Immediate Postpartum Assessments and Frequency (Nursing)

00:01 Cletus is arrived.

00:03 And so now it's time to check the patient and make sure that everything is okay as we transition to postpartum.

00:10 So let's talk about that assessment and what the nurse should be looking forward to make sure that everything is A-OK.

00:18 There going to be some assessments that are done immediately and quite frequently after delivery.

00:23 We're going to check vital signs to make sure that the heart rate, the temperature, the respiratory rate are all stable and normal, indicating that everything is going well.

00:33 We want to look for signs of hemorrhage, so excessive bleeding.

00:36 So we're going to look at the bleeding and it's called lochia.

00:39 That is the word lochia, we're going to examine that to make sure that it is a normal amount.

00:45 One of the things that can cause heavy bleeding is uterine atony.

00:49 And that's where the uterus is not contracted, it's very soft or mushy or soggy.

00:55 And so we want to make sure that when we palpate the uterus, it's nice and firm, like a tennis ball or something that is not soft.

01:02 The bladder will be assessed to make sure that it's not filling, not only is it uncomfortable to have a full bladder, but a very full bladder can also keep the uterus from contracting, which will increase the bleeding, which will set us up for a postpartum hemorrhage.

01:18 There's some other things we can encourage in the postpartum period to help make the transition easier for the patient and for the baby.

01:26 Breastfeeding is definitely one of those things.

01:29 The first hour after delivery, the baby's going to be awake and alert, understandably, because a lot just happened.

01:36 At the end of that hour, however, they'll get sleepy.

01:39 So this is a perfect time during that first hour to really try breastfeeding, and get it establish so that it'll be easier later on.

01:48 Skin to skin contact is also really important.

01:51 So imagine if you just got out of the shower or the bath and you're wet, and you come into a room that's cold, and you're wet, this is not good.

02:00 So if we place the fetus or the baby actually on the maternal chest, or give it to dad or the other partner, other parent that's in the room, then that's a way to help improve thermal regulation for the baby.

02:13 It works really well.

02:15 It also promotes bonding.

02:18 We want to think about all the ways that the patient might be uncomfortable, they've just delivered a baby, whether it's vaginally or by a cesarean.

02:26 We want to make sure that they are feeling good because they might be breastfeeding, they hopefully are doing kangaroo care.

02:32 And we want to make sure that they are well and A-OK.

02:37 Now let's think about the frequency of those assessments.

02:41 So for the first hour after delivery, we're going to check the lochia and the uterus, the bladder and the vital signs about every 15 minutes.

02:48 So we'll do that 4 times in the first hour.

02:52 During the next hour, we'll check about every 30 minutes.

02:55 So we're spacing the time out because hopefully, we've established that the client is a little more stable.

03:01 And then after the first 1-2 hours, we'll space it out to every 4.

03:06 And then after the next day postpartum and through discharge, we will do those checks about every 8 hours.

03:13 Keep in mind if we have a situation where the client's experienced some kind of complication, or you noticed that the bleeding is heavy, or you notice that one of the vital signs causes some concern, then the frequency of assessment is going to change.