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SEMINAR
ON
ASSESSMENT OF POSTNATAL
WOMEN & NURSING
MANAGEMENT
SUBMITTED TO:
MRS. VAHITHA S
LECTURER, CON JIPMER
SUBMITTED BY:
LIPI MONDAL
M.SC NURSING 1ST YEAR STUDENT
CON, JIPMER
“Assessment of postnatal women & nursing management”
INTRODUCTION:
Motherhood is a beautiful experience, which is a period of peak of happiness and confusion at postnatal
period. The major goal of postnatal care is to restore the health of the mother and the newborn. It is a time of
transition where physiological changes occur, the woman adapts to mothering role and the family system is
altered by the addition of the newborn. Nursing care during the immediate postpartum period is highly
significant for the later period. This needs a skilled nursing care for mother and the newborn.
POSTPARTUM ASSESSMENT:
Postpartum period is a period from the birth of the newborn to six weeks. An arbitrary time frame
divides the period into the immediate postpartum (first 24 hours), early postpartum (first week) and late
postpartum (up to 90 days).
“Assessment of postnatal women & nursing management”
Do not forget to remember “Assessment BUBBLERS – Breast, Uterus, Bladder, Bowel, Lochia,
Episiotomy/Incision, Emotional Response and Homan’s Sign”.
Postnatal Assessment
Immediate Assessment
i) Vital signs
Temperature :
Pulse/min :
Resp/min. :
Blood Presssure :
(Adequate or not)
( Emoted/distended)
v) Bladder:
vi) Breast:
a) Colostrum
b) Nipple
“Assessment of postnatal women & nursing management”
Late Assessment
i) Vital signs:
Temperature :
Pulse :
Respiration :
Blood pressure :
a) Head:
( Hair)
Sclera
Conunctiva
Tongue : Dry/moisture/pale/cracked
Teeth : Normal/dental carries
e) Neck:
Thyroid gland:
Lymph nodes:
f) Chest
Nipple : Erect/flat/inverted/sore/crakced
Milk secretion : Adequate/Inadequate
“Assessment of postnatal women & nursing management”
h) Abdomen
i) Perineum:
Episiotomy:
j) Extremities:
Swelling :
Homan’s sign :
k) Personal hygiene:
Health education:
a) Assessment
Observe for sign of normal involution of uterus.
Observe signs of healing of episiotomy.
Observe for lactation and breast feeding.
Observe the mother providing care to her newborn.
Teach the mother aspects of self-care and newborn care.
Report and record for increased pulse rate, decreased B.P. and elevated temperature.
Gently massage the fundus if boggy and express clots if any, from the fundus.
b) Care of Episiotomy
i) Soon after delivery, apply ice or cold therapy to the episiotomy or if any laceration. After that, apply
Help the mother in cleaning of her perineum after each voiding and evacuation.
Clean the perineal area from the front to back to avoid infection.
Clean with warm water or clean water or with antiseptic solution.
Apply perineal pad from front to back.
Instruct mother to wear perineal pads loosely and to lie in Sim’s position (sideline position).
Assess the breast for softness or hardness, condition of breast nipples (e.g. flat, inverted, big/small,
cracked etc.).
Assess mother’s knowledge on breast feeding.
Help the mother to breast feed within ½ an hour of delivery. Put the newborn in monkey position on the
mothers’ chest.
Tell the mother to breast feed whenever newborn cries (demand feed). Instruct her to feed 6 to 10 times
a day from both the breasts at each feed.
Help the mother to position the new born properly while breast feeding for adequacy. Tell the mother to
adopt to timely feeding (2/3 hourly)—Advice her for wearing well fitting brassieres.
Instruct regarding care of newborn during and after breast feeding.
Instruct the mother to identify for rooting reflexes (i.e. tell mother to bring her breast nipples near the
cheeks of the newborn and newborn automatically turns to fix the mouth to the breast nipples). ·
“Assessment of postnatal women & nursing management”
Instruct her to hold the feeding breast with her fingers in a scissors grasp hold.
Relax and feed the baby from each breast at least for 5-10 minutes. ·
Advice her to burp the baby after feeding from the first breast. After feeding, repeat for the next breast
(To burp the baby, hold the baby in upright position).
Advice her to put the baby in right sideline positions after feeding.
Advice her to express the extra milk from the breast after each feed.
Clean the mouth of the newborn.
Advice her to put well fitting brassiers.
Under privacy, ask her to expose the breast and nipple to air for a few minutes every day.
Observation for any abnormalities:
— Cracked nipple
— Sore nipple
Encourage mothers for spontaneous voiding of urine at the urge (within 6-10 hours) after birth.
Motivate her to have adequate fluids and water.
Encourage mother to consume a balanced diet.
Observe for bladder distention. Mother will report of fullness of bladder with urge to urinate, but
inability to do so.
“Assessment of postnatal women & nursing management”
Observe for adequate sleep and rest and general behaviour towards self, baby and others.
Day 1
1) Ambulation walk
1) Sit comfortably
Day 2
1) Pelvic floor Exercises: Pelvic floor contractions (tightening of buttocks and pelvic floor muscles)
Procedure:
1) Lie in supine position flat and bend
2) Tighten tummy muscles and squeeze
3) Now your back should be pressed down
4) Count 1-4 and then let go
2) Stopping stream of urine for a while and then pass (do whenever you can void)
Day 3
1) Pelvic Tilt
Procedure:
1) Lie in supine position flat and bend knees and foot resting on bed
2) Tighten tummy muscles and squeeze buttocks.
3) Now your back should be pressed down.
4) Count 1-4 and then let go.
Procedure:
1) Lie in supine or sit comfortably
2) Place hands over abdomen
3) Take deep breath, hold for count 1-3
4) Exhale by pursed lip
“Assessment of postnatal women & nursing management”
Benefits: To ease backache, strengthen back and muscles of abdomen Morning Evening 4-5 times 4-5
times
Straight Curl-Ups
Procedure:
Procedure:
1) Lie flat on back with knees bent and feet flat on touch.
2) Raises head.
4) Count 1-4
Day 1
Day 2
3) Straight curl-Ups
4) Diagonal Curl-Ups
5)Pelvic Tilt
Day 3
Day 5
Breastfeeding
As providers of MCH services, it is important to support successful breastfeeding practices. The benefits of
breastfeeding can promote and protect the health of both infant and mother.
Booklets and leaflets regarding breastfeeding should be distributed and explained for each mother during
antenatal period and immediately postnatal period.
Encourage Optimal Breastfeeding Practices at the PHC level by teaching and helping mothers to:
Breastfeed as soon as possible after birth, and to remain with the mother for at least several hours following
delivery.
Breastfeed frequently, whenever the infant is hungry, both day and night (generally at least eight times during
24 hours and at least once during the night).
Breastfeed exclusively for the first six months, giving no water, other liquids, or solid foods.
Give complementary feeds after six months (breastfeed before giving complementary feeds).
Encourage the mother to eat a well balanced diet including the following: eat protein and energy rich
foods, vitamins, mineral and fluids; continue taking supplements (e.g. iron).
Rest
Encourage the mother to take rest and encourage other family members to help her with the household
tasks including preparing food, cleaning the house, and caring for the other children. A well-rested mother
is a better mother and spouse.
Personal Hygiene
The mother can and should bathe herself daily after giving birth. Bathing is not harmful following
childbirth. In fact, women who let many days pass without bathing may develop an infection of the skin or
perineum.
Recommended bathing practice is to use a shower, if available, or to pour water over the body. Wash
breasts and perineum as part of the daily bath.
Wash the genital area with mild soap and water after passing urine or stool. Wipe or cleanse vulva from
front to back, anus last. Change perineal pads every time you go to the bathroom for passing urine or stool
and at least four times per day.
Exercise
Encourage the mother to exercise daily, beginning with performing some small household tasks, and then
establish a daily routine that includes pelvic floor/Kegel exercises.
Be alert to any changes in the mother’s mood, such as sadness, unexplained crying, or lack of maternal
feeling. Explain to the mother that these symptoms and feelings sometimes occur after delivery.
“Assessment of postnatal women & nursing management”
Encourage the mother to seek support and to express her feelings to her family; however, if symptoms of
depression continue, become more severe, or seem harmful to the mother, refer the mother for specialized
care from the psychiatrist at a nearby hospital.
Sexuality
It is advised to abstain from sexual intercourse for six weeks after delivery, to prevent infection and also
to allow the perineum to heal. However, if the vaginal area has healed and bleeding (lochia) has stopped,
there is no medical risk in having intercourse.
Smoking
For health reasons for both the mother and newborn, the mother should not smoke at all (including the
arguila, a traditional water pipe). If the mother did not stop smoking during pregnancy and continues
smoking after delivery, advise her not to smoke near the time of breastfeeding.
Danger Signs
Advise the mother to return to the health center if she has any of the following: heavy bleeding, fever or
chills, abdominal pain or foul smelling lochia (vaginal discharge), pain, tenderness or heat in the leg(s).
Keep the cord clean and dry. Normally, it falls off within 7-14 days. Do not cover the cord or apply any
medicine or ointment to the cord area. If a bad smell, pus, or signs of infection occur in the navel (cord)
area, take the infant to the health center for care.
The baby should sleep in a clean, safe, smoke-free and warm area and not far from the mother. The
preferred position for the newborn/infant is on the baby’s right side. From time to time, turn the baby’s
head from the right side to the left. When putting the baby to sleep, advise the mother not to place the infant
on his or her abdomen.
“Assessment of postnatal women & nursing management”
Temperature Regulation
Protect the baby from cold, and also from too much heat. Dress the baby as warmly as you feel like dressing
yourself.
Cleanliness
Keep the infant in a clean place away from smoke and dust.
Change the diaper or bedding each time the infant wets or dirties the diaper.
If the infant’s skin becomes red or irritated, leave the diaper off to promote healing, change more frequently,
and keep the irritated area clean and dry.
Bathe the infant daily with mild soap and warm water. Avoid getting the cord wet.
Promote early. This includes cooing, talking, holding, touching, rocking, singing, and looking and smiling at
the infant. Encourage family members to hold the infant close to their hearts when carrying the infant.
Monitor using the infant height and weight chart and milestones for development.
Immunizations
Danger Signs
Advise the mother to be aware and to take the infant to a health care provider at the health center if the
newborn has any of these signs:
o Fever or hypothermia
o Jaundice
o Persistent vomiting
o Eye discharge
Postnatal Contraception
Postnatal infertility usually lasts for approximately six weeks for the woman who does not breastfeed
exclusively. Sometimes the infant’s on-demand pattern of feeding may not support prevention of ovulation. For
these reasons and to provide maternal recuperation before another pregnancy occurs, contraception should be
offered during the postnatal period.
Postpartum Hemorrhage
Assessment H/O any
o Previous PPH
o Rapid or prolonged labor
o Uterine over distension
o Operative birth due to parity
o Placental abnormality
o Previous uterine surgery
o Assess blood loss
Weigh pads 1 gm = 1 ml
Assess vital signs every 15 minutes
Mean arterial pressure (MAP)
Assessment of intake-output accurately
Plan the care e.g. early recognition and early attention
o Nursing intervention to be planned
— IV Tray. Draw blood for hemoglobin and hematocrits cross match type, coagulation time.
— Insert Foley’s catheter to empty the bladder
— Administer IV fluid with prescribed drops
— Administer oxygen
— Provide emotional support
Postpartum Infection
o Assessment of vital signs
o Increase fluid intake and encourage adequate nutrients intake
o Encourage adequate output.
o Provide comfort by meeting mother’s personal hygiene, cool compress, perineal care and
positioning.
o Prompt observation to avoid septic shock
o Postpartum learning needs assessment and education
o On assessing learning needs the teaching be planned and conducted on any of the selected
topics:
— Pelvic floor exercises: Kegels exercises.
“Assessment of postnatal women & nursing management”
— Contraception: Discuss and provide the best choice of selection of contraception to the
couples.
— Transition to parenthood: Fatigue is most commonly found among post partum period.
Need prompt guidance to the family members for support will help.
— Additional stress on: Adoption to post partum period. Role conflict, newborn needs, changes
in parent relationship. Encourage to develop a greater sense of well being through guidance
and support.
— Postpartum blues and depression: Assess for any transient emotional disturbances to “baby
blues” which occurs 3 to 4 days post partum and lasts for some time. Identify symptoms e.g.
Interventions:
Interventions:
Interventions:
Interventions:
Interventions:
Altered bowel & bladder elimination due to anesthesia, decreased oral intake & immobility
Interventions:
Interventions:
Interventions:
Help the mother to empty each breast after feeding each time.
Help her to clean the breast before & after feeding.
Teach breastfeeding techniques.
Ensure a comfortable position to the mother & the baby.
Assess the breast changes: redness, swelling, pain,fullness, tenderness, warmth.
Altered sleeping pattern related to pain in the incisional site & baby feeding.
Interventions:
Interventions:
CONCLUSION:
A specific emphasis on individualized, client-driven postpartum teaching, including both self care and
newborn care, is essential. Nursing care should be flexible and organized in collaboration with the woman so as
to address her individual needs and the needs of the family as a unit.
“Assessment of postnatal women & nursing management”
JOURNAL ARTICLE:
Knowledge and Practice of Postnatal Mothers Regarding Personal Hygiene and Newborn Care
Postnatal period is a crucial period in woman's life. They are in need of special care during pregnancy, at the
time of labour as well as after delivery of child in order to prove safe motherhood and healthy living. Mostly,
incorrect perception of postnatal health practices leads the individual to move towards the unsafe motherhood.
So the researcher was interfered to assess the knowledge and practice of postnatal mothers regarding personal
hygiene and newborn care.
A study was conducted with the objective to determine the knowledge and existing practice of the postnatal
mothers regarding personal hygiene and newborn care and to find out the association between the knowledge
and practice of postnatal mothers with the selected demographic variable.
A descriptive research design was adopted. A total number of 60 postnatal mothers were selected by
random sampling method in order to assess their knowledge and practice. Out of them, 38(63.3%) were
between the age of 21-25 years, 17(28.3%) were between the age of 26-30 years. Regarding education
38(63.3%) were studied primary school, 10(16.7%) were studied middle and high school, 8(13.3%) were had
higher secondary and 4(6.7%) were graduates and others. Most of them 39(65%) were house wife. Regarding
knowledge on personal hygiene, 42(70%) were having inadequate knowledge and 18(30) were having
moderately adequate knowledge and none had adequate. About their practice, 38(63.3%) were having poor
practice and remaining 22(36.7%) were having satisfactory practice and none had good practice. There was
statistically significant association between the mother's knowledge with the age, education and family type at
P=<0.05, P=<0.001 and P=<0.01 respectively.
The study concluded that there is a need to create awareness among the postnatal mothers regarding
personal hygiene and new born care aspects in rural areas in order to reduce maternal and neonatal
complications.
(ARTICLE INFORMATION: Int. J. Pharm. Sci. Rev. Res., 40(1), September – October 2016; Article No. 18,
APPLICATION OF THEORY:
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