12 Point Postpartum Assessment Page 199 1 General Data LOC skin color facial expression grooming posture motor activity gait speech hygiene Massage top of the uterus fundus it is important you hold pressure and hold support at the bottom because you don t want to invert the uterus as we grow the uterus grows when it shrinks back down it is called involution the uterus should be at the umbilicus each day the uterus should go one finger lower the day of delivery we cant palpate it at all normal process Relate where it is according to umbilicus position midline what we want or right or left whether firm or boggy want firm if it s boggy hemorrhage biggest thing we monitor in stage 4 of labor postpartum is watching for hemorrhage the whole postpartum period will last for about 6 weeks if it is to the right or left instead of midline the bladder is right underneath and when your bladder gets full it can shift the uterus to the right or left so assess the bladder frequently most moms have epidurals during birth so cant tell they need to go or they don t want to get up want to empty bladder every 2 hours could be retained placental fragments or could be blood clots and that will cause it to shift as well and remain boggy if breast feeding mother needs 300 500 extra calories day mothers need to be on demand baby needs to eat every 2 3 hours bottle feeding every 3 4 hours 2 Vital Signs REPORT any of the following variations Temp 100 4 after 1st 24 hours OR 101during 1st 24 hours Pulse 50 90 Respirations 16 24 Abnormal breath sounds Blood pressure 90 50 or 140 90 PIH 30mmHg systolic baseline OR 15 mgHg diastolic baseline 3 Breasts Breastfeeding or bottlefeeding breastfeeding breasts grow during pregnancy all internal structures are made for this the areola and nipple enlarge gets darker and enlarges bigger target for baby Bra Supportive bra Nipples intact cracked bruised inverted flat if not latching baby on nipples can get cracked red and very painful want to know if inverted or flat bc that baby needs the nipple to latch on and theyre going to need more support encouragement and possibly a nipple shield to get baby to latch on correctly Breasts soft filling firm warm red Teach self breast exam montgomery glands have a bacteria property to it and help lubricate the breast don t use soap just water bc soap could decrease the amount of oil that the montgomery glands produce the bumps on the nipple make sure babies do the THREE A S TO MAKE SURE BABY IS LATCHED ON CORRECTLY Alignment don t want baby to pull down on nipple want them at level of nipple bc depending on angle baby puts on mouth can decrease nipple soreness and want as much of the areola in the nipple as possible Areola grasp Audible swallowing when baby latches on to areola it clamps down those sinus are right behind the areola so when the baby clamps down cause objection of milk into the babies mouth and that will force them to swallow Check sucking reflex on finger first few days maternal antibodies colostrum protein babies stomachs 10 drops of colostrum 1 oz of formula so monitor for how long baby breast feeding milk doesn t come in till anywhere up to 72 hours and breast start filling first milk is foremilk thinner helps quench babies throat makes them cute and chubby hind Milk thicker and more substance when baby getting sleepy it s because they re full some babies like to use mom as pacifier baby always sucks the strongest on first breast always offer both some babies only like one one time start right next left 4 Uterus fundus Make sure bladder is empty and HOB flat Support bottom of uterus with one hand and palpate fundus with other hand very gentle after c s Palpate for tone firm or boggy Height in relation to umbilicus U U 1 U 2 Position midline left right Tenderness a tender uterus on the outside might indicate some type of infection c section will be more tender but tender at incision site not when palpating the uterus try to be gentle when massaging fundus if the uterus is boggy the first thing we do is massage it and then later on give Pitocin very careful with Pitocin we want tetany and want the uterus to clamp down sometimes can get Pitocin IM not often most patients have IVs so just give it IV Normal involutions in firm U on day of delivery and the decreases by 1 fingerbreath each day REPORT boggy uterus U 1 or extreme tenderness 5 Bladder Assess distension voiding output dysuria frequency Foleys amount of urine color odor aside from epidurals having no sensation to void women can get swelling from pushing and periurethral swelling is when the urethra swells and that can cause women to not empty their bladder can get lacerations can be very painful and swollen if swollen put a urinary catheter in 6 Lochia c section patients still have this but maybe not as much Assess color rubra red day 1 3 serosa pink day 3 10 alba white day 10 Clots Odor fleshy or foul shouldn t smell foul Amount scant small moderate large excessive is 1 pad hour scant if looking at a peripad and barely see any bleeding like a dime size then small and that s probably a little more not a lot of bleeding moderate of the peripad having drainage large or excessive and excessive you saturate a peripad within 2 hours for large and excessive saturate within 15 minutes blood starts to pool underneath normal for lochia to trickle slowly if running like a faucet that is not normal and either having postpartum hemorrhage or something else Pattern should never reverse As massaging fundus and it s at the right spot look at the lochia bleeding lochia rubra occurs the first 1 3 days you see while in the hospital dark red bleeding should never see a huge amounts of clots patient is typically sitting a majority of the time but when sitting the blood will make little quarter sized clots should not make clots that are the size of an orange apple should see little clots but nothing large day 3 10 not dark red lightening up alba whitish color important to know general time lines bc if at any point we start having lochia rubra again like at day 10 that could mean we have an issue going on if they stop bleeding all together then start bleeding again they probably need to go see their physician again subinvolution some placenta could have been left in there anytime normal process is interrupted it is not normal and needs to be evaluated 7 Incision Vaginal assess perineum for bruising edema hematoma hemorrhoids Assess episiotomy for REEDA always assess REEDA redness