Health Assessment during Postpartum PeriodHealth Assessment during Postpartum Period

byby

Assoc. Prof. Dr. Susanha YimyamAssoc. Prof. Dr. Susanha Yimyam

Faculty of Nursing, CMUFaculty of Nursing, CMU

• HHistory, istory, PPhysical Examination hysical Examination ((OObservation, bservation, PPalpation, alpation, LListening), istening), LLaboratory, aboratory, SSpecial Examinationpecial Examination• 4 Dimensions 4 Dimensions : : PP , , PP sychological, sychological, SS oci al and oci al and SSpppppppp pppppppp di mensi onsdi mensi ons• 12 B 12 B

• : : pp , , pp odycondi t i ons, odycondi t i ons, ppodyody temp&Bl oo temp&Bl oo d pr essur e d pr essur e

• ppp= > ppp= > pp pppppppppp & , pppppppppp & , pp elly &Uterus, elly &Uterus, pp ladder, ladder, pppp pp pp pp

movement, movement,pp leeding & Lochia, leeding & Lochia, ppppppp ppppp

• pppppppppp• BBabyaby• BBonding & Attachmentonding & Attachment

PrinciPrincipleple

1. 1. BackgrouBackgroundnd 11. Personal data

• age, education, occupation, income • residence, culture, beliefs & value • supporting persons & network in family & community

12 Pregnancy history• Parity, childbearing, childrearing & complications

13 Current pregnancy & childbirth• type & duration of labor• medications during labor & complication

16 Family’s health history

17 Culture, health beliefs & value Self-care & infant care

1. 1. Background Background (cont.)(cont.) 14 Postpartum data

General health Maternal adaptation Ability of breastfeeding Supports from family & community

15 Laboratory & Special

examinatio n

2. 2. Body Body conditionsconditions 21. General

Appearance, Manner, Clean & Comfort Weakness, Lift up from bed Abilities for routine activities o fnormal life

22. Anemia Conjunctiva, Nail, Hb & Hct

23. Lower extremity Color edema Varicose vein

24. Sleep pattern

25. Foods & water

26. Readiness & demand to learn

3 . 3 . Body temperature Body temperature & Blood pressure& Blood pressure

31. Body Body temperaturetemperature

24 hours of after birth Body temperation = / > 38 C Infection

32. PulsePulse

33. Blood pressureBlood pressure

24 hours of after birth => Orthostatic

hypotension

=> Postpartum Hemorrhage

4. 4. Breast Breast & Lactation& Lactation 41. Breasts

Balance, Rash ? Comfort, Breast engorgement ?

42. Nipples Normal, Short, Invert, Crack ? Engorge areola ? Painful ?

43. Breast milk Milk production & lactation Quantity & Quality of breast milk

5 . 5 . Belly Belly and Uterusand Uterus

51. Abdomen Striae gravidarum, linea nigra

Diastasis recti

Rash, Scar

52. Uterus Contraction, Fundal height, Involution

After (birth) pain

6 . 6 .BladdBladderer

61. 61. Full bladderFull bladder

62. 62. UrineUrine

63.63. Urination Urination

PainfulPainful during urinationduring urination Frequency of Frequency of urinationurination Urinary incontinenceUrinary incontinence

71. Characteristic & Quantity Lochia rubra Lochia rubra : 2-3 days after birth: darkled red, no blood clot Lochia serosaLochia serosa: 4-9 days after birth: pink or brown Lochia albaLochia alba: 10 days after birth: yellow or white/ cream

7.7. Bleeding Bleeding

& Lochia& Lochia

- Lochia: heavy & with blood clot Postpartum hemorrhage- Lochia rubra: through after birth

retained a pieces of placenta/membranes- - 34 after birth: bleeding/ lochiainfection / Subinvolution

- continued serosa & alba lochia endometritis

72. Quality (smell) : Normal:Normal: like menstruation p ppp pp ormal:ormal: foul lochia => infection

bad smell => no enough perineum care

8. 8. BottomBottom

81. 81. PerineumPerineum : pain scale, healing of perineum Check signs of infection by using REEDAREEDA((RRedness edness EE dema dema EE cchymosi s cchymosi s ppi schari schar ge ge AApproximation)pproximation)

82. 82. Genital organGenital organ : Edema, Hematoma, & VVaricose vein

83. 83. RectumRectum : EEdema,dema, PPain, ain, HHemorrhangeemorrhange

9.9.Bowel Bowel movementmovement

• normal l abor- 23 after birth may constipation

• abnormal l abor

perhaps NPO should observe p pp p p ovement

before start oral foods

1 0 .1 0 .BlBluesues : Emotional status

: Maternal role adaptation : Acceptance of infant & Social support : Bonding & Attachment

Maternal behaviorMaternal behavior

1. Taking-in phase (dependent phase) : Dependent within - 12 days 2. Taking-hold phase (dependent-independenr phase) : Dependent & Independent within 10days 3. Letting-go phase

(independent phase) : Independent about Day 10 after birth

11. 11.BabyBaby : : Head & FaceHead & Face

: : Skin, Chest, Abdomen Skin, Chest, Abdomen & Back& Back: : Genital organ, RectumGenital organ, Rectum: Extremities & : Extremities & movementmovement: Vital signs: Vital signs: : Sucking & UrinationSucking & Urination

12. 12.BondingBonding

- Attachment between Attachment between mother & babymother & baby

- - Observation Observation attachment behaviorattachment behavior : touch, hug, talk

: eye contact, hold, feeding

- ObservationObservation family family adaptationadaptation

- Sibling relationshipsSibling relationships