You are on page 1of 26

CLINICAL SPECIALITY-I

SEMINAR
ON
ASSESSMENT OF POSTNATAL
WOMEN & NURSING
MANAGEMENT

SUBMITTED TO:
MRS. VAHITHA S
LECTURER, CON JIPMER
SUBMITTED BY:
LIPI MONDAL
M.SC NURSING 1ST YEAR STUDENT
CON, JIPMER
“Assessment of postnatal women & nursing management”

INTRODUCTION:

Motherhood is a beautiful experience, which is a period of peak of happiness and confusion at postnatal
period. The major goal of postnatal care is to restore the health of the mother and the newborn. It is a time of
transition where physiological changes occur, the woman adapts to mothering role and the family system is
altered by the addition of the newborn. Nursing care during the immediate postpartum period is highly
significant for the later period. This needs a skilled nursing care for mother and the newborn.

GOALS OF POSTPARTUM CARE:

 Promote the physical well-being of both mother and baby.


 Promote maternal rest and recovery from the physical demands of pregnancy and the birth experience.
 Support the developing relationship between the baby and his or her mother, and support/family.
 Support the development of infant feeding skills.
 Support the development of parenting skills.
 Encourage support of the mother, baby, and family during the period of adjustment (support may be
from other family members, social contacts, and/or the community).
 Provide education resources and services to the mother and support in aspects relative to personal and
baby care.
 Support and strengthen the mother’s knowledge, as well as her confidence in herself and in her
baby’s health and well- being, thus enabling her to fulfill her mothering role within her particular
family and cultural beliefs.
 Assess the safety and security of postpartum women and their newborns (families) (e g potentially
violent home situations, substance use, car seats).
 Identify and participate in implementing appropriate interventions for postpartum maternal and
variances/concerns Assist the woman in the prevention of postpartum variances/concerns.

POSTPARTUM ASSESSMENT:

Postpartum period is a period from the birth of the newborn to six weeks. An arbitrary time frame
divides the period into the immediate postpartum (first 24 hours), early postpartum (first week) and late
postpartum (up to 90 days).
“Assessment of postnatal women & nursing management”

 Immediate Postpartum Assessment :


 Assess vital signs every 15 minutes for one hour and as per the protocol of the institution. ·
 Palpate fundus for uterine tone and position.
 Assess lochia every 15 minutes for one hour, then every 4 hours or more frequently if indicated, for
12 to 24 hours. ·
 Massage the uterus gently if uterus does not remain firmly contracted. ·
 Support the lower uterine segment during massage. It prevents inversion of uterus or prolapse.
 Encourage breast feeding within half an hour after delivery.

 Late Postpartum Assessment:


a) Emotional Status
Assess for interaction of mother with new born, fatigue level and for social support e.g. support by
her family members and friends.
b) Physical Assessment
 Assessment of Breast:
— Redness
— Pain
— Engorgement
— Lactation technique of breast feeding to newborn
 Assessment of uterus and Lochia
 Assessment of bladder:
— Dullness before/after voiding

— Measure the first void

 Tone of abdominal muscles and assess for bowel sounds.


 Assess perineum, labia, and anus for edema, redness, pain, bruising and hematoma.
 Assess episiotomy incision for approximation.
 Assess legs and feet for edema, varicosities. ·
 Assess Homan’s sign. If thrombophlebitis, take the width of calf and measure of both extremities.
 Assess activity tolerance.
 Assess for her comfort level.
 Assess for breath sound.
 Assess the needs of both-mother and baby.
“Assessment of postnatal women & nursing management”

 Do not forget to remember “Assessment BUBBLERS – Breast, Uterus, Bladder, Bowel, Lochia,
Episiotomy/Incision, Emotional Response and Homan’s Sign”.

Postnatal Assessment

 Name of the mother :


 Age :
 Religion :
 Education :
 Occupation :
 Date of admission :
 Date of delivery :
 Type of delivery :
 Address :
 Obstetric Score:
 LMP:
 EDD:
 GPLA:

Immediate Assessment

i) Vital signs
 Temperature :
 Pulse/min :
 Resp/min. :
 Blood Presssure :

ii) Vaginal bleeding :

iii) Height of fundus :

(Adequate or not)

iv) Level of hydration :

( Emoted/distended)

v) Bladder:

vi) Breast:

a) Colostrum

b) Nipple
“Assessment of postnatal women & nursing management”

c) Hygiene : Health/Swelling/Pain/Any other

vii) Episiotomy wound

viii) Perineal laceration, if any

Late Assessment

i) Vital signs:
 Temperature :
 Pulse :
 Respiration :
 Blood pressure :

ii) Head-foot assessment

a) Head:

( Hair)

b) Face Puffiness : Yes/No

c) Eye Puffiness : Yes/No

 Sclera
 Conunctiva

d) Mouth Anglo Stomatitis : Yes/No

 Tongue : Dry/moisture/pale/cracked
 Teeth : Normal/dental carries

e) Neck:

 Thyroid gland:
 Lymph nodes:

f) Chest

 Respiratory rate/ min:


 Heart rate/min:
 Heart (murmur):

g) Breast Feel : Soft/hand

 Nipple : Erect/flat/inverted/sore/crakced
 Milk secretion : Adequate/Inadequate
“Assessment of postnatal women & nursing management”

h) Abdomen

 Organomegally : Yes/No, if yes specify


 Bowel sounds:
 Fundal height:

i) Perineum:
 Episiotomy:

j) Extremities:

 Swelling :
 Homan’s sign :

k) Personal hygiene:

l) Postnatal discomforts, if any:

Physical examination finding:

Health education:

Date of discharge (if continued care):

CARE OF WOMEN DURING POSTNATAL PERIOD:

a) Assessment
 Observe for sign of normal involution of uterus.
 Observe signs of healing of episiotomy.
 Observe for lactation and breast feeding.
 Observe the mother providing care to her newborn.
 Teach the mother aspects of self-care and newborn care.
 Report and record for increased pulse rate, decreased B.P. and elevated temperature.
 Gently massage the fundus if boggy and express clots if any, from the fundus.

b) Care of Episiotomy

i) Soon after delivery, apply ice or cold therapy to the episiotomy or if any laceration. After that, apply

moist or dry heat to promote comfort.

 Provide sitz bath twice a day.


“Assessment of postnatal women & nursing management”

 Administer analgesics as per the physician’s instructions.


 Advice mother to squeeze both the buttocks together and tighten the perineal region before sitting.

ii) Perineal hygiene:

 Help the mother in cleaning of her perineum after each voiding and evacuation.
 Clean the perineal area from the front to back to avoid infection.
 Clean with warm water or clean water or with antiseptic solution.
 Apply perineal pad from front to back.
 Instruct mother to wear perineal pads loosely and to lie in Sim’s position (sideline position).

iii)Episiotomy suture care:

 Clean the episiotomy suture with antiseptic solution.


 Observe for any edema, redness, varicosites etc. if so, apply ice or cold to decrease edema and
reduction in pain due to anaesthetic effect. ·
 Apply dry or moist heat to the episiotomy for comfort and healing.

c)Breast Care and Breast Feeding

 Assess the breast for softness or hardness, condition of breast nipples (e.g. flat, inverted, big/small,
cracked etc.).
 Assess mother’s knowledge on breast feeding.
 Help the mother to breast feed within ½ an hour of delivery. Put the newborn in monkey position on the
mothers’ chest.
 Tell the mother to breast feed whenever newborn cries (demand feed). Instruct her to feed 6 to 10 times
a day from both the breasts at each feed.
 Help the mother to position the new born properly while breast feeding for adequacy. Tell the mother to
adopt to timely feeding (2/3 hourly)—Advice her for wearing well fitting brassieres.
 Instruct regarding care of newborn during and after breast feeding.
 Instruct the mother to identify for rooting reflexes (i.e. tell mother to bring her breast nipples near the
cheeks of the newborn and newborn automatically turns to fix the mouth to the breast nipples). ·
“Assessment of postnatal women & nursing management”

 Instruct her to hold the feeding breast with her fingers in a scissors grasp hold.
 Relax and feed the baby from each breast at least for 5-10 minutes. ·
 Advice her to burp the baby after feeding from the first breast. After feeding, repeat for the next breast
(To burp the baby, hold the baby in upright position).
 Advice her to put the baby in right sideline positions after feeding.
 Advice her to express the extra milk from the breast after each feed.
 Clean the mouth of the newborn.
 Advice her to put well fitting brassiers.
 Under privacy, ask her to expose the breast and nipple to air for a few minutes every day.
 Observation for any abnormalities:

— Cracked nipple

— Sore nipple

— Condition of breast (hardness or softness)

— Redness, pain, varicosites, warmth and fever

d)Meeting the Nutritional Need of Lactating Mother (Postnatal Women)

 Assess the nutritional status of the mother.


 Help her to take well balanced diet rich in proteins, vitamins and minerals and their importance.
 Help her to add foods of fiber content (e.g. Ladies finger, drumstick, green leafy vegetables etc.).
 Help to take more fluids for adequate bowel movement.
 Assess for adequacy of breast milk production.
 Advice her to add foodstuff for improving breast secretion.
 Provide the list of iron rich diets (e.g. dates, ragi, jaggery etc.).

e) Maintenance of Normal Elimination

 Encourage mothers for spontaneous voiding of urine at the urge (within 6-10 hours) after birth.
 Motivate her to have adequate fluids and water.
 Encourage mother to consume a balanced diet.
 Observe for bladder distention. Mother will report of fullness of bladder with urge to urinate, but
inability to do so.
“Assessment of postnatal women & nursing management”

 Avoid rapid emptying if catheterization is done

f) Observation and Early Identification of Stress in Mother

Observe for adequate sleep and rest and general behaviour towards self, baby and others.

g) Essential Exercises Following Normal Delivery

Day 1

1) Ambulation walk

Morning 4 mtrs. Night bed time 5 mts.

2) Exercises before feeding Arm stretching, shoulder rotation, 4-5 times.

 Benefits: Improve circulation and prevent stagnation of milk.


 Procedure:

1) Sit comfortably

2) Keep both hands on both shoulders

3) Stretch hands on both shoulders inward and outward

4) Do this 4-5 times

5) Rotate single hand on shoulder forward and outward

3) Foot and Leg Exercises: Bend, Stretch and rotate ankles

Morning Evening 4-5 times 4-5 times

 Benefits: To improve blood circulation and reduce edema.


 Procedure:
1) Sit or lie comfortably
2) Stretch, bend and rotate ankles
3) Do 4-5 times
“Assessment of postnatal women & nursing management”

Day 2

1) Pelvic floor Exercises: Pelvic floor contractions (tightening of buttocks and pelvic floor muscles)

Morning Evening 4-5 times 4-5 times

 Procedure:
1) Lie in supine position flat and bend
2) Tighten tummy muscles and squeeze
3) Now your back should be pressed down
4) Count 1-4 and then let go

2) Stopping stream of urine for a while and then pass (do whenever you can void)

 Benefits : To prevent urinary incontinence and strengthen pelvic floor muscles.

Day 3

1) Pelvic Tilt

Morning Evening 4-5 times 4-5 times

 Procedure:
1) Lie in supine position flat and bend knees and foot resting on bed
2) Tighten tummy muscles and squeeze buttocks.
3) Now your back should be pressed down.
4) Count 1-4 and then let go.

3) Abdominal breathing with abdominal wall tightening on outward breath

 Benefits: It improve long expansion.

Morning Evening 4-5 times 4-5 times

 Procedure:
1) Lie in supine or sit comfortably
2) Place hands over abdomen
3) Take deep breath, hold for count 1-3
4) Exhale by pursed lip
“Assessment of postnatal women & nursing management”

5) Repeat 4-5 times

4) Straight and diagonal curl-ups

 Benefits: To ease backache, strengthen back and muscles of abdomen Morning Evening 4-5 times 4-5
times

Straight Curl-Ups

 Procedure:

1) Lie flat on bed.

2) Tighten tummy muscles.

3) Stretch right hand across body to touch outside thigh.

4) Lift head to look at hands as you go.

5) Feel twist of waist

6) Count 1-4 then let go.

Diagonal Curl Ups

 Procedure:

1) Lie flat on back with knees bent and feet flat on touch.

2) Raises head.

3) Stretches both arms to reach opposite knees.

4) Count 1-4

5) Repeat next hand with opposite knee.

h) Essential exercises for Caesarean mother:

Day 1

1) Abdominal breathing with abdominal wall tightening on outward breath


 Benefits: Improve lung expansion
“Assessment of postnatal women & nursing management”

 Morning Evening 4-5 times 4-5 times


 Procedure:

1) Lie in supine position or sit comfortably.

2) Place hands over abdomen.

3) Take deep breath, hold for count 1-3.

4) Exhale by pursed lip.

5) Repeat 4-5 times.

2) Foot and leg Exercise: Bend, stretch and rotate

 Benefits : To improve blood circulation and reduce edema


 Morning Evening 4-5 times 4-5times
 Procedure:
1) Sit or lie comfortably
2) Stretch, bend and rotate ankles
3) Do 4-5 times

Day 2

1) Exercises before feeding

Arm stretching, shoulder rotation, 4-5 times

 Benefits: Improve circulation and prevent stagnation of milk


 Procedure:
1) Sit comfortably
2) Keep both hands on both shoulders.
3) Stretch hands on both shoulders inward and outward
4) Do this 4-5 times
5) Rotate single hand on shoulder forward and outward

2) Bending and Straightening alternate knee

 Benefits: Improves circulation


“Assessment of postnatal women & nursing management”

 Morning Evening 4-5 times 4-5 times


 Procedure:
1) Lie comfortably
2) Bend straighten alternate knee
3) Repeat 4-5 times

3) Straight curl-Ups

 Morning Evening 4-5 times 4-5 times


 Procedure:
1) Lie flat on bed
2) Tighten tummy muscles
3) Stretch right hand across body to touch outside thigh
4) Lift head to look at hands as you go
5) Feel twist of waist
6) Count 1-4 then let go

4) Diagonal Curl-Ups

 Morning Evening 4-5 times 4-5 times


 Procedure:
1) Lie flat on back with knees bent and feet flat on touch
2) Raise head
3) Stretche both arms to reach opposite knees
4) Count 1-4
5) Repeat next hand with opposite knee

5)Pelvic Tilt

Day 3

1) Bending and straightening alternate knee


2) Straight curl ups
3) Diagonal curl ups
“Assessment of postnatal women & nursing management”

Day 5

 Pelvic floor exercises


1) Stopping urinary stream in between and pass (do when every time you void).
2) Pelvic floor contraction, tightening of buttocks and pelvic floor muscles.
 Benefits:
To prevent urinary incontinence and strengthen pelvic floor muscles.

e)Health Education and Counseling

 Breastfeeding

As providers of MCH services, it is important to support successful breastfeeding practices. The benefits of
breastfeeding can promote and protect the health of both infant and mother.

Breastfeeding should be initiated immediately after delivery.

Booklets and leaflets regarding breastfeeding should be distributed and explained for each mother during
antenatal period and immediately postnatal period.

Encourage Optimal Breastfeeding Practices at the PHC level by teaching and helping mothers to:

Breastfeed as soon as possible after birth, and to remain with the mother for at least several hours following
delivery.

Breastfeed frequently, whenever the infant is hungry, both day and night (generally at least eight times during
24 hours and at least once during the night).

Breastfeed exclusively for the first six months, giving no water, other liquids, or solid foods.

Give complementary feeds after six months (breastfeed before giving complementary feeds).

Continue to breastfeed for up to two years, and beyond, if possible.

Continue breastfeeding even if the mother or the baby becomes ill.

Avoid using bottles, pacifiers (dummies), or other artificial nipples.


“Assessment of postnatal women & nursing management”

 Care and Counseling of the Mother


 Diet

Encourage the mother to eat a well balanced diet including the following: eat protein and energy rich
foods, vitamins, mineral and fluids; continue taking supplements (e.g. iron).

Encourage the mother to drink fluids every time she breastfeeds.

 Rest

Encourage the mother to take rest and encourage other family members to help her with the household
tasks including preparing food, cleaning the house, and caring for the other children. A well-rested mother
is a better mother and spouse.

 Personal Hygiene

The mother can and should bathe herself daily after giving birth. Bathing is not harmful following
childbirth. In fact, women who let many days pass without bathing may develop an infection of the skin or
perineum.

Recommended bathing practice is to use a shower, if available, or to pour water over the body. Wash
breasts and perineum as part of the daily bath.

Wash hands before and after going to the bathroom.

Wash the genital area with mild soap and water after passing urine or stool. Wipe or cleanse vulva from
front to back, anus last. Change perineal pads every time you go to the bathroom for passing urine or stool
and at least four times per day.

 Exercise

Encourage the mother to exercise daily, beginning with performing some small household tasks, and then
establish a daily routine that includes pelvic floor/Kegel exercises.

 “Baby blues” or Early Postpartum Depression

Be alert to any changes in the mother’s mood, such as sadness, unexplained crying, or lack of maternal
feeling. Explain to the mother that these symptoms and feelings sometimes occur after delivery.
“Assessment of postnatal women & nursing management”

Encourage the mother to seek support and to express her feelings to her family; however, if symptoms of
depression continue, become more severe, or seem harmful to the mother, refer the mother for specialized
care from the psychiatrist at a nearby hospital.

 Sexuality

It is advised to abstain from sexual intercourse for six weeks after delivery, to prevent infection and also
to allow the perineum to heal. However, if the vaginal area has healed and bleeding (lochia) has stopped,
there is no medical risk in having intercourse.

 Smoking

For health reasons for both the mother and newborn, the mother should not smoke at all (including the
arguila, a traditional water pipe). If the mother did not stop smoking during pregnancy and continues
smoking after delivery, advise her not to smoke near the time of breastfeeding.

 Danger Signs

Advise the mother to return to the health center if she has any of the following: heavy bleeding, fever or
chills, abdominal pain or foul smelling lochia (vaginal discharge), pain, tenderness or heat in the leg(s).

 Care of the Newborn


 Breastfeeding

Should be encouraged whenever possible

 Care of the Cord

Keep the cord clean and dry. Normally, it falls off within 7-14 days. Do not cover the cord or apply any
medicine or ointment to the cord area. If a bad smell, pus, or signs of infection occur in the navel (cord)
area, take the infant to the health center for care.

 Sleeping Arrangements and Position

The baby should sleep in a clean, safe, smoke-free and warm area and not far from the mother. The
preferred position for the newborn/infant is on the baby’s right side. From time to time, turn the baby’s
head from the right side to the left. When putting the baby to sleep, advise the mother not to place the infant
on his or her abdomen.
“Assessment of postnatal women & nursing management”

 Temperature Regulation

Protect the baby from cold, and also from too much heat. Dress the baby as warmly as you feel like dressing
yourself.

 Cleanliness

Take special care in relation to cleanliness of the infant.

Keep the infant in a clean place away from smoke and dust.

Change the diaper or bedding each time the infant wets or dirties the diaper.

If the infant’s skin becomes red or irritated, leave the diaper off to promote healing, change more frequently,
and keep the irritated area clean and dry.

Bathe the infant daily with mild soap and warm water. Avoid getting the cord wet.

 Parent-Child Attachment and Stimulation

Promote early. This includes cooing, talking, holding, touching, rocking, singing, and looking and smiling at
the infant. Encourage family members to hold the infant close to their hearts when carrying the infant.

 Growth and Development

Monitor using the infant height and weight chart and milestones for development.

 Immunizations

Review with the mother the recommended immunization schedule.

 Danger Signs

Advise the mother to be aware and to take the infant to a health care provider at the health center if the
newborn has any of these signs:

o Poor feeding or sucking,

o Sleeping all the time

o Fever or hypothermia

o No stool by third day


“Assessment of postnatal women & nursing management”

o Blueness of the lips or skin

o Jaundice

o Persistent vomiting

o Vomiting with a swollen abdomen

o Difficulty establishing regular breathing

o Eye discharge

o Water or dark green stools with mucus or blood

 Postnatal Contraception

Postnatal infertility usually lasts for approximately six weeks for the woman who does not breastfeed
exclusively. Sometimes the infant’s on-demand pattern of feeding may not support prevention of ovulation. For
these reasons and to provide maternal recuperation before another pregnancy occurs, contraception should be
offered during the postnatal period.

IDENTIFICATION OF DEVIATIONS FROM NORMAL PUERPERIUM:

 Appearance of Signs and Symptoms of Breast Engorgement

Signs and symptoms of breast engorgement

 Feeling of fullness of the breast


 Feeling of pain on the breasts
 Tenderness
 Warm to touch
 Redness over the breast
 Palpable lumps present
 Painful feeding
 Shining skin over the breast
 Superficial vein visible
 Increased body temperature
 Swolen axillary lymphnodes
“Assessment of postnatal women & nursing management”

 Postpartum Hemorrhage
 Assessment H/O any
o Previous PPH
o Rapid or prolonged labor
o Uterine over distension
o Operative birth due to parity
o Placental abnormality
o Previous uterine surgery
o Assess blood loss
 Weigh pads 1 gm = 1 ml
 Assess vital signs every 15 minutes
 Mean arterial pressure (MAP)
 Assessment of intake-output accurately
 Plan the care e.g. early recognition and early attention
o Nursing intervention to be planned
— IV Tray. Draw blood for hemoglobin and hematocrits cross match type, coagulation time.
— Insert Foley’s catheter to empty the bladder
— Administer IV fluid with prescribed drops
— Administer oxygen
— Provide emotional support
 Postpartum Infection
o Assessment of vital signs
o Increase fluid intake and encourage adequate nutrients intake
o Encourage adequate output.
o Provide comfort by meeting mother’s personal hygiene, cool compress, perineal care and
positioning.
o Prompt observation to avoid septic shock
o Postpartum learning needs assessment and education
o On assessing learning needs the teaching be planned and conducted on any of the selected
topics:
— Pelvic floor exercises: Kegels exercises.
“Assessment of postnatal women & nursing management”

— Abdominal breathing exercises.

— Sexuality: Coping mechanism to both parents should be explained.

— Contraception: Discuss and provide the best choice of selection of contraception to the

couples.

— Transition to parenthood: Fatigue is most commonly found among post partum period.

Need prompt guidance to the family members for support will help.

— Additional stress on: Adoption to post partum period. Role conflict, newborn needs, changes

in parent relationship. Encourage to develop a greater sense of well being through guidance

and support.

— Postpartum blues and depression: Assess for any transient emotional disturbances to “baby

blues” which occurs 3 to 4 days post partum and lasts for some time. Identify symptoms e.g.

Fatigues, psychic anxiety, worry.

— Family transition to parenthood.

— Assess risk mothers and their social status in the family.

NURSING CARE PLAN FOR THE MOTHER DURING POSTNATAL PERIOD:

 Alteration in comfort: pain related to surgery.

Interventions:

 Assess the nature, duration & location of pain.


 Provide comfort measures like comfort measures like position changes, support to abdomen with
pillows.
 Encourage use of relaxation techniques like deep breathing exercises.
 Support the abdominal incision, when moving, coughing or exercising.
 Promote activity & exercise to the extent possible.
 Administer analgesics as prescribed.
“Assessment of postnatal women & nursing management”

 Potential for fluid volume deficit related to decreased oral intake

Interventions:

 Maintain intake & output chart.


 Monitor vital signs.
 Check the colour, amount & specific gravity of the urine.
 Administer IV fluids as prescribed. Start oral fluid intake in small amount as tolerated.
 Provide oral hygiene.
 Monitor skin condition.

 Potential complication related to anesthesia

Interventions:

 Assess the level of consciousness of the mother.


 Position the mother comfortably & place the on one side.
 Assess cough & gag reflex.
 Monitor the vital signs.
 Position the mother in supine position atleast 6 hours.
 Ask the mother to move her toes.

 Activity intolerance due to pain in the incision site & weakness.

Interventions:

 Assess mother’s level of mobility.


 Encourage adequate rest periods especially before ambulation.
 Ambulate the mother as early as possible.
 Plan activities for times mother has most energy.

 Altered nutrition less than body requirement related to surgery

Interventions:

 Administer IV fluids as prescribed.


 Adjust the flow rate as per total volume.
“Assessment of postnatal women & nursing management”

 Auscultate the abdomen for bowel sounds.


 Provide a test feed.
 Watch for vomiting.
 Maintain oral hygiene before & after each feeding.
 Gradually increase oral intake as tolerated.
 Provide semi-solid food gradually.

 Altered bowel & bladder elimination due to anesthesia, decreased oral intake & immobility

Interventions:

 Assess the elimination pattern & frequency.


 Auscultate bowel sounds.
 Give more oral fluids.
 Administer IV fluids as prescribed.
 Maintain intake output chart.
 Encourage progressive ambulation starting within 24 hours.
 Explain the importance of exercise.

 High risk for infection

Interventions:

 Assess signs & symptoms of infection.


 Wash hands before & after given the care to mother & baby.
 Limit visitors. Ask the mother to maintain personal hygiene.
 Ask the mother to clean the hands & breast before & after giving each feeding.
 Maintain strict aseptic techniques while giving care to the umbilical cord,baby bath & eye care.

 High risk for breast engorgement

Interventions:

 Assess the condition of the breast & nipple.


 Initiate breastfeeding as early as possible.
 Establish to have rooming in.
“Assessment of postnatal women & nursing management”

 Help the mother to empty each breast after feeding each time.
 Help her to clean the breast before & after feeding.
 Teach breastfeeding techniques.
 Ensure a comfortable position to the mother & the baby.
 Assess the breast changes: redness, swelling, pain,fullness, tenderness, warmth.

 Altered sleeping pattern related to pain in the incisional site & baby feeding.

Interventions:

 Assess the sleeping pattern.


 Teach relaxation exercises.
 Maintain proper body alignment.
 Administer analgesics as prescribed.
 Adjust sleep schedule.

 Knowledge deficit related to self care & baby care.

Interventions:

 Assess ability to learn or perform desired health related care.


 Teach her about the importance of personal hygiene- perineal care,daily bath, breast care.
 Educate her about the breastfeeding techniques.
 Guidance for immunization schedule.
 Educate her about the importance of well balanced diet.
 Explain about follow-up.

CONCLUSION:

The puerperium is a time of considerable physiological and psychological adjustment. In an effort to


facilitate a healthy adjustment, nursing interventions during the postpartum period must be based upon an
accurate obstetrical history and an awareness of family reactions.

A specific emphasis on individualized, client-driven postpartum teaching, including both self care and
newborn care, is essential. Nursing care should be flexible and organized in collaboration with the woman so as
to address her individual needs and the needs of the family as a unit.
“Assessment of postnatal women & nursing management”

JOURNAL ARTICLE:

Knowledge and Practice of Postnatal Mothers Regarding Personal Hygiene and Newborn Care

-Sahbanathul Missiriya (2016)


Abstract

Postnatal period is a crucial period in woman's life. They are in need of special care during pregnancy, at the
time of labour as well as after delivery of child in order to prove safe motherhood and healthy living. Mostly,
incorrect perception of postnatal health practices leads the individual to move towards the unsafe motherhood.
So the researcher was interfered to assess the knowledge and practice of postnatal mothers regarding personal
hygiene and newborn care.

A study was conducted with the objective to determine the knowledge and existing practice of the postnatal
mothers regarding personal hygiene and newborn care and to find out the association between the knowledge
and practice of postnatal mothers with the selected demographic variable.

A descriptive research design was adopted. A total number of 60 postnatal mothers were selected by
random sampling method in order to assess their knowledge and practice. Out of them, 38(63.3%) were
between the age of 21-25 years, 17(28.3%) were between the age of 26-30 years. Regarding education
38(63.3%) were studied primary school, 10(16.7%) were studied middle and high school, 8(13.3%) were had
higher secondary and 4(6.7%) were graduates and others. Most of them 39(65%) were house wife. Regarding
knowledge on personal hygiene, 42(70%) were having inadequate knowledge and 18(30) were having
moderately adequate knowledge and none had adequate. About their practice, 38(63.3%) were having poor
practice and remaining 22(36.7%) were having satisfactory practice and none had good practice. There was
statistically significant association between the mother's knowledge with the age, education and family type at
P=<0.05, P=<0.001 and P=<0.01 respectively.

The study concluded that there is a need to create awareness among the postnatal mothers regarding
personal hygiene and new born care aspects in rural areas in order to reduce maternal and neonatal
complications.

(ARTICLE INFORMATION: Int. J. Pharm. Sci. Rev. Res., 40(1), September – October 2016; Article No. 18,

Pages: 89-93 ISSN 0976 – 044X )


“Assessment of postnatal women & nursing management”

APPLICATION OF THEORY:

O Maternal role attainment theory:

BIBLIOGRAPHY:

 Pacific Postpartum Support Society, Postpartum Depression and Anxiety, Vancouver, 2001.
 Health and Welfare Canada, Family-Centred Maternity and Newborn Care National Guidelines, 2000.
 Health Canada. (2000). Early Postpartum Care of the Mother and Infant and Transition to Home.
Family Centred Maternity and Newborn Care: National Guidelines (4th Edition). Chapter 6. Author.
www.hc-sc.gc.ca/indexeng.php
 Health Nexus & Province of Ontario (2007). Best Start: Ontario's Maternal Newborn and Early Child
Development Resource Centre www.beststart.org:80/ resources/breastfeeding
 Lowdermilk, D. L. & Perry, S. E. (2007). Maternity & Women’s Health Care (9th ed.). St. Louis, MI:
Mosby.
 Ministry of Health (1998). Ministry of Health and Women’s Health Bureau and the Women-Centred
Care Project (WCP)
 Ministry of Health. (2006). Baby’s Best Chance. (6th ed). Victoria, BC: Open School BC.
www.publications.gov. bc.ca
“Assessment of postnatal women & nursing management”

 World Health Organization. (1998). Health Topics, Pregnancy, Making Pregnancy Safer, All
Publications, Postpartum care, Postpartum Care of Mother and Newborn: A Practical Guide.
www.who.int/en/
 National Collaborating Centre for Women’s and Children’s Health (2004). Caesarean Section. Clinical
Guideline. RCOG Press. (p.8) www.nice.org.uk/nicemedia/pdf/ CG013fullguideline.pdf
 Dutta D. C. Textbook of Obstetrics. 6th edition. Kolkata. New central book agency. 2004.

 Fraser D.M, Cooper MA. Myles textbook for midwives.15th edition New York. Churchill Livingstone.
2009.
 Pillitteri A. Maternal & child health nursing. 6th edition. Philadelphia. Lippincott Williams & willkins.
2010.
 Park K. Text book of Preventive and Social Medicine. 18th edition. Published by Banarsidas Bhanot,
2005, 389-390.
 Fikirte Tesfahun, Walelegn Worku, Fekadu Mazengiya and Manay Kifle. Knowledge, Perception and
Utilization of Postnatal Care of Mothers in Gondar Zuria District, Ethiopia: A Cross-Sectional Study,
Maternal Child Health Journal. 18(10), 2014, 2341-2351.
 Obimbo E, Musoke RN and Were F. Knowledge, attitudes and practices of mothers and knowledge of
health workers regarding care of the newborn umbilical cord, East African Medical Journal. 76(8), 1999
Aug, 425-9.
 Shrestha T, Bhattarai SG and Silwal K. Knowledge and practice of postnatal mother in newborn care:
Journal of Nepal Medical Association, 52(190), 2013 Apr-Jun, 372-7.
 Sandhu G.K.Obstetrics & Midwifery.1st edition. Jalandhar city. Lotus publishers.2013.
 Gopalan S, Jain V, Mudaliar & Menon’s clinical obstetrics.11th edition. Hyderabad. Universities pree
pvt limited.2011.
 Elizabeth M. Midwifery for nurses. 2nd edition. New Delhi. CBS Publishers.2013.
 Padubidri V, Anand E. Textbook of obstetrics.1st edition. New Delhi. B.I. Publications pvt ltd.2006.
 Ricci Scitt S. Essentials of maternity, newborn & woman’s health nursing. 3 rd edition. Philadelphia.
Wolters kluwer. 2013.
 Oats J, Abraham S. Llewellyn –Jones fundamentals of obstetrics & gynecology. 9th edit