RNSG 2504 – Care of the Patient with Commonly Occurring Health Problems
Unit IV – Care of the Patient Experiencing Perinatal Cycle
Part C - Postpartum
Behavioral Objectives
1. Define the terms in the content column
as related to the postpartal period.
Content Outline
I. Definition of terms
A. Afterbirth pains
B. Attachment
C. Diaphoresis
D. Fundus
E. Homan’s sign
F. Involution
G. Lactation
H. Let/down reflex
I. Lochia (rubra, serosa, alba)
J. Oxytocin
K. Prolactin
L. Puerperal diuresis
M. REEDA
N. Subinvolution
O. Taking-hold phase
P. Taking-in phase
Q. Uterine atony
2. Compare and contrast the physical and
psychological adaptation that occurs
in the post partum patient.
II. Postpartal adaptation
A. Physical
1. Reproductive system
2. Lactation
3. Gastrointestinal system/abdomen
4. Urinary tract
5. Vital signs
6. Blood values
7. Weight loss
8. Postpartal chill/diaphoresis
9. Afterpains
B. Psychologic adaptation
1. Maternal role attainment
a. Taking in
b. Taking hold
2. Postpartum blues
3. Cultural influences
4. Development of parent infant attachment
Clinical Objectives
See Unit IVA
Learning Opportunities
See Unit IVA
RNSG 2504 – Care of the Patient with Commonly Occurring Health Problems
Unit IV – Care of the Patient Experiencing Perinatal Cycle
Part C - Postpartum
Behavioral Objectives
Content Outline
3. Identify factors to include in the
assessment of the postpartum patient
including the developmental and
cultural considerations.
III. Postpartal assessment
A. Interview
1. Medical history
2. Family medical/social history
3. Obstetrical history
4. Knowledge of health maintenance
5. Identify risk factors
B. Physical exam
1. Vital signs
2. Reaction to/recovery from
anesthesia
3. Lungs
4. Breast
5. Abdomen and fundus
6. Lochia
7. Perineum
8. Lower extremities
9. Elimination
10. Sleep rest status
11. Nutritional status
C. Psychologic assessment
1. Attachment
2. Bonding
D. Laboratory studies
1. Hemaglobin and hematocrit
2. Blood group and type/Rh Factor
3. Rubella titer
E. Cultural influences
F. Developmental
1.
Teenager
2.
Over 35
4.
IV. Selected nursing diagnoses / implementation
/evaluation
A. Pain related to delivery process (perineal
edema, altered skin integrity, generalized
muscular discomfort)
Discuss analysis, planning,
implementation, and evaluation for
the nursing management of post
partum patients.
Clinical Objectives
Learning Opportunities
RNSG 2504 – Care of the Patient with Commonly Occurring Health Problems
Unit IV – Care of the Patient Experiencing Perinatal Cycle
Part C - Postpartum
Behavioral Objectives
Content Outline
1. Independent interventions
a. Post partum assessment q 15 minutes
x 4, q ½ hours x 2, q 1 hour x 2, then
q 4 hours
(1) Vital signs – p, R, B/P
(2) Fundal firmness
(3) Perineum
(a) Sutures
(b) Edema
(c) Bruising
(d) Lochia
(e) Pain
(4) Urinary status
(5) Breasts
(6) Assess comfort level
b. Pericare after each elimination
c. Ice pack first 24 hours
d. Warm packs after first 24 hours
e. Warm showers for after pains and
muscular soreness
f. Position – side-lying or prone with
small pillow to abdomen
2. Collaborative interventions
a. Sitz bath 8-12 hours after delivery
b. Heat lamps
c. Administer medications and monitor
for desired effects/adverse
effects/side effects.
(1) Mild analgesics
(2) topical agents
3. Recognition of complications
a. Hemorrhage
b. Breast engorgement
c. Infection
d. Urinary retention
e. Pain
Clinical Objectives
Learning Opportunities
RNSG 2504 – Care of the Patient with Commonly Occurring Health Problems
Unit IV – Care of the Patient Experiencing Perinatal Cycle
Part C - Postpartum
Behavioral Objectives
Content Outline
4. Evaluation of outcomes: The patient will
have decreased pain as evidenced by:
a. Involution of uterus 1 cm per day
below umbilicus.
b. Perineum intact without evidence of
infection.
c. Voiding without discomfort by
discharge.
d. Breasts remain soft and pain free.
e. Pain less than 3-4 on a scale of 1-10
before discharge
B. Altered health maintenance: Knowledge
deficit
1. Patient teaching
a. Assess readiness to learn, ability,
current level of knowledge
b. Perineal care after each elimination
c. Breast care
(1) Nursing
(2) Lactation suppression for nonnursing
d. Nutritional/hydration needs
e. Monitor urinary function/constipation
f. Promotion of rest
g. Activity resumption
(1) No heavy lifting – nothing
heavier than infant
(2) No heavy housework
(3) Off work 4-6 weeks
(4) Exercise/activity resumption –
gradual
(5) Resumption of sexual activity
h. Avoid overstimulation
i. Post partum blues
j. Development of routine for self and
infant care
k. Care of the father/partner
l. Promotion of family wellness
Clinical Objectives
Learning Opportunities
RNSG 2504 – Care of the Patient with Commonly Occurring Health Problems
Unit IV – Care of the Patient Experiencing Perinatal Cycle
Part C - Postpartum
Behavioral Objectives
Content Outline
m. Postpartum follow up care
n. Symptoms to report to caregiver
o. Medication teaching
(1) Pain management (afterbirth
pains, episiotomy, hemorrhoids)
(2) Rho (d) immune globulin
(RhoGAM)
(3) Rubella vaccine
(4) Contraceptives
(a) Types
(b) Advantages and
disadvantages
2. Community resources
a. Family planning clinic
b. La Leche League
c. Women/Children (WIC)
d. Empty cradle
3. Evaluation of outcomes: The patient will
maintain health status (decreased
knowledge deficit) as evidenced by:
a. o evidence of postpartum infection.
b. Successful breast feeding or lactation
suppression within 2 weeks of
delivery.
c. Resumption of activity without injury
d. Participation of follow up care as
scheduled.
N/AND/Transition/RNSG 1327 Unit IV Part C Postpartum
Clinical Objectives
Learning Opportunities
Reviewed 03/12
Reviewed 03/13
RNSG 2504 – Care of the Patient with Commonly Occurring Health Problems
Unit IV – Care of the Patient Experiencing Perinatal Cycle
Part C - Postpartum