• Greatest risk for postpartum complications is during the first 24 hours after delivery
• Identification of potential problems; immediate intervention; reassessment

• Assessment includes:
– Condition of uterus
– Amount of bleeding
– Bladder & voiding
– Vital Signs
– Perineum

• Fundus = Palpated to assess firm & well contracted
• Bleeding = Assess drainage on pad
• Pulse & Bp = Assess cardiovascular function
• Perineum = Assess for signs of hematoma, lacerations, & edema

• Assessments are q 15 minutes for the first hour post delivery
• Temperature is taken at the end of first hour
• Transferred to Postpartum Unit when stable

• Report between L&D Nurse & PP Nurse
• Preparations made for receiving the Mother such as:
– Room Ready
– IV Pole
– Admission Assessment
– Vital Signs Equipment

• Assessment is immediately upon arrival to the PP Unit
– Complete Assessment
– BUBBLE HE & VS included
• Reassessment q Hour x 4 Hours
– Uterus, Lochia, Bladder, Bp & Pulse
– Abnormal Findings

• Elevated Temperature
– Normal finding for first 24 hours
– Sign of Dehydration
– Sign of Infection
• Bradycardia
– Normal Finding

• Tachycardia
– Infection
– Hemorrhage
– Pain
– Anxiety
• Lowered Blood Pressure
– Orthostatic Hypotension
– Shock

• Elevated Blood Pressure
– Pregnancy-induced Hypertension

• Soft, firm, can be lumpy
• Secretion of Colostrum
• Engorgement
• Assessment of:
– Breasts
– Nipples

• Process of Involution
• Height
– First Day = at Umbilicus
– Decreases 1 FB per Day
• Consistency
– Firm, Round, Smooth; Not “Boggy”
• Location
– Midline

• Often times will be catheterized in L&D post delivery
• Assess for Bladder Distention:
– Uterine Atony
– UTI
• Recatheterize in 6 hours if not voided (Dr.)
• Measure Urine Output

• Assessment for Bowel Sounds
• Complaints of Gas Pains
• Usually has Stool 2-3 days post delivery
• May need medication for gas pains, laxatives, stool softeners, enemas

• Amount
– Estimate of Drainage
– Number of Pads
• Color
– Rubra
– Serosa
– Alba

• Assessment for:
– Hematomas
– Ecchymosis
– Edema
– Erythema
– Intact Suture Line
– Signs of Infection

• Assessment for Thrombophlebitis
– Swelling
– Reddness
– Warmth
– Pain
• Unilateral Findings
• C/S Mother at Higher Risk

• Can have Mood Swings
• Observing Bonding Behavior & Ability to give Infant Care
– Rubin’s Phases
– En face
– Engrossment

• Assessment of Lower Extremities for:
– Sensation
– Movement
• Remains on Bedrest

• Additional Assessment:
– Incision
– Fluid Intake
– Bladder & Bowel
– Ambulation/Orthostatic Hypotention
– Thrombophlebitis

• Assessment Checklist Form
• Graphic Sheet
• Narrative Notes
– Admission
– Daily

• Throughout the chapter
• NCP

• Prevention of Complications
• Reduce Discomfort
• ADL
– Nutrition
– Rest & Sleep
– Ambulation
– Bathing
– Kegel Exercises

• Rubella Vaccine
– Titer
– Hypersensitivity to eggs
– Administration of Vaccine
– Patient Teaching
• Rho Immune Globulin
– Criteria
– Administration of Rhogam

• Instructions for Mother & Infant Care
• Next Appointment
• Referrals