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  • PRO Post Natal Assessment

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    Mali Kanu
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    The document outlines the steps and objectives of a postnatal assessment. It describes assessing the mother's general appearance, vital signs like temperature and blood pressure, and conducting a head-to-toe examination including the breasts, abdomen, genitalia, and lochia discharge. The assessment is aimed at identifying any postpartum complications or deviations from normal postnatal changes in the mother.

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    The document outlines the steps and objectives of a postnatal assessment. It describes assessing the mother's general appearance, vital signs like temperature and blood pressure, and conducting a head-to-toe examination including the breasts, abdomen, genitalia, and lochia discharge. The assessment is aimed at identifying any postpartum complications or deviations from normal postnatal changes in the mother.

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    597 views9 pages

    PRO Post Natal Assessment

    Uploaded by

    Mali Kanu
    The document outlines the steps and objectives of a postnatal assessment. It describes assessing the mother's general appearance, vital signs like temperature and blood pressure, and conducting a head-to-toe examination including the breasts, abdomen, genitalia, and lochia discharge. The assessment is aimed at identifying any postpartum complications or deviations from normal postnatal changes in the mother.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
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    of 9

    Post natal Assessment

    Introduction:

    The postnatal period is also known as Puerperium. Puerperium is the period


    following childbirth during which the body tissues, specially the pelvic organs
    revert back approximately to the pre pregnant state both anatomically and
    physiologically. The woman is termed as a puerperal.

    Puerperium begins as soon as the placenta is expelled and lasts for


    approximately 6 weeks when the uterus becomes regressed almost to the non
    pregnant size. The period is arbitrarily divided into – a) Immediate: within 24
    hours; b) early: up to 7 days; and c) remote: up to 6 weeks. Similar changes
    following abortion but takes a shorter period for the involution to complete.

    Objectives of Post Natal assessment:

    - To identify the mother’s postpartum condition.


    - To identify the normal Puerperium.
    - To recognize deviations from the normal postnatal changes.
    - Detect any postnatal complication and make appropriate referral.

    Preliminary Assessment:

    - Check for right patient.


    - Check the patient condition.
    - Check the doctor’s order for any specific order.

    Preparation of Environment:

    - Maintenance of Privacy: A separate examination room is needed. Keep the


    doors closed. The relatives are not allowed. Drape the patient according to the
    parts that are exposed.
    - Lighting: As far as possible natural light should be available in the
    examination room.
    - Comfortable bed: The patient should be placed comfortably throughout the
    examination. There should be provision for the maintenance of a suitable
    position.
    Preparation of the patient

    - Explain the procedure to the patient.


    - Ask the patient for Urination or Evacuation.
    - Drape the patient with extra sheets and expose only the needed areas.
    - Avoid unnecessary exposure.

    Preparation of the Articles:

    Sr. No. Articles Use


    1 Sphygmomanometer To measure B.P.
    2 Stethoscope To listen the body sound.
    3 T.P.R. Tray To assess the Vital signs.
    4 Tape Measure To measure Fundal Height.
    5 Flash Light To visualize any part.
    6 Weight machine To check the weight.
    7 Gloves To do vaginal Examination.
    8 Long Sheet To cover the patient.
    9 Spirit Swabs To clean the Stethoscope.
    10 Kidney tray To collect the waste.
    11 Paper Bag To collect the waste.
    12 Screen To provide Privacy.

    Steps of the procedure:

    General Appearance:

    Nourishment:Well- nourished or under nourished

    Body Build: Thin or obese.

    Health Status: Healthy or Unhealthy

    Activity:Active, Lethargic, Weakness, Fatigue


    Mental Status:

    Level of conscious: Conscious or Unconscious, Delirious, Incoherently.

    Look:Anxious or worried,Depressed

    Posture:

    Body Curve:Lordosis, Kyphosis, scoliosis

    Movement: Any limp

    Weight: Weight loss is occurring due to expulsion of the uterine contents. Further
    weight loss occur due to diuresis.

    Vital Signs:

    Temperature:The temperature should not be above 37.2 0Cwith in the first 24


    hours. There may be slight reactionary rise following delivery by 0.5 o F but comes
    down to normal within 12 hours. On the 3 rdday, there may be slight rise of
    temperature due to breast engorgement which should not last for more than 24
    hours. However, genitourinary tract infection should be excluded if there is rise of
    temperature.

    Puerperal pyrexia is due to infection in genital or urinary tract infection, congestion


    in breast or within the venous system (white leg). Temperature 37.4 0 C three times
    a day or 380 C more 1 time a day is a matter of concern. Some underlined cause of
    rise in fever should be ruled out. E.g., Common cold etc.

    Pulse:For a few hours after normal delivery, the pulse rate is likely to be raised,
    which settles down to normal during the second day. However, the pulse rate often
    rises with after pain excitement.

    Respiration:After delivery respiration rate should be normal 16 – 20 per minute to


    that of the pregnant level as circulatory haemodilution subside and upward
    pressure on diaphragm cases.

    Respiratory stress increases in condition of muscular strain, Complications of


    anesthesia (e.g., atalactesis, Bronchopneumonia) as response to infection, PPH
    affecting blood volume, pulmonary embolism. It could be due to some other reason
    which should be ruled out and treated.

    Blood Pressure: Women who had normal blood pressure their BP should be check
    in 1st 24 hours. Whereas those who were pre eclamptic, hyper or hypotensive are to
    be check regularly till stabilized, also in cases of PPH, after any surgical
    interventions (e.g., caesarean section). It has been known that recovery from
    preeclampsia takes time and chances of eclampsia and maternal death are there.
    Therefore it is important and advisable for high risk women to remain or referred
    to health facilities at least for few days for the close observation.

    Head to toe Examination:


    Skin: After delivery the skin changes caused by pregnancy begin to recede. As the
    melanocyte stimulating hormone that causes pigmentation al changes is eliminated,
    melasama disappears, unless excessive pigmentation has occurred.

    Striaegravidarum may fade to a silvery colour in light skinned women but they
    remain deeper on darker skin. The lineanigra and darkened areola fade but in some
    women faint traces will persist. In few months’hair and nail growth will return to
    pre pregnant pattern.

    Head: Examine for Cleanliness, dandruff, pediculi, texture of hair, any infection in
    scalp or injury marks in the scalp.

    Face:Examine for Pale, Flushed, Puffiness, Fatigue on the face, any skin
    discoloration on the face.

    Mouth:Color of lips, odor of the mouth, bleeding from the gum, Discoloration of
    the teeth, any throat infection.

    Eyes:Vision, pain,any discoloration or discharge from the eyes. Colour of the


    conjunctiva – Pink or Pale.

    Ears:Hearing ability, discharge from the ear, and pain in the ear.

    Nose:Nasal septal deviation, any discharge


    Mouth and Pharynx:

    - Lips: dry, redness, swelling, crusts, cyanosis etc.


    - Odour of the mouth: Foul smelling
    - Teeth: Discoloration and dental caries
    - Mucous membrane and gums: Ulceration and bleeding, swelling, Pus
    formation.
    - Tongue: Pale, Dry, Lesions etc.
    - Throat and Pharynx: enlarged tonsils, redness

    Neck: Neckmass, neck rigidity, Thyroid enlargement, Range of motion.

    Chest: Shape of the chest, Movement of the chest.

    Breast:Gently palpate each breast. If mother feel nodules in the breast, the ducts
    may not have been emptied at last.Stroke downward towards the nipple, and then
    gently release the milk by manual.If nodules remain, notify the doctor. Also
    observe and examine the breast for pain, heaviness, cracked or sore nipple,
    engorged breast etc.

    Take this opportunity to explain the process of milk production, what to do about
    engorgement, how to perform self breast examinations, and answer any questions
    she may have about breastfeeding.

    Abdomen:The abdomen is examined while the patient is in a dorsal recumbent


    position and the knees are slightly flexed to promote relaxation of the abdominal
    muscles.

    - Inspection: Inspect relaxed or tense muscles, Striaegravidarum and lineanigra


    etc.
    - Palpation: Palpate for examine the involution of Uterus.

    After the delivery uterus becomes firm and retracted with alternate hardening and
    softening. The uterus measures about 20 x12x7.5 cms. (Length, breadth, and
    thickness) and weighs about 1000 gms. At the end of 6 weeks it returns to
    pregravid size.
    Immediately after labour fundus is 5 cms. Below umbilicus or 12 Cms.
    above the symphysis pubis. Within 12 hours it rises to the level of umbilicus or
    slightly above it. Uterus begins to descend into the pelvic cavity at a rate of about 1
    cm a day until the 10th day, when it may be palpated at or below the level of
    symphysis pubis.

    Extremities:Examine the legs for any redness, heat, tenderness; presence of these
    suggests superficial or deep veins thrombosis.Check for homon’s sign. An
    examination is done by give supine position to the patient and asks the patient to
    extend the toes towards the knee. If the Patient feels pain thenHomon’s sign is
    present.Examine for ankle oedema, movement of joints etc.

    Back:Examine the curve of the spine.

    Genitalia:Delivery cause some injury and swelling to perineum and external


    genitalia which get subsided by third or fourth day of the postnatal. There may be
    cervix or extended tear deep within the vagina which may not be seen. Larger tear
    of this nature likely to give rise to per vaginal bleeding even if uterus is well
    contracted. Such condition requires prompt intervention or else it will leads to
    hypovolaemic shock. There will be vulvalhematoma which can be seen as tender,
    purple, swelling which is very painful specially while standing. It can burst and
    cause shock.

    Also examine for Episiotomy suturing like gaping, bleeding, infection etc.
    Hemorrhoids (Piles) which have developed during pregnancy get resolved
    gradually itself after delivery, but cause pain during defecation, such woman may
    require local application of cream that reduces pain and shrinks piles, oral
    analgesics before defecation help in reducing pain and sitz warm saline bath help
    in resolving of the piles and reduces pain.

    Lochia:It is the vaginal discharge for the first fortnight during Puerperium. The
    discharge originates from the uterine body, cervix and vagina.

    - Odour and reaction: It has got a peculiar offensive fishy smell. Its reaction is
    alkaline tending to become acid towards the end.
    - Colour: Depending upon the variation of the colour of the discharge, those are:

    1) Lochia rubra – Red, 1 – 4 days

    2) Lochia serosa – Yellowish or pink or pale brownish, 5 – 9 days

    3) Lochia alba – Pale white, 10 – 15 days

    After Care of Patient and Articles:


     Provide comfortable position to the patient.
     Discuss the findings with the patient.
     Take all the articles to the utility room.
     Wash the used articles properly and Keep in proper place.
     Replace the articles.
     Do hand washing.
     Record the procedure.
    J.G COLLEGE OF Nursing, AHMEDABAD

    SUBJECT : obstetric and gynecological nursing-II


    TOPIC : postnatal assessment & physical
    Examination

    SUBMITTED TO: SUBMITTED BY:


    Ms. Rekha mam GHOGHARA PINAL R
    Associate professor s.Y M.SC NURSING Student
    j.g college of nursing, j.g college of nursing,

    DATE OF SUBMISSION:

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