1 by Assoc. Prof. Dr. Susanha Yimyam Faculty of Nursing, CMU

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byby

Assoc. Prof. Dr. Susanha Assoc. Prof. Dr. Susanha

YimyamYimyam

Faculty of Nursing, CMUFaculty of Nursing, CMU

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Objective:Objective: assess for postpartum uterine involution. One hour after delivery, it has risen to the level of the umbilicus. It will decrease a fingerbreadth (1 cm.) a day in size until 10th day uterus no longer be detected by abdominal palpatn.

Indication:Indication: 24 hours after normal birth . (Contraindicated in cesarean births as i t may be painful).

Time: 1000. am. EquipmentEquipment:: Ruler

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Procedure: Procedure: 1. Explain the procedure & rationaleExplain the procedure & rationale for

each step before beginning procedure. 2. Ensure privacyEnsure privacy & an environment

where the woman can lay on her back without a pillow and knees bent.

3. The nurse-midwife should have clean, warm hands and should help womanto expose her abdomen; Lower the perineal pads to observe lochia.

Amount: Amount: Mild, Moderate, HeavyMild, Moderate, HeavyCharacteristic: Characteristic:

Normal Bleeding Normal Bleeding,, Rubra lochia Rubra lochia,, Serosa l Serosa lochiaochia, , Alba lochia Alba lochia

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Procedure (Cont.): Procedure (Cont.): 4. Use the flat part of fingerspart of fingers (not

fingertips) for palpation. 5. Begin palpation at the umbilicus, &

palpate gently until fundus is located. Notice how the hand

“cups” the uterus to determine firmness firmness

& location of fundus.& location of fundus. Fundus should be firm, midline, & ~ at level of umbilicus.

6. Fundus is palpated to assess degree of uterine contraction & its location by using

a ruler to measure from symphysis pubis to measure from symphysis pubis to

fundal heightfundal height. Any pain or tenderness should be noted.8. Following assessment, the mother

should be informed informed regarding any findings,

any further action that is required, & then noted in nursing notesnoted in nursing notes.

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ObjectivesObjectives::1 ) Prevention of infectio

n.2 ) Observe lochia, perin

eal wound, & state of healing.

3 ) Comfort.Types:Types: at bedside & in tre

atment room

Indication of Perineal Nursing Care at Bedside:

1. Women after vaginal birth who canno -t perform self care;

2. Women after Cesarean section who c - annot perform self care;

3 . Women with complications such as po stpartal hemorrhage, intravenous fluids, retained catheterization, or restricted be

d rest.

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Procedure:

1. Wash hands before & after cleansing per ineum & after changing pad.

2. Prepare instruments for bedside. 3. Provide privacy by using curtain.

EEEEEEE EEEEEEEEE EEE EEEEEEEEEE 4. Put on mask and clean gloves. 5 . Ask the women to assume a supine posit

EEE E EEE EEEEE EEEEE EEEE EEEEEEEE E EEEEE EEEEEEE EE E6 . ,

over the legs with socks or a blanket.

EEE EEEE-EEE EEEE EEEEE EE EEEEE E EE7 . , p soiled pad and discard properly.

E EEEEE EEEEEEEE E EEEE EEE EE EEEE EEE E8 . haracteristic of lochia.

EEEE EEE EEEEEEEEE E EE EEEEEEEEEE EEE EE9 . dness, ecchymosis, edema, discharge, and

approximation (REEDA).

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10. Note the number and size of hemorrhoids. 11. Place bed pan gently under mother’s buttock and encourage her to pass urine.

12. Use forceps to hold cotton balls dipped with 7.5% Providine; clean perineum from sy

E EEEEEE EEEEE EE EEEE EEEEE 1

st cotton mons pubis area

2nd cotton mother’s faring thigh

3rd cotton mother’s closing thigh

4th cotton mother’s faring labia minora & majora

5 th cotton mother’s closing labia minora &majora

6th cotton clitoris through anus

13. Rinse normal saline solution throug hout mons pubis. 14. Use forceps for holding each cotton

ball with normal saline solution in jug to w ipe perineum (external genital organ) are

12a; repeat the same as in step . 15. Use forceps for holding dry cotton b

all moistened with a little of normal saline solution; wipe perineum.

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- 17. Apply peri pad from front to back, p rotecting inner surface of pad to contami

nate from ascending colon. 18. Remove socks or blanket. 19. Clean instruments. 20. Record in nursing notes characterist

ic of perineal wound, lochia or presence of h

emorrhoids.

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Objectives: Stimulate blood circulation, E EEE EEE E EEEE EEEEing, & Relieve pain and edem

a at perineum Indication: Indication: Women with episiot

omy wound 2. Instruct women to empty bladder, clean -perineum and apply clean peri pad.

- 3. Place mother in lithotomy or side lying position on the bed, with appropriate dra

pe as needed. 4 50. Place infra red lamp cm away from t

he perineum. - 5 35. Routine lamp use: minutes/ once aday. - 6. Instruct women to apply a clean peri pad

after dry heat. 7. Assess and report to mother about episi

otomy site when treatment is completed.

ProcedureProcedure:: 1. Explain procedure & ratio

nale of using a heat lamp.

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Objective:Objective: 1 . Promote abdominal

& perineal muscles to -return to pre pregnan

cy state.2. Promote blood circul

ation & EEEEEEE EEEEE bophlebitis.

3. Refresh postpartal mother

4. - Regain non pregnantfigure

5. E EEE EEE EEEEEEEEE

Indication:Indication: Women with adequate rest (approximately 24 hours) with normal delivery;

Contraindicated Contraindicated for cesarean births or abdominal tubal resection.

Duration: These exercises lasts ~ - 10 30

1000min. a day; start at . am.

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EPreparation: Nurse should suggest mot

her to 1. Breastfeed their infant before

starting postpartal exercise; 2. Wear appropriate dress;

3. Should empty bladder before sta rting exercise.

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Procedure:Procedure: Postpartal exercise at Postpartal exercise at university universityhospitalhospital

1 Abdominal breathing This is one of the simpl

est exercises & EEE EE started on the first pos tpartum day. E EE EE assumes a supine posi

tion.

She inhales through nose, keeps rib cage as stationary as possible, and allows the abdomen to expand. She then contracts the abdominal muscles as she exhales slowly through the mouth.

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She inhales deeply to begin, then exhales while lifting the head slowly; she holds the position for a few seconds and relaxes. Practice 5 – 10 times.

2 Head lift

This exercise can be started within a f ew days after childb

irth. M other is supi ne with knees bent

& arms outstretche d at her side.

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she brings the hands together above the chest while keeping arms straight; she holds for a few seconds and return to the starting position. She repeats the exercise 5 - 10 times.

3. Chest exercise

This is an excellent exercise to strengthen the chest muscles. The mother lies flat with arms extended straight out to the side.

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4. Knee and abdominal exercise

The woman assumes a supine position. She inhales deeply to begin, and flexes right knee and thigh until foot touches buttock while straighten left leg.

She then exhales and straightens right leg and lowers it slowly while flexing left knee and thigh until foot touches buttock. Practice 5-10 times. This exercise strengthens abdominal muscles, upper legs, and hips.

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5. Leg raising The woman lies on her back (no pillow) with arms to her side.

Raise right leg upward as much as possible then lower slowly. Repeat with left leg. Practice 5-10 times. This exercise strengthens abdominal muscles, upper legs, and hips.

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6. Buttocks Lift

The woman lies on her back (no pillow), arms on her side and both knees bent.

Slowly, raise buttocks and arch back wh ile tighten perineal muscles. Return slo

wly to starting position and relax perinea - 510l muscles. Practice times. This exer

cise strengthens perineal muscles.

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7 . Prone position

The woman lies in a prone position with a small pillow under abdomen for 20 minutes. This exercise is good for uterine involution & drainage of vaginal discharge.

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Postpartum ExercisePostpartum ExercisePostpartum ExercisePostpartum ExerciseProcedure:Procedure: Postpartal exercise at Postpartal exercise at health promotion health promotion hospitalhospital

1. Shoulder and arm exercise 2. Neck and head

exercise

3. Leg exercise

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Infant Infant BathingBathing

Objectives:Objectives: 1. Clean & EEEEEEE EEE EEE EEEE

2. Observe abnormal sig ns & sympt oms

3. Prevent itching 4. Establish parent & EE

wborn attachment

Indication: EEE EEEEEEE EEEEEE

contraindication. The i nfant should be

EEEEEE & washed hair at l EEE E E EEEE 1 .

D emonstrate at first ti EEEE E EEEEE E EEE,

EEEEEE-EEE EEEEEEEEEE E t the following days.

Time: - 11001200at : : aE E

Place: EEEE E EEE EEEE E

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General Guidelines

1. A complete sponge bath with mild soap and water is given on admission and if the newborn remains in the nursery may be given every day or every other day in addition to the periodic cleansing of face and buttocks.

2. Daily cleansing of the newb orn’s skin may be limited to

washing the buttocks and pe rineal area with a mild soap a

nd water during diaper chan ges and washing the face wit

h warm water as needed. 3. Before beginning, all suppli

es needed for bath should be assembled, & area should be

warm and free from drafts.

Preparation

- Rinse warm water to a basin, then test temperature of water by using nurse’s elbowE

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Procedure:Procedure:

Eye:Eye: Use a clean cotton ball or clean area of washcloth for each eye. Face:Face: Wash face first with clean water, using soft washcloth or cotton balls. Nose : Nose : Use small twisted piece

of cotton moistened with water if some dried mucus needs to be removed from nose.

Ears:Ears: Twisted cotton or a soft washcloth can be used to clean outer ear. Nothing should be put inside ear or nose.

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Procedure:Procedure: Head:Head: • Swaddle the newborn in a blanket or towel andhold in a football position. • Use the same soap that the newborn is bathed with or any brand of baby shampoo to lather scalp. • Rinse head well with very wet washcloth or by holding newborn over basin and scooping water up with hand and dripping over head. • Dry immediately and thoroughly. • Wash the head each time the newborn in bathed. • Avoid putting oil on the hair.

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Procedure:Procedure: Body and Body and Extremities:Extremities:•Pay special attention to area under chin, palms of hands, between fingers and toes, and in other areas where skin surfaces come together.

• Rinse and dry well, especially as previously noted.

Cord Care: Cord Care:• Clean around the junction between the cord stump and the skin with alcohol. • Observe for a red, inflamed area around the stump or any discharge with an odor.

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Genitalia:Genitalia:

For the uncircumcised boy, the penis should be washed a

s any other part. If the foresk in is retracted, it should not b

e pushed any further than it will easily go, and it must be r

eplaced over the glands after cleaning.

For the circumcised boy, ge ntly cleanse the penis with co tton balls moistened with war

m tap water. A fresh sterile p etroleum jelly dressing may b

e applied according to policy. Observe closely for bleeding.

For female newborns, the fo lds of the labia should be care

fully cleansed with moistened cotton balls,

- - using front to back direction& a clean cotton ball for eachstroke.

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ReferencesReferencesReferencesReferences

Lowdermilk, D.L., Perry, S.E., & Piotrowski, K.A. (Eds.). (2004).

Maternity & Women’s Health Care (8th Ed.). St.Louis: Mosby.

Pillitteri, A. (2003). Maternal & Child Health Nursing: Care of the

childbearing & childrearing family (4th Ed.). Philadelphia: Lippincott

Williams & Wilkins.

Reeder, S.J., Martin, L.L., Koniak-Griffin, D. (1997). Maternity Nursing

(18th Ed.). New York: Lippincott.

Varney, H. (1997). Varney’s Midwifery (3rd Ed.). Sudbury, MA: Jones

and Bartlett Publishers.

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1 by Assoc. Prof. Dr. Susanha Yimyam Faculty of Nursing, CMU