POSTNETAL ASSESSMENT

INTRODUCTION:-

Examination of a postnatal mother and early identification of complication is one of the important
responsibilities of a nurse in the postnatal area. Adequate postnatal examination is necessary for
planning the care of postnatal mother.

DEFINITION:-

Post-natal care includes systematic examination of mother and the baby and the appropriateadvice
given to the mother during postpartum period. Postnatal assessment is an importantcomponent of
postnatal care.

PURPOSE:-

1) To assess the health status of the mother and institute therapy to rectify the defect ifany.

2) To detect and treat at the earliest any gynaecological condition arising out of obstetriclegacy.

3) To impart family planning guidance.

AIMS:

1. Demonstrate understanding of the normal and expected postpartum changes.

2. Conduct thorough assessments to identify signs and symptoms of problems before

they become serious complications.

3. Initiate appropriate interventions when problems do occur.

4. Prevent problems by teaching the woman appropriate ways to care for herself and her
new born.
EQUIPMENTS

S.NO. ARTICLES PURPOSES

1. A trolley consists of,TPR tray To check temperature, pulse

and Respiration

2. BP apparatus and stethoscope To check blood pressure.

3. A sterile bin with, To check milk secretion.

2 gauze piece To observe tongue.
1 spatula To observe vagina and lochia.
1righthand autoclaved
gloves/paper gloves

4 To check fundal
Inch tape
height

5. To observe eyes, ears, nose,

Torch
mouth andgenitalia.

6. Weighing machine To check weight of the

mother.

7. Kidney dish To collect waste

STEPS OF POSTNATAL EXAMINATION

HISTORY COLLECTION

 Review antepartum and intrapartum history

 Receive report
 Determine educational needs
 Consider religious and cultural factors
 Assess for language barriers
 Family profile-support person, no. of children, occupation, educational Status, socioeconomic
status.
 Pregnancy history-Para, gravid, EDD, any pregnancy complication.
 Delivery history-data and time of delivery, duration of labor, type of delivery, labor
complications.
 Baby condition: Birth weight, sex, any difficulty at birth, breastfeeding and congenital anomalies.

PREPARATION OF THE PATIENT AND ENVIRONMENT

 Maintain privacy with adequate drapes and screens.

 Adequate lighting provided.
 Comfortable bed or examination table.
 Room should be warm without draughts.
 Prepare the patient physically and mentally with adequate explanation.
 Explain the procedure to the patient to allay the anxieties to win confidence and cooperation.

PROCEDURE

 Treat the mother and ask how she is feeling whether she feels tired/not 0 Assess mothers Rh
factor. If Rh negative administer immunoglobulin within 72 hours of delivery.

 Vaccination: If mother is not vaccinated for rubella, vaccine can be given and pregnancy can be
avoided for next 3 months.

 Record the vital signs

 After 24 hours, the temperature should be normal.

 A temperature greater than 100.4˚F and rapid pulse suggests excessive bleeding and
puerperal infection.
 Blood pressure should remain stable. Fall in BP indicates hypovolemic
shock .Hypovolemia can indicate postpartum hemorrhage. Hypervolemia could indicate
preeclampsia
  Pulse: Bradycardia of 50-70 bpm is normal Tachycardia is not considered a normal
occurrence and may indicate excessive blood loss
 Respiration: Should remain stable and within normal range

 Height and weight measurement.

 General physical examination

 Nourishment: Well-nourished or undernourished Body build: Thin or obese
 Healthy: Healthy/unhealthy
 Activity: Active/dull, tired

 Mental status
 Consciousness-conscious, delirious talking incoherently
 Look-anxious/worried/depressed
 Body posture- Lordosis/kyphosis/scoliosis Movement-any limb

 Skin condition:
 Color-pallor/jaundice/cyanosis/flushing
 Texture-moist/dry
 Texture-smooth/ rough
 Skin turgor-hydrated/dehydrated
 Temperature-warmth/cold/clammy
 Lesions-macula/papules/vesicles/wounds
 Presence of-spider nevi. palmar erythema, superficial varicosities
 Hyperpigmentation of-areola nevi, linea nigra, chloasma
 Head and face:
 Scalp: Cleanliness, Condition of the hair.
Dandruff, pedicle
 Face
Pale/flushed/puffiness/fatigue/pain/fear/anxiety
 Eyes
o Eyebrows-normal/absent
o Eyelashes-infection/sticky
o Eyelids-edema/lesions
o Eyeballs-sunken/protruded
o Conjunctive-pale/red/purulent discharge
o Sclera-jaundiced
o Cornea or iris-irregularities and abrasions
o Pupils-dilated/constricted/reaction to light
o Vision-normal/myopia/hyperopia
 Ears
 o External ear-any discharges/cerumen
o Tympanic membrane perforations/lesions/bulging
o Hearing-hearing acuity

 Nose
o External nares-crusts or discharges
o Nostrils-inflammation of mucous membrane/septal deviation

Mouth and pharynx Lips-redness, swelling, crusts Odor of the mouth-angular stomatitis, foul
smelling Teeth-discoloration and dental caries Mucus membrane-ulceration and bleeding, swelling,
pus formation Tongue-pale, dry lesions, sordes, tongue tie, etc. Neck Lymph nodes-enlarged,
palpable Thyroid gland-enlarged Range of motion-flexion, extension and rotation Chest and
thorax: Shape, symmetry of expansion, posture. Breath sounds-wheezing. rales, crepitation,
pleural sub etc. Heart sound-size and location murmurs BUBBLEHE STANDS FOR Breast Lochia Uterus
Episiotomy Bladder Homan's sign Bowel Emotional status BREASTS Usually enlarged, soft and warm and
contain only small amount of colustrum. The nipples should be intact without redness, tenderness,
cracks, or blisters. The mother may experience breast engorgement (enlargement and filling of breasts
with milk) which may begin as a tingling sensation in the breasts, 2-4 days after the delivery. The mother
may be prescribed analgesics for breast discomfort and manual expression of milk and stimulation of
nipples to be avoided. UTERUS Palpate the uterus. It generally takes 6 weeks for complete physiologic
involution of the uterus. The fundal height will be 13.5 cm above symphysis pubis. Make the patient
feel her uterus as explained about the process of involution. Immediately after delivery, the uterus
weighs about 100 g, measuring 8-10 cm, which is 2-3 times the non-pregnant state. If uterus is not
involuted properly, check for infection, fibroids and lack of tone. Unsatisfactory involution may result if
there are retained bits of placenta inside the uterus. BLADDER In the immediate postpartum period,
the bladder is congested, edematous, and hypotonic from the effects of labor. LOCHIA Assess the
amount and type of lochia on pad in relations to the number of postpartum days. First 1-4 days of
postpartum, one should find a very red lochia similar to the menstrual flow (lochia rubra). During the
next few days (5-9 days), it should become watery serous (lochia serosa). From 10-15 days, it should
become thin and colorless (lochia alba). Educate the woman regarding her next menstrual period,
when win it probably begin and when she can resume sexual relationship. Discuss family planning at this
time. Notify the doctor if the lochia looks abnormal in color or contains clots other than small ones.
EPISIOTOMY Inspect episiotomy incision thoroughly using flashlight if necessary, for better visibility.
Check for REEDA sign. R- Redness(hyperaemia) E- Edema E- Ecchymosis D- Discharge A- Approximation
of the wound edges Check rectal area. If hemorrhoids are present, the doctor may want to start on sitz
bath and local analgesic medication. Reassure patient and answer questions she may have regarding
pain, cleanliness, and coitus. Check the incision at area for proper wound healing, infection,
inflammation, and suture sloughing. If the surrounding skin is warm to touch and the patient complains
of discomfort, notify the doctor. HOMAN’S SIGN Press down gently on the patient’s knee (legs
extended flat on bed) and ask her to flex her foot. Pain or tenderness in the calf is a positive Homan’s
sign and indication of thrombophlebitis. Physician should be notified immediately. EMOTIONAL STATUS
Throughout the physical assessment, notice and evaluate the mother’s emotional status. Explain to the
mother and to her family that she may cry easily for a while and that her emotions may shift from high
to low. The changes are normal and are probably caused by the tremendous hormonal changes
occurring in her body and by her realization of new responsibilities that accompany each child’s birth.
AFTER CARE Place the patient comfortably. Replace the articles to the utility room. Record the
findings in the nurse’s record. Report to the doctor if any abnormal findings were found.