1. POST PARTAL ASSESSMENT

13. POSTPARTUM NURSING CARE Nursing alert!!! Perform postpartum assessment and instruct client on postpartum care. Goal : To initiate routine postpartum assessment 1. General observations of mood, activity level, and feeling of wellness; routine vital sign assessment. 2. Inspection of breast; Check for beginning engorgement and presence of cracks in nipples, any pain or tenderness, progress of breast feeding. 3. Check uterine fundus; determine height of fundus in relation to umbilicus; should feel firm and globular. 4. Assess for bladder distention, especially during the first 24-48 hours after delivery.

14. 5. Perineal area: -observe episiotomy site : evaluate healing status of episiotomy, apply anesthetic sprays or ointments to reduce pain -Determine whether hemorrhoids are present, and if so provide relief measures. -Lochia: record the color,odor, and amount of discharge -Lower extremities: assess for thrombophlebitis; -Abdomen and perineum: Initiate strengthening exercises for both abdominal wall and perineum. (e.g. kegels)

15. Goal : To provide comfort and relief of pain . Episiotomy : ice packs for first few hours, followed by peri light, hot sitz baths. Perineal care : use of “peri bottles” to squirt warm water over perineum (front to back) to prevent contaminations and avoid use of toilet tissue. Afterpains; use of analgesics (preferably 1 hour before feeding, especially for breastfeeding mothers.) hemorroidal pain . Sitzs baths, analgesic, rectal suppositories, Encourage lying on side and avoidance of prolonged sitting. Stool softener or laxatives may be indicated; client usually has a normal bowel movement usually by second or third day postpartum. Breast engorgement ; well fitting bra should be worn to provide support.

23. Goal: To maintain adequate circulating blood volume to prevent shock and anemia. Type and crossmatch blood for women at high risk for development of postpartum hemorrhage. Anticipate replacement of IV fluids and blood. Check hematocrit and hemoglobin levels. Treat for shock Monitor vital signs and amount of lochia. Goal: To prevent postpartal infection . Maintain aseptic technique Administer prophylactic antibiotics. Monitor vital signs.

36. Women who have other psychiatric illnesses, such as bipolar disorder or schizoaffective disorder, may be at greater risk of developing postpartum psychosis. Postpartum psychosis requires immediate medical attention and, often, a brief hospitalization. If you or someone you know is experiencing symptoms, don't delay getting medical attention.