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