Postpartum Care and Assessment Mother

General Assessment Pearls
■ Monitor for signs of postpartum hemorrhage and shock.
■ If preeclamptic, assess blood pressure every hour.
■ It’s considered normal to have a slight fever (100.4 F) for the first 24 hours postpartum. Temp 101.4 F indicates an infection.
■ Urinary retention is likely to occur postpartum; encourage fluids and monitor I & O for the first 12 hours.
■ Encourage early ambulation; instruct Pt to change position slowly, because postural hypotension is common postpartum.

Breast and Breastfeeding
■ Colostrum appears within 12 hours and milk appears in about 72 hours postpartum. Breasts become engorged by postpartum day 3 or 4 and should subside spontaneously within 24–36 hours.
■ Assess breasts for infection and assess nipples for irritation.
■ Encourage the use of a bra between feedings. Complications:
■ Pain: Assess for mastitis, abscess, milk plug, thrush, etc. Proper positioning of infant (football carry) will minimize soreness. Breast shields are used to prevent clothing from rubbing on the nipples.
■ Engorgement: Apply moist heat for 5 minutes prior to breastfeeding. Use ice compress after each feeding to reduce swelling and discomfort. Avoid giving baby bottles and pacifiers while engorged, as they may cause nipple confusion or preference.
■ Mastitis: Encourage rest and continuation of feeding or pumping. Administer prescribed antibiotics. Note: Breast milk is not infected and will not harm the infant.

Abdomen and Uterus
■ The uterus should be firm, about the size of a grapefruit, central, and at the level of the umbilicus immediately postpartum. Deviation to the right may indicate distended bladder.
■ Assess for bladder fullness have mother void if bladder is full. A full bladder may inhibit uterine contractions, causing bleeding.
■ If postvoid uterus is still boggy, massage top of fundus with fingers held together and reassess every 15 minutes.
■ Mother and/or partner may be instructed to massage fundus.
■ Auscultate bowel sounds and inquire daily about BMs.
■ Constipation is common from anesthesia and analgesics as well as fear of perineal pain.
■ Increased fiber and fluid intake, along with early and routine ambulation, will help to reduce the occurrence of constipation.

Perineum
■ Episiotomy: Assess for swelling, bleeding, stitches, infection.
■ Hemorrhoids: Encourage sitz baths to help reduce discomfort.
■ Lochia: Amount, character, and color. Explain the stages and duration of lochial discharge and instruct Pt to report any odor.
■ Lochia rubra: 1–3 days postpartum, mostly blood and clots.
■ Lochia serosa: 4–10 days postpartum, serosanguineous.
■ Lochia alba: 11–21 days postpartum, creamy-white, scant flow.

Lower Extremities
■ Thrombophlebitis: Unilateral swelling, decreased pulses, redness, heat, tenderness, and positive Homans’ sign (calf pain or tenderness upon dorsiflexion of the foot). Leg exercises and early ambulation help minimize the occurrence of venous stasis and clot formation.

Emotional Status
■ Explain to the mother and to her family that her emotions may shift from high to low and that these changes are considered normal due to the tremendous hormonal changes occurring postpartum.
■ Assess parent-infant bonding and family support system.


Normal Pediatric Vital Signs

Age	RR	HR	SBP	Temp
Preterm	50–70	140–180	40–60	36.8–37.5 C
Newborn	30–60	110–120	60–90	36.8–37.5 C
6 months	25–35	110–180	85–105	37.5 C
1 year	20–30	80–160	95–105	37.5 C
2 years	20–30	80–130	95–105	37.5 C
4 years	20–30	80–120	95–110	37.5 C
6 years	18–24	75–115	95–110	37 C
8 years	18–22	70–110	95–115	37 C
10 years	16–20	70–110	95–120	37 C
12 years	16–20	60–110	95–125	37 C
Teenager	12–20	60–100	95–135	37 C

Average Height and Weight (50th Percentile)

Age	Height		Weight
	in	cm	lb	kg
Newborn	18	45.7	8	3.6
6 months	26	66	16	7.2
1 year	30	76.2	21	9.5
2 years	34	86.4	27	12.2
4 years	40	101.6	35	16
6 years	45	114.3	45	20.5
8 years	50	127	56	25.5
10 years	55	139.7	73	33.2
12 years	60	152.4	92	41.8
Teenager	65	165.1	> 110	> 50