postnatal assessment.pptx

KING GEORGE’S MEDICAL UNIVERSITY
KGMU COLLEGE OF NURSING
TOPIC : POSTNATALASSESSMENT
SUBJECT : OBSTETRICS AND GYNAECOLOGY
PRESENTED BY –
MS. SUSHMITA YADAV
M.SC.(N) 1ST YEAR

INTRODUCTION
25-05-2023 POSTNATAL ASSESSMENT[KGMUCON] 2
Systematic
examination of
mother and
baby
Begins with 4th
stage and
extends
throughout
postnatal
period

PURPOSES OF POSTNATALASSESSMENT
Promote physical and emotional
well being
Restore health status of the
mother
Prevent infections and
complications

PERIOD OF POSTNATALASSESSMENT
Immediate : 24 hours
after delivery
Late : up to 6 weeks
Early : up to 7 days

POSTNATALASSESSMENT PROCEDURE
• HISTORY COLLECTION
1. Review antenatal, labor, delivery history
2. Receive any previous delivery report
3. Determine educational needs
4. Consider religious and cultural factors
5. Assess for language barriers

HISTORY COLLECTION(CONT…)
6. Family profile :
Support person
No. of children
Occupation
Educational status
Socioeconomic status
7. Pregnancy history:
Para
Gravida
EDD ( expected date of
delivery)
Any pregnancy
complications

HISTORY COLLECTION(CONT…)
8. Delivery history
Date and time of
delivery
Duration of labor
Type of delivery
Labor complications
9. Baby condition
Birth weight
Sex
Any difficulty at birth
Breastfeeding
Congenital anomalies

2. PREPARATION OF ARTICLES
ARTICLES PURPOSES
Handwashing Maintain aseptic technique
Draw sheet To cover the bed
A pair of gloves Maintain aseptic technique
Mask Personal protection and prevent cross infection
Weighing machine Measure weight of mother
Bp apparatus Measure blood pressure of mother
Measuring tape Maintain SFH ( symphysio fundal height )

PREPARATION OF ARTICLE (CONT…)
ARTICLES PURPOSES
Sanitary pad To apply for vaginal discharge
Cotton swabs To clean area for vaginal discharge
TPR tray To measure vitals
Perineal examination tray If required

3. PREPARATION OF PATIENT AND ENVIRONMENT
Maintain
privacy
Provide
comfort
Room
should be
warm
Explain
procedure
to patient

IMMEDIATE POSTNATALASSESSMENT
The 1st hour after
delivery of
placenta is a
critical period

1. Assessment
• Assess maternal history of etiologic of previous postpartum hemorrhage.
• Assess blood loss
• Evaluate presence of blood clots
• Note number of pads saturated in 1 hour
• Assess for vital signs – temperature, pulse, blood pressure, respirations
• Assess for intake and output chart

2. INSPECT
THE INTACTNESS
OF PERINEAL
REPAIR
Episiotomy wound inspection for
assessment of wound infection

3. PALPATE
• Steps of procedure • Rationale
• Assess location and firmness of the
fundus and fundal height.
• Soon after delivery fundus will be
at the level of umbilicus
• The bladder distention and
catheterize if needed
• Distended bladder prevent uterine
involution

4. BONDING
Help With Colostrum Feeding Of Baby
Soon After Birth

EARLY POSTPARTUM ASSESSMENT
When mother is
shifted to
postnatal ward

1. RECORD VITAL SIGNS
Postnatal Normal Vital Signs Are:
• Temperature - 100°F
• Pulse – 56 beats/min
• Respiration – 16 breath/min
• Blood pressure – 110/65 mmHg

2. HEIGHT AND WEIGHT MEASUREMENT
Generally , 5-6 kg
weight loss after
delivery
Further 2-3 kg during
puparium

3. GENERAL PHYSICAL EXAMINATION
• General Appearance –
Nourishment : Well Nourished / Undernourished
Body Build : Thin / Obese / Healthy
Healthy / Unhealthy Activity : Active / Dull / Tired

GENERAL PHYSICAL EXAMINATION ( CONT…)
• Mental Status-
Consciousness : Conscious, Delirious Talking Incoherently
 Look : Anxious / Worried / Depressed
Body Posture : Lordosis / Kyphosis / Scoliosis
Movement : Any Limb

GENERAL PHYSICAL EXAMINATION ( CONT…)
• Skin Condition –
Color : Pallor / Jaundice / Cyanosis / Flushing
Texture : Moist / Dry
Skin Turgor : Hydrated / Dehydrated
Temperature : Warmth / Cold / Clammy
Lesions : Macula / Papules / Vesicles / Wpunds
Presence Of : Spider Nevi, Palmar Erythema, Superficial Varicosities
Hyperpigmentation Of : Areola Nevi, Line Nigra, Chloasma

4. HEAD AND FACE
• Scalp : check for cleanliness, condition of hair ,
dandruff , pedicle
• Face : pale/ flushed / fatigue / pain / fear / anxiety

Eyes :
Eyelids – edema/ lesions
Eyeballs- sunken/ protruded
Conjunctiva – pale/ red/ purulent discharge/
Sclera –jaundiced
Cornea or iris –irregularities and abrasion
Pupils –dilated/ constricted/ reaction to light
Vision –normal/ myopia / hyperopia

HEAD AND FACE(CONT..)
• Ears :
External ear –any discharge/ cerumen
Tympanic membrane –perforations / lesions/ bulging
Hearing –hearing acuity
• Nose:
External nares –crusts/discharges
Nostrils –inflammation of mucous membrane/ septal deviation

HEAD AND FACE(CONT..)
• Mouth And Pharynx:
Lips –Redness, Swelling, Crusts
Odor Of The Mouth –Angular Stomatitis, Foul Smelling
Teeth –Discoloration And Dental Caries
Mucous Membrane –Ulceration And Bleeding, Swelling, Pus Formation
Tongue –Pale, Dry Lesions, Sores, Tongue Tie

5. NECK
• Lymph Node: Enlarged , Palpable
• Thyroid Gland : Enlarged
• Range Of Motion : Flexion, Extension, And Rotation

6. CHEST AND THORAX
• Shape , Symmetry, Of Expansion, Posture
• Breath Sound : Wheezing, Rales, Crepitation, Pleural Rubs And Stridor
• Heart Sound : Size And Location, Murmurs

BUBBLEHE
B- Breasts
H –Homan
Sign
E –Episiotomy
L –Lochia
B –Bowels
B -Bladder
U -Uterus
E –Emotional Status

BREAST EXAMINATION : INSPECTION
• Size
• Shape
• Firmness
• Redness
• Symmetry
• Engorgement
• Areola –primary and secondary areola
• Nipples –check for cracks, redness,
fissure, flat, inverted or erect
• Evaluate for mastitis
• Lumps and axillaries veins can be
prominent

BREAST EXAMINATION: PALPATION
• Feel any nodules, lumps in breast
• Breast engorgement, warmth and ancillary
lymph nodes
• Allow mother to assess her own breasts by
doing self –breast examination

NURSING INTERVENTION
Lactating Mother :
• Supportive bra
• Correct position
• Correct latch –on technique
• Warm showers
• Expose to air
Non Lactating :
• Avoid stimulation
• Wear support bra 24 hours
• Ice packs or cabbage leaves
• Mild analgesic for discomfort

UTERUS EXAMINATION : INSPECTION
• Presence of scar or wound on abdomen
• Size, shape of the uterus
• Umbilicus –dimple hernia, protruded or not
• Lactation immediately after birth
• Consistency –firm / boggy

ON OBSERVATION –
• Presence of striae albicans, striae gravidarum
• Midline or deviated uterus to the left or right : if deviated , usually
sign of full bladder

Cont…
Boggy Fundus – Uterine Atony
Bulky Uterus – Presence Of Clots/ Retained
Product Of Conception
Tenderness –Indicates Infection

UTERINE EXAMINATION : PALPATE
UTERINE INVOLUTION( MEASURE FUNDAL HEIGHT )
Explain the mother about
abdominal palpation
Empty bladder
Provide position : supine with legs
extended

By 10th -14th days , uterus becomes a pelvic
organ
Measure the fundal height by inch tape which
indicates uterine involution
Palpate fundus with finger breaths from
symphysis pubis towards umbilicus and locate
fundus

CLINICAL MEASUREMENT OF SYMPHYSIOFUNDAL
HEIGHT (SFH)
• Following delivery : fundus lies 13.5cm above symphysis pubis
• Within 24 hours : no change in fundal height
• After 24 hours : fundal height decreases by 1 cm to 1.25 cm
• End of 2nd week : uterus become pelvic organ
• 6th week : complete involution of uterus

BLADDER
• Spontaneous void : 6-8 hours
• Postpartum diuresis : first 24 hours
• Encourage frequent voiding : every 4-6 hours
• Monitor intake and output for 24 hours
• Early ambulation
• Void within 4 hours after birth
• Catheterize if unable to void

BOWEL
1. Assess for presence of bowel sound.
2. Spontaneous bowel movements occur on 2nd to 3rd postpartum day.
3. Assess for gastric motility.
NURSING INTERVENTION:
• Increase fiber in diet
• 6-8 glasses of water or juice Stool softener
• Laxative
• Sitz bath for discomfort
• Medications for hemorrhoids

LOCHIA DISCHARGE

ASSESS FOR LOCHIA
• Note the character, colors, amount, odor of lochia.
• Count the number of perineal pads that are
saturated in each 8 hours period.
Nursing intervention:
• Teach mother and family members about perineal
care for maintaining the perineal hygiene.

• Provide sitz baths or dry heat as per
hospital protocol.
• Sit in the tub on the towel for 15 to
20 minutes. If the water starts getting
cool, then let some water out and add
new warm water.

Educate the mother for following sign and symptoms to be informed to
health care provider immediately:
• Heavy bleeding that soaks more than 1 pad per hour for 3 hours.
• Blood clots or bright red blood after the 4th day
• Bad ordor of lochia (fishy smell) Any lochia during the first 2 weeks
• Bad cramps and heavy bleeding Fever over 100.4" F
• Severe pain in lower abdomen

EPISIOTOMY ASSESSMENT:
• Inspect perineum, vulva and anus daily
• If perineal wound is present inspect, it daily frank bleeding and signs of infection If
perineal wound is present, it has to be inspected for infection.
PERINEALAREAASSESSMENT:
• Pull the labia from front to back . Check the episiotomy or areas of vaginal tearing
• Look for hematoma formation-a collection of blood in between tissue
• Look for hemorrhoids (developed during pregnancy or during labor from the
pushing process)/anal varicosities.

REEDAASSESSMENT:
R: Redness
E: Edema
E: Ecchymosis
D: Discharge
A: Approximation/closeness of skin edges.

HOMANS' SIGNS: EXTREMITIES
Inspect the legs/extremities for signs of thromboembolism and assess
Homans' sign.
Homans' signs assessment:
1. Make the patient lie on supine position in bed.
2. Keep the sole of the patient's foot on non- dominant hand.
3. The calf is flexed at a 90°angle.
4. Manipulates the foot in a dorsiflexion movement.
5. If pain is felt in the calf, the Homans' sign is said to be positive.
6. Homans' sign is positive that indicates deep vein thrombosis.
7. Do the procedure on both legs.

EMOTIONAL STATUS:
• Assess emotional risks and evaluate the interaction and care skills of the mother and family
with the infant.
• Assess about emotional well-being, family and social support and their usual coping
strategies of mother for dealing with day-to-day matters. Mother may need support and
education regarding the care of new baby. At 10-14 days after birth, assess the woman's
psychological well-being for postnatal depression.
• Encourage women and their families/partners to tell their health care professional about any
changes in mood, emotional state and behavior that are outside of the woman's normal
pattern.

LATE POSTNATALASSESSMENT
Assess following history of mother who came for follow-up and postnatal check up:
 Postnatal complications- urinary tract infections, breast engorgement or any other
problems.
 Physical symptoms, such as bleeding on occasion, having any abdominal discomfort,
vaginal or perineal pain, urinary tract infections, breast engorgement or any other problems.

• Physical symptoms, such as still Bleeding on occasion, having any
abdominal discomfort, vaginal aur perineal pain, urinary or anal
incontinence or breast pain.
• Emotional status of mother. If she is feeling overwhelmed, anxious, or
depressed.
• Breastfeeding status-exclusive breastfeeding or any breastfeeding
problems.

SUMMARY
• Postnatal care includes systematic examination of mother and baby and appropriate advice
given to the mother during postpartum period. Over 5,36000 women die annually from
complications during pregnancy, child birth or the postpartum period.
• Nearly all of this death occur in developing countries where fertility rates are higher and a
women’s life time risk of dying during pregnancy or child birth. Almost all 95% of this
maternal death occurred in Africa and Asia. The burden of maternal complications and
deaths is also highest in the first few days of delivery.

RECAPITALIZATION:
• What is postnatal period?
• Explain bubblehe.
ASSIGNMENT:
Write role of nurse during postnatal assessment by 28/02/2023.

BIBLIOGRAPHY
• Book refrences:
1. Swain Dharitri, Obstetrics Nursing Procedure Manual. 2nd ed. New Delhi: Jaypee Brothers Medical
Publishers;2023.
2. Sharma JB, Midwifery And Gynaecological Nursing. 1st ed. New Delhi: Aviachal Publishing Company;2018.
• Internet refrences:
• https://www.slideshare.net/ImranNurManik/postnatal-care-manik
• https://www.slideshare.net/TriptiGoarya/postnatal-assessment-249381381
• https://www.slideshare.net/sakshirana18/postnatal-assessment-147054988

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