Monitoring Postpartum Recovery

Jolene K. Bethune, RN, MSN

At the completion of this presentation, you will be able to:Perform postpartum checks according to protocolMonitor vital signs and blood pressureInspect and palpate the breastsPalpate the fundus and bladderMonitor urinary outputMonitor bowel activityMonitor lochiaInspect the perineumMonitor extremities for thrombophlebitis

Objectives

Hand-washing station.Gloves.Oral glass, electronic or tympanic thermometer.Stethoscope.Doppler ultrasound stethoscope or probe.

You will need:

Conductive jelly.Watch with sweep second hand.Sphygmomanometer with assorted cuffs; or continuous

non-invasive blood pressure monitoring device.Maternity pads.

Frequency of postpartum checks according to protocol:First hour: every 15 minutes

Second hour: every 30 minutes

First 24 hours: every four hours

After 24 hours: every 8 hours

Postpartum Check

Wash hands and explain the procedure to the patientTo make sure the client is as comfortable as possible, make

sure the patient has voided.Take vital signs and make sure they are within normal limits

when compared to the baseline. Take vital signs before hands-on procedures; the

discomfort of palpating the fundus could reflect in an elevated blood pressure or pulse.

Vital Signs and Blood Pressure

Raise the head of the bedAsk the patient lower her gown so that her breasts can be

examinedVisually inspect and palpate each breast noting:Soft, filling or firmEngorged, reddened, or painfulNipples: erectility, possible cracks and redness

Inspect and Palpate the Breasts

The fundus should be palpated until the 10th day postpartum.

Since patients are usually discharged sooner, patients should be instructed in self-examination so that she can be alert to sudden changes in the uterus.

Lower the head of the bed so that the abdomen will be relaxed.

Position the ring finger directly over the umbilicus so that the small finger is the closest to the client’s head.

Palpate the Fundus

Using the ring finger as a fulcrum, roll the hand back and forth gently and note the fundus in relationship to the umbilicus. Note:

Fundal consistency and toneFundal position – in relationship to

the midline. Displacement to the left or right could be caused by a distended bladder.

Fundal height – measured in finger breadths from the umbilicus.

Palpate the Fundus

During fundal palpation

Bladder palpability

Bladder distention could displace the uterus

Impeding involutionImpeding the control of bleeding.

Palpate the Bladder

Voiding pattern and amounts voided:Is it at least 30ml/hr?Distention:Is a distended bladder displacing the

uterus?Pain:Is voiding painful, burning or

itching?S/S of what?

Monitor Urinary Output

Bowel movements:When was her last BM?Normal, diarrhea or constipation?Hemorrhoids:Are there hemorrhoids present?Is there active bleedingBowel sounds: auscultate all four quadrants:Especially C/S patients; why?Normo-, hyper- or hypoactive?

Monitor Bowel Activity

Detach the peripad from the front to the back to minimize the risk of contaminating the vagina with rectal discharge. Note:

Type and amount – rubra (dark and red); serosa (serous or brown)

Four to eight saturated pads per 24 hours is normal.

Presence of odor – could indicate infectionPresents of clots – could indicate retained

placental tissue or inadequate uterine contraction.

Monitor Lochia

Instruct the client to assume a side-lying (Sims) position.

If a laceration or episiotomy repair is present, instruct the client to flex the top leg to minimize the strain on the repair.

Gently separate the buttocks and inspect the perineum for:

Episiotomy, lacerations and hemorrhoidsBruising, hematoma, edema, discharge,

approximation

Inspect the Perinuem

Homan’s sign (calf pain from passive dorsiflexion of foot)

Redness, tenderness or warmth

Monitor Extremities for Thrombophlebits

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References