Postpartum Care and Assessment: Mother

Postpartum Care and Assessment: Mother

General Assessment Pearls

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

Breasts and Breast-feeding

■ Colostrum appears within 12 hours, and milk appears in ~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 use of 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 nipples. ■ Engorgement: Apply moist heat for 5 minutes before breast-feeding. Use ice compress after each feeding to reduce swelling and discomfort. Avoid bottles and pacifiers while breasts engorged, because 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 infant.

Abdomen and Uterus

■ Uterus should be firm, about size of grapefruit, central, and at level of umbilicus immediately postpartum. Deviation to the right may indicate distended bladder. ■ Assess for bladder fullness (full bladder may inhibit uterine contractions and cause uterine bleeding). Have mother void if bladder is full. ■ 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 occurrence of constipation.

Perineum

■ Episiotomy: Assess for swelling, bleeding, and infection. ■ Hemorrhoids: Encourage sitz baths to help reduce discomfort. ■ Lochia: Amount, character, and color. Explain 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 on dorsiflexion of foot). Leg exercises and early ambulation help minimize occurrence of venous stasis and clot formation.

Emotional Status

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