Lesson

Outline
Sub Name: Transition to Teacher's Name: Kazi Mask Mousumi
Registered Midwifery Akter
Topic Name: Institute Name: Nursing Institute,
Teaching Method: Joypurhat
Materials: Level of Students:
Number of Students:
Venue:
Date:
Time:
Duration:
 Objective

 Introduce postnatal assessment.

 Define postnatal assessment and its purpose.
 Explain the involution of the uterus and describe changes in the
fundal position.
 Identify the causes of post-delivery pain, fever, heavy bleeding, or
sepsis.
 Distinguish among the characteristics of lochia rubra, serosa, and
alba.
Lesson plan
 Postnatal Assessment
 Introduction:
The postnatal assessment is a critical responsibility of a nurse/midwife
to identify complications early and plan appropriate care for the mother.

 Definition:
Postnatal care involves a thorough examination of both the mother and
baby, offering guidance throughout the postpartum period.
 Purpose:
 Assess the mother’s health and correct any issues.
 Detect and treat medical/gynecological complications.
 Provide guidance on family planning.
Equipment
 Preparation
 Preparation of Patient
 Explain the procedure to the mother.
 Instruct the mother to empty her bladder and wash the perineum with
warm water.
 Place the mother in a supine position with hands at the sides and legs
straight.
 Drape the mother.
 Bring the mother towards the examiner.
 Ask the mother to relax.
 Preparation of Environment
 Select a calm and quiet environment.
 Provide privacy.
Uterus Involution
 Postnatal Assessment Procedure
 Preparation of Patient
 Explain the procedure clearly to the mother.
 Ask the mother to empty her bladder.
 Ensure privacy and gather necessary equipment.
 Check general appearance (dull/good/fair).
 Check vital signs: Temperature, pulse, respiration, blood
pressure
 Postnatal Assessment Procedure
 BUBBLE-HB Assessment:
 B - Breast
 U - Uterus
 B - Bowels
 B - Bladder
 L - Lochia
 E - Episiotomy
 H - Homan's sign
 E - Emotional status
 Physical Examination: Monitor blood pressure, pulse, respiration,
and temperature.
 General Appearance: Assess for any abnormalities.
 Nourishment: Determine if the mother is well, under, or poorly
nourished.
 Head-to-Toe Examination
 Skin: Assess color, lesions, and rashes.
 Head:
 Scalp: Dandruff, lice, hair distribution, color, surgical scars.
 Face: Wrinkles, puffiness, scars.
 Eyes: Palpebral conjunctiva for pallor, sclera for jaundice,
signs of infection.
 Nose: Deviated septum, infection, blockage.
 Mouth:
 Tongue for pallor and glossitis (vitamin deficiencies).
 Teeth/gums for caries and stomatitis.
 Tonsils for tonsillitis.
 Ears: Check for infection, blockage, and wax.
 Neck: Assess veins, thyroid, lymph glands for abnormalities.
 Breast Examination:
 Expose only the necessary breast at a time.
 Inspect for engorged veins and redness.
 Inspect the nipple for retraction, discharge, cracking, and crust formation.
 Breast Evaluation:
 Size
 Shape
 Firmness
 Redness
 Symmetry
 Palpation
 Feel for warmth.
 Palpate from the periphery to the center with finger pads in a circular motion.
 Palpate for any masses/lumps, hardness. While palpating the axillary tails,
instruct the mother to raise her hands above shoulder level.
 Express colostrum/milk and wipe with a gauze piece.
 Repeat this for the other side.
 Bladder Assessment:
 Ask the mother when she last voided.
 Establish a voiding schedule to prevent bladder distention and urinary stasis.
 Encourage the mother to urinate every time she feels the urge.
 Warning Signs: The perineal area, especially if dark, moist, and bloody,
may indicate urinary stasis.
 Bowel Assessment:
 Bowels may be in shock and may have moved into some strange positions.
 Use stool softeners to prevent tearing or injury to the episiotomy incision or
trauma to the C-section.
 Most women do not have the urge to defecate for a few days following delivery,
although some may do so. Loss of abdominal tone contributes to problems with
constipation following childbirth. Fear of pain from tissue damage during
defecation can also be a concern.
 Lochia Assessment:
 Assess the color, odor, and amount of lochia.
 The lochia color should progress in a forward manner, never backward.
 Lochia Colors
 Lochia Rubra (1-4 days):
 Bright red
 May have small clots
 Usually lasts about 3 days
 Lochia Serosa (5-10 days):
 Pink, serous, with other tissue
 Flow is moderate, with fewer or no clots
 Lochia Alba (10-15 days):
 Whitish, with possible small clots
 Minimal flow or spotting
 Lochia Odor:
 A foul or malodorous smell indicates infection.
 Retained placental tissue or cotton pieces inside the vagina should be
considered.
Lochia Stages

Lochia Rubra: This is the

first stage of lochia. You
can expect:
 Dark to bright red blood.
Lochia Stages

Lochia Serosa: A pinkish-brown

discharge that is less bloody and
more watery.
Lochia Stages

Lochia Alba: A yellowish-

white discharge.
a. Scant: 2 inch stain (10 ml), b. Small 4 inch stain (10-25 ml),
c. Moderute 6 inch stain (25-50 ml), d. Stain Large > 6 inch stain
(50-80 ml),
Stains:

 Small: 2-inch stain (minimal)

 Moderate: 4-inch stain
 Large: 6-inch stain
Amount:

 Scant: 2.5 centimeters saturation

 Light: < 10 centimeters saturation
 Moderate: 10 centimeters saturation
 Heavy: A pad that is completely saturated within 2 hours
 Postpartum hemorrhage: A pad saturated within 15-30 minutes is clinically defined as a significant concern.

 Perineal Area Assessment:

 Pull the labia from front to back.
 Check the episiotomy or areas of vaginal bleeding.
 Look for hematoma formation—a collection of blood in the tissue.
 Look for hemorrhoids (developed during pregnancy or during labor from the pushing process).
 Hematoma Care:
 Apply cold to stop the bleeding. Once it stops, begin warm compresses.
 Continue to monitor the area.
 If it worsens, it may indicate an active area of bleeding.
 Homan's Sign:
 Homan's sign is a test used to check for deep vein thrombosis (DVT) of the calf,
sometimes called the dorsiflexion sign. It is commonly performed with the patient
in bed, lying in a supine position.
 The calf is flexed at a 20-degree angle.
 The nurse manipulates the foot into dorsiflexion.
 If pain is felt in the calf, Homan's sign is said to be positive.
 Signs of DVT:
 Sudden and unexplained pain, usually in the back of the leg or calf.
 Tachycardia and shortness of breath (dyspnea).
 Edema, redness, and warmth localized over the area of the DVT.
 Preventing DVT:
 Dangle legs at the side of the bed within 6 hours.
 Stand up within 8 hours.
 Encourage ambulation as soon as possible and independent walking when ready.
 Emotional Status

 Relationship with the Newborn and Family Dynamics:

The early postpartum period is ideal for bonding between the mother and
newborn. The immediate family should have the opportunity to spend time
with each other and the newborn while their emotions and level of
excitement are high.

 Self-Care Ability:The nurse must assess the woman's ability to care for
herself and her newborn.
 Documentation:
Document procedures and inform physicians of any deviations from normal.
 Education:
Educate the mother regarding hygiene, postnatal diet, personal feeding
techniques, breastfeeding, immunization schedule, and care of the
newborn.
 Replace Articles:
Ensure all necessary articles are replaced and readily available.
 Postpartum Blues: Postpartum blues usually occur within 2-3 weeks.
Mothers may be sensitive, such as crying during commercials or humorous
moments. In hindsight, they may view these experiences as normal and
common.

 Postpartum Depression (PPD): When the blues move to the point where
the mother cannot care for herself or the baby, it may indicate postpartum
depression.

 Postpartum Psychosis: This is a severe form of depression that requires

immediate intervention. When mothers harm themselves or the neonate,
or consider doing so, it typically follows depressive episodes.
Thanks
To
ALL