cross infection during feeding .
PURPOSES
To clean the breast.
To detect any abnormalities.
To stimulate milk ejection .
To prevent local infection.
To prevent breast complications.
INDICATIONS
Postnatal mothers.
Before and after breastfeeding.
Cracked nipple.
Pt. who are not able to take self care.
Nipple with unhygienic conditions.
PREPRATION OF ARTICLES
Screen
Mackintosh with towel.
A bowel with 2-3 cottons.
A bowel with boiled and cool cotton swabs.(12-15)
A bowel with dry gauze pieces.(12-15)
Kidney tray/Paper bag
Nursing records.
STEPS OF PROCEDURES.
Arrange all articles .
Explain the procedure to the mother about benefit of breast care.
Provide screen for privacy.
Provide comfortable position to the mother preferable sitting position.
Spread the mackintosh with towel over the lap of the mother.
Wash hand
Stand on the right side of the mother whole giving care.
Expose both the Brest firth and check symmetry.
Inspect the Breast for size and any abnormality.
-Inverted nipple
-Cracked nipple.
-Retracted nipples
-Any sign of infection
Palpate the breast from superficial to deep for tenderness, pain, tumors, exaggerated lymph nodes, etc
Squeeze the breast and observe the secretions.
Clean the secretion with the pad and throw In paper bag.
Take the cotton swab and squeeze excess water holding the tail and keeping above the hand.
Clean the breast in the following order—nipple-primary areola-secondary areola- total breast –lower crease-axilla.
Dry the breast with gauze pieces following the same order.
Cover the further breast exposing the near one.
Inspect, palpate and squeeze in the previous manner.
Assist the mother to do hand wash for return demonstration.
Assist the mother to clean the breast in same manner.
Put the baby on to the breast.
Make the mother and baby comfortable after care.
Record any abnormal findings.
SUMMARIZATION
Definition
Purposes
Indications
Articles
Steps of procedure
BIBLIOGRAPHY
Ghai, sandhya .(2018) clinical nursing procedures. New Delhi: satish kumar. Pp.613-616.
Dharitri, swain.(2017) obstetrics nursing procedure manual. New Delhi: jappee brothers. Pp. 158--159.
THANKS
Health education on Antenatal care include definition,aim, objectives, registration, antenatal check up, immunization, iron & folic acid, diet, bowel care, cleanliness, clothing, shoes, dental care, care of breast, sleep, exercise, coitus, travel, smoking & alcohol, family support & dangers signs during pregnancy.
Postnatal care (PNC) for the mother should respond to her special needs, starting within an hour after the delivery of the placenta and extending through the following six weeks. The care includes the prevention, early detection and treatment of complications, and the provision of counselling on breastfeeding, birth spacing, immunization and maternal nutrition. To standardise the PNC service, you are advised to use the screening, counselling and postnatal care cards. These cards ensure that you have covered all the essential steps in every home visit.
this ppt is beneficial for nursing and obstetric and gynaecology students.
Preparation for delivery of mother, baby and midwife and equipmentsDR MUKESH SAH
In addition to their delivery bags, midwives “carry” many other invaluable tools ... family planning, delivery preparation, postnatal counseling and breastfeeding. ... With this equipment, we can recover 80% of newborns. ... “Midwifery feels good when both the mother and baby come out of the labor ward alive.
BREAST CARE (PRECEDURE)
PRESENTED BY – M. MANJOT KAUR GILL
DEFINITION
Breast care is the process of cleaning the breast of mother that helps in maintaining hygiene and prevent from cross infection during feeding .
PURPOSES
To clean the breast.
To detect any abnormalities.
To stimulate milk ejection .
To prevent local infection.
To prevent breast complications.
INDICATIONS
Postnatal mothers.
Before and after breastfeeding.
Cracked nipple.
Pt. who are not able to take self care.
Nipple with unhygienic conditions.
PREPRATION OF ARTICLES
Screen
Mackintosh with towel.
A bowel with 2-3 cottons.
A bowel with boiled and cool cotton swabs.(12-15)
A bowel with dry gauze pieces.(12-15)
Kidney tray/Paper bag
Nursing records.
STEPS OF PROCEDURES.
Arrange all articles .
Explain the procedure to the mother about benefit of breast care.
Provide screen for privacy.
Provide comfortable position to the mother preferable sitting position.
Spread the mackintosh with towel over the lap of the mother.
Wash hand
Stand on the right side of the mother whole giving care.
Expose both the Brest firth and check symmetry.
Inspect the Breast for size and any abnormality.
-Inverted nipple
-Cracked nipple.
-Retracted nipples
-Any sign of infection
Palpate the breast from superficial to deep for tenderness, pain, tumors, exaggerated lymph nodes, etc
Squeeze the breast and observe the secretions.
Clean the secretion with the pad and throw In paper bag.
Take the cotton swab and squeeze excess water holding the tail and keeping above the hand.
Clean the breast in the following order—nipple-primary areola-secondary areola- total breast –lower crease-axilla.
Dry the breast with gauze pieces following the same order.
Cover the further breast exposing the near one.
Inspect, palpate and squeeze in the previous manner.
Assist the mother to do hand wash for return demonstration.
Assist the mother to clean the breast in same manner.
Put the baby on to the breast.
Make the mother and baby comfortable after care.
Record any abnormal findings.
SUMMARIZATION
Definition
Purposes
Indications
Articles
Steps of procedure
BIBLIOGRAPHY
Ghai, sandhya .(2018) clinical nursing procedures. New Delhi: satish kumar. Pp.613-616.
Dharitri, swain.(2017) obstetrics nursing procedure manual. New Delhi: jappee brothers. Pp. 158--159.
THANKS
Health education on Antenatal care include definition,aim, objectives, registration, antenatal check up, immunization, iron & folic acid, diet, bowel care, cleanliness, clothing, shoes, dental care, care of breast, sleep, exercise, coitus, travel, smoking & alcohol, family support & dangers signs during pregnancy.
Postnatal care (PNC) for the mother should respond to her special needs, starting within an hour after the delivery of the placenta and extending through the following six weeks. The care includes the prevention, early detection and treatment of complications, and the provision of counselling on breastfeeding, birth spacing, immunization and maternal nutrition. To standardise the PNC service, you are advised to use the screening, counselling and postnatal care cards. These cards ensure that you have covered all the essential steps in every home visit.
this ppt is beneficial for nursing and obstetric and gynaecology students.
Preparation for delivery of mother, baby and midwife and equipmentsDR MUKESH SAH
In addition to their delivery bags, midwives “carry” many other invaluable tools ... family planning, delivery preparation, postnatal counseling and breastfeeding. ... With this equipment, we can recover 80% of newborns. ... “Midwifery feels good when both the mother and baby come out of the labor ward alive.
Most of the rules about working conditions are governed by state laws, but the federal government also has a set of standards. The Federal Labor Standards Act, or FLSA, sets the minimum standards for state wage and hour laws.
Fourth stage of labor: The hour or two after delivery when the tone of the uterus is reestablished as the uterus contracts again, expelling any remaining contents. These contractions are hastened by breastfeeding, which stimulates production of the hormone oxytocin.
postpartum period Is the period beginning immediately after the birth of a child and extending for about six weeks.
The World Health Organization (WHO) describes the postnatal period as the most critical and yet the most neglected phase in the lives of mothers and babies; most deaths occur during the postnatal period
It is the time after birth, a time in which the mother's body, including hormone levels and uterus size, returns to a non-pregnant state.
Postpartum Nursing Physical Assessment
Physical Assessment is necessary to identify individual needs or potential problems
Explain to pt purposes of the examination.
obtain her consent.
Record your findings and report results to the mother.
Avoid exposure to body fluids.
Teach pt as you assess – use every opportunity since there is limited time.
Most of the rules about working conditions are governed by state laws, but the federal government also has a set of standards. The Federal Labor Standards Act, or FLSA, sets the minimum standards for state wage and hour laws.
Fourth stage of labor: The hour or two after delivery when the tone of the uterus is reestablished as the uterus contracts again, expelling any remaining contents. These contractions are hastened by breastfeeding, which stimulates production of the hormone oxytocin.
postpartum period Is the period beginning immediately after the birth of a child and extending for about six weeks.
The World Health Organization (WHO) describes the postnatal period as the most critical and yet the most neglected phase in the lives of mothers and babies; most deaths occur during the postnatal period
It is the time after birth, a time in which the mother's body, including hormone levels and uterus size, returns to a non-pregnant state.
Postpartum Nursing Physical Assessment
Physical Assessment is necessary to identify individual needs or potential problems
Explain to pt purposes of the examination.
obtain her consent.
Record your findings and report results to the mother.
Avoid exposure to body fluids.
Teach pt as you assess – use every opportunity since there is limited time.
Taking-In Phase
It takes 2-3 days, during which time the mother’s first concern is with her own needs (sleep and food).
The woman reacts passively, mostly dependent on others to meet her needs.
She is quite talkative during this phase about every detail of her labor and delivery experience
Taking-Hold Phase (Taking Responsibility as a Mother)
It starts the 3rd day postpartum
She progresses from the passive individual to the one who is in command of the situation.
This phase lasts about 10 days.
Once the mother has taken control of her physical being and accepted her role as a mother, she is able to extend her energies to her mate and other children.
Letting-go Phase
This generally occurs when the mother returns home.
In this phase there are two separations that the mother must accomplish.
One is to realize and accept physical separation from the infant. The other is to relinquish her former role as a childless person and accept the enormous implications and responsibilities of her new situation.
Letting-go Phase
This generally occurs when the mother returns home.
In this phase there are two separations that the mother must accomplish.
One is to realize and accept physical separation from the infant. The other is to relinquish her former role as a childless person and accept the enormous implications and responsibilities of her new situation.
Physical Assessment is necessary to identify individual needs or potential problems
Explain to pt purposes of the examination.
Obtain her consent.
Record your findings and report results to the mother.
Ensure privacy and environment where the mother can lie on her back with her head supported.
Ensure bladder is empty & lay patient supine with legs flexed.
The midwives hands should be clean and warm
Learning disabilities are neurologically-based processing problems. These processing problems can interfere with learning basic skills such as reading, writing and/or math.
Mania is a facet of type I bipolar disorder in which the mood state is abnormally heightened and accompanied by hyperactivity and a reduced need for sleep.
Bipolar disorder, also known as manic-depressive illness, is a brain disorder that causes unusual shifts in mood, energy, activity levels, and the ability to carry out day-to-day tasks.
Depression (major depressive disorder) is a common and serious medical illness that negatively affects how you feel, the way you think and how you act. Fortunately, it is also treatable. Depression causes feelings of sadness and/or a loss of interest in activities once enjoyed. It can lead to a variety of emotional and physical problems and can decrease a person’s ability to function at work and at home.
Adolescence, transitional phase of growth and development between childhood and adulthood. The World Health Organization (WHO) defines an adolescent as any person between ages 10 and 19.
Rheumatoid arthritis (RA) is a long-term autoimmune disorder that primarily affects joints. It typically results in warm, swollen, and painful joints.Most commonly, the wrist and hands are involved, with the same joints typically involved on both sides of the body.
Head injuries are one of the most common causes of disability and death in adults. The injury can be as mild as a bump, bruise (contusion), or cut on the head, or can be moderate to severe in nature due to a concussion, deep cut or open wound, fractured skull bone, or from internal bleeding and damage to the brain.
A stroke is a medical condition in which poor blood flow to the brain results in cell death. There are two main types of stroke: ischemic, due to lack of blood flow, and hemorrhagic, due to bleeding.Both result in parts of the brain not functioning properly.
A spinal cord injury refers to any injury to the spinal cord that is caused by trauma instead of diseases resulting in a change either temporary or permanent, in its normal motor, sensory or autonomic function.
In 1911, Eugen Bleuler, first used the word "schizophrenia."The word schizophrenia does come from the Greek words meaning "split" and "mind," & refers to the way that people with schizophrenia are split off from reality; they cannot tell what is real and what is not real.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
4. Objective
• To observe the general condition of the
mother.
• To find out postnatal problem and manage.
• To provide necessary health teaching to
mother and family.
• To improve mental and physical health of
mother.
12. Gait and Movement
- Normal walk without a limp
- Gait and movements are steady
and moderately paced.
Behavior &Facial expression
- Alert, responsive, cooperative,
calm
13. General cleanliness, noting visible dirt
and odor.
Check skin noting lesions and bruises
- Normally , skin free from lesions and
bruises.
Check conjunctiva
– If conjunctiva appears white or very
pale see anemia for additional
information
15. 2. Vital Signs measurement:
Temperature
- Temperature during the first 24
hours postpartum is within the
normal range.
- If fever, up to 100.4◦F (38◦C)→
indicate dehydration
16. - Temperature should be normal
after 24 hours with replacement of
fluids
- A temperature above100.4◦F
(38◦C) at any time or an abnormal
temperature after first 24 hours →
indicate infection
17. Pulse
- Puerperal bradycardia (40 to 80
beats per minute) → normal during
the first week after birth
- Orthostatic hypotension
- Tachycardia → indicate anxiety,
excitement, fatigue, pain, excessive
blood loss, infection, cardiac
problems.
18. Blood pressure
• Immediately after childbirth, the
blood pressure should remain
the same as during labor.
• An increase in blood pressure
→indicate gestational
hypertension
19. A decrease in blood pressure →
indicate shock, orthostatic
hypotension, dehydration, a side
effect of epidural anesthesia.
Blood pressure vary based
on the woman's position,
so assess blood pressure in
the same position every
time.
20. Respirations
- Normal respiratory rate of 12 to
20 breaths per minute should be
maintained.
- No important to assess breath
sounds → if the mother has had a
normal vaginal delivery, is
ambulatory, and is without signs
of respiratory distress.
21. • Breath sound always should be auscultated if
the birth was cesarean or the mother is
receiving magnesium sulfate, is a smoker, or
has a history of frequent or recent upper
respiratory tract infections, or asthma.
-Important for auscultation of breath
sound →if birth was cesarean,
mother is receiving magnesium
sulfate, is a smoker, or has a history
of frequent or recent upper
respiratory tract infections, or
asthma.
22. Pain
• Pain is fifth vital sign
• Ask the woman about the type
of pain and its location and
severity using a numeric scale
from 0 to 10 points
27. • One breast is slightly larger than
other.
• If breastfeeding, breasts look
lumpy or irregular than usual.
• Veins larger and darker, more
visible beneath the skin.
• Regular with no dimpling, no
visible lumps, skin is smooth with
no puckering, no redness, no
lesion sores or rashes.
• Tenderness and lumpiness in both
breasts during the menstrual cycle.
• Areolas larger and darker.
Normal
Breast
28. • Changes in colour of breast
or nipple, wrinkling,
dimpling, thickening,
puckering.
• A nipple sink into breast.
• A red, scaly rash or sore
on breast &nipple.
Abnormal
findings
32. Palpate
• If breastfeeding, breast feel
lumpy or irregular depending
on emptying of milk
ducts/lobes.
• No discharge, pus coming from
nipple, no cracks, fissures, or
other lesions , no inverted
nipples.
• A clear or milky discharge
called galactorrhea present
when nipple is squeezed.
Normal
Finding
34. • Redness, warmth, painful
lump or on entire breast
→indicate abscess or
mastitis.
• A bloody discharge or milk
discharge occur without
stimulation
Abnormal
Finding
36. Inspection
Inspect the shape, size, movement of abdomen
with respiration, scarred gravid, linea nigra,
caesarean section, old and new incision on the
abdomen.
Caesarean section incision sites →healing
process, discharge, redness and signs of
infections.
39. Palpate Fundus
2.Place mother in a supine position with her
knees slightly flexed.
1. Palpate fundus for consistency and location.
It should be firmly contracted and at or near the
level of the umbilicus.
40. 4. Place non-dominant hand above
mother’s symphysis pubis. This supports
and anchors the lower uterine segment
during palpation or massage of the fundus.
3. Put on clean gloves and lower the
perineal pads to observe lochia as the
fundus is palpated.
41. 6. Palpate gently at umbilicus until the fundus
is located.
Determine the firmness and location of the
fundus.
This should be firmly contracted, in the midline
and approximately at the level of the
umbilicus.
5.Use flat part of fingers (not the finger tips)
for palpation. Palpation may be painful, for
the mother who had a cesarean birth.
42. 8.The location of fundus should be rechecked
after emptying bladder.
If fundus is difficult to locate or is soft or boggy,
keep non dominant hand above symphysis pubis
and massage fundus with dominant hand until
fundus is firm.
7.If uterus is above the expected level or shifted
from the middle of the abdomen (usually to the
right), the bladder may be distended.
43.
44. - Removing clots allows the uterus to contract properly. A firm fundus and pressure over the lower uterine segment help prevent uterine inversion.
9.After boggy fundus is massaged until it is firm, press
firmly to expel clots.
Do not attempt to expel clots before the fundus is firm.
Keep one hand pressed just above the symphysis (over
the lower uterine segment) throughout.
- Removing clots allows the uterus to
contract properly.
- A firm fundus and pressure over
the lower uterine segment help
prevent uterine inversion.
45. 11. Document the consistency and location of
the fundus.
10.Measure fundus height in centimeters or
use fingers breaths.
Generally fundal height decreases about 1cm
per day for first 9-10 days post-partum
46. - Consistency is recorded as "fundus firm", "firm
with massage", or "boggy".
- Fundus height is recorded in finger breaths or
centimeters above or below the umbilicus.
For example, "fundus firm,
midline, ↓1'' (one finger breath
or 1 cm below the umbilicus).
- "fundus firm with light massage,
U+2 (two finger breaths or 2 cm
above the umbilicus), displaced
to right".
47. 5. Bladder examination
- Ask to pass urine frequently the first few
days.
- Normal if bladder is not palpable.
- Women is able to urinate when the urge is
felt.
48. - Monitor clients for signs of UTI, including
fever, urinary frequency and/ or urgency,
difficult or painful urination.
- Infrequent or insufficient voiding (less than
200 ml) discomfort, burning urgency, or foul
smelling urine suggest infection
49. 6. Bowel examination
Inspect the woman's abdomen for distention,
auscultation for bowel sounds in all four
quadrants prior to palpating the uterine
fundus, and palpate for tenderness.
Ask the patient about daily bowel movement
or has passed gas since giving birth.
50. She must no become constipated.
Explain that she should wipe from front to back
after voiding or defecating.
Normal assessment findings are active bowel
sounds, passing gas, and a non-distended
abdomen.
51. 7. Lochia Examination
Check and
note
colour,
order and
amount of
lochia.
To assess amount
- ask her how many perineal
pads she has used in the
past 1 to 2 hours and
- how much drainage was on
each pad. (pad completely,
or was only half of pad
covered with drainage)
- Ask about
color of
drainage,
odor, and
presence of
any clots.
Lochia increases with maternal activity
and breastfeeding which is normal.
52. Lochia Type & Color
Lochia Rubra.
• Bright red,
have small clots
• Usually lasts
first 3 days
Lochia Serosa
• Pink, contain more
serum, leucocytes
and bacteria
• Discharge
usually during
4th to 7th day.
Lochia alba
• White in colour,
creamy brown.
• Contains leucocytes,
cervical mucus,
serous exudates,
granular epithelial
cells, cholesterol
crystal, debris from
healing tissue.
• Usually discharge
upto 10-15 days.
If lochia is foul
smelling, lochia
rubra persists for 2
weeks or more
need more
additional
assessment.
54. Lochia Amount
• 5cm saturation of pad in
one hour =10 ml.Scant
• 10 cm saturation of pad
within 1 hour =10 to 25mlLight
The average amount of discharge for the
first 5-6 days is estimated to be 250 ml.
55. • Moderate; 15cm
saturation with in 1 hour
=25 to 50 ml.
Moderate
• Heavy; pad is completely
saturated within 1 hour =
50 to 80 ml.
Heavy
• Postpartum hemorrhage is
clinically defined as a pad
saturated within 15-30
minutes.
PPH
57. During examination, the quantity, colour,
odor and consistency of lochia are
significant.
a. Persistence of red lochia → indicates
secondary postpartum hemorrhage.
b. Brown profuse lochia with bulky uterus →
sub-involution of the uterus
c. Excessive lochia → retained product of
conception.
58. d. Scanty lochia → indicate poor drainage.
e. When associated with pyrexia they are due
to localized uterine infection.
59. 8. Episiotomy and perineum examination
Examine episiotomy and perineum
area through REEDA Assessment
R-Redness E-Edema E-Ecchymosis
D-Discharge
A-
Approximation
60. • Redness → infection or hematoma.
• Ecchymosis (excessive bruising) → vaginal
trauma and requires additional evaluation.
• Discharge→ should follow the expected lochia
pattern.
• Approximation→ episiotomy lines should be
well approximated.
62. Perineum
• Pull the labia from front to back.
• Check the episiotomy or areas of vaginal tearing.
• Look for hematoma formation, hemorrhoids,
vaginitis, perineal tearing.
64. 9. Homan’s sign
Complain of pain in calf of the leg upon dorsi-
flexion of foot with leg extended is diagnostic of
Deep Vein Thrombosis (DVT) of the area.
A positive Homan's sign is indicative of DVT.
66. 10. Emotional status
After delivery the woman may progress
through Rubin’s stages of taking in,
taking hold & letting go phases.
• May Begin with a refreshing sleep after
delivery.
• During first 24 to 48 hours after giving
birth, mother exhibits passive, dependent
behavior.
• New mothers spend time touching baby
commonly identifying specific features in
newborn such as " he has my nose" or his
fingers are long like his father's.
1.
Taking
In
Phase
67. • Starts on 2nd to 3rd day postpartum
and may last several weeks.
• Woman begins to initiate action and
to function more independently but
still show dependent behaviors.
• Woman may require more explanation
and reassurance that she is functioning
well, especially in caring for her infant.
• As the woman meets success in caring
for the newborn, her concern extends
to other family members and their
activities.
2.Taking
hold
phase
68. • It begins near end of 1st
weeks.
• Mother reestablishes
relationships with couple and
other people.
• She assumes responsibility and
care for newborn
independently.
3.
Letting
go
phase
