BUBBLESHE

BREASTS
Bra
Support Straps

Adjustable
Wide Back

One size larger

BREASTS
Size Shape Softness Firmness Warmth Redness

BREASTS
Physical Assessment/Normal Findings General Appearance Alterations and Possible Causes

-Smooth -Even pigmentation -Changes in Pregnancy still apparent -One may appear larger -Depending on the postpartal day -May be soft, filling, full, or engorged -Supple, pigmented, intact -Becomes erect when stimulated

-Reddened Area (mastitis)

Palpation

-Palpable Mass (caked breast, mastitis) -Engorgement (venous stasis)

-Fissures, cracks, soreness
(problems with breastfeeding)

Nipples

-Not erectile when with stimulation (inverted

nipples)

BREASTS
Nipples
Cracks
Fissures Soreness

UTERUS
Physical Assessment/Normal Findings Musculature Alterations and Possible Causes

-Abdomen may be soft, have a doughy texture -rectus muscles intact

-Separation in musculature (diastasis recti abdominis)

Fundus

-Firm, midline -Should be following the process of involution

-Boggy (full bladder, uterine bleeding)

-May be tender when palpated

Constant tenderness (infection)

BLADDER

Encourage to void every 4 to 6 hours Assess for bladder distention

Catheterization (8 hours)
Assess for possible signs of UTI

BLADDER
Physical Assessment/Normal Findings Alterations and Possible Causes

-Voiding in sufficient quantities at least every 4 to 6 hours -Bladder not palpable

-Inability to void (urinary retention) -Symptoms or urgency, frequency, dysuria (UTI)

BOWEL

Constipation Fluid intake of 2,000 mL /day or more) Stool softeners

BOWEL
Physical Assessment/Normal Findings Alterations and Possible Causes

-Should have normal bowel movement by 2nd or 3rd day postpartum

-Inability to pass feces (constipation due to fear of pain from episiotomy, hemorrhoids, or perineal trauma)

LOCHIA
Vaginal discharge of cellular debris, mucus and blood following childbirth
Musty, stale odor Average amount: 225mL Assess for change in progression and amount

LOCHIA
Lochia rubra
Dark red Occurs 2 to 3 days

Lochia serosa
Pinkish Day 3 to day 10

Lochia alba
Creamy or yellowish Day 7 to day 14

LOCHIA
Heavy amount
stain larger than 6 inches in length within 1 hour 50 to 80 mL lochia

Moderate amount
stain less than 6 inches in length within 1 hour

25 to 50 mL lochia

Small amount
Less than 1 inch amount in length within 1 hour 10 to 25 mL lochia

Scanty amount
Less than 1 inch in length after 1 hour or is only on tissue when woman wipes

LOCHIA
Physical Assessment/Normal Findings
Alterations and Possible Causes

-Scant to moderate amount, earthly odor; no clots

-Large amount, clots (hemorrhage) -Foul-smelling lochia (infection) Failure to progress normally (subinvolution)

Normal progression of lochia

UTERINE ATONY vs SUBINVOLUTION

EPISIOTOMY
Initial healing would occur in 2 to 3 weeks after birth Complete healing may take up to 4 to 6 months Position in checking: Sims position

Check for
RRedness
EEdema or swelling EEcchymosis or bruising DDrainage (gently palpate, also noting the hardness and warmth of the surrounding area)

AApproximation (how well the edges of the incision are)

Foul odor=infection- report to physician

SKIN

Skin turgor Perineal area for infection Dehydration

Increase oral fluid intake (caffeine-free)

HOMANS SIGN
Assess lower extremities
If with pain DVT (deep vein thrombosis)

Prevent thrombophlebitis
Early ambulation Prevent pressure behind the knee Avoid crossing legs

EMOTIONS
Taking-In and Taking-Hold (Rubin, 1961)

Taking In:
1st to 2nd day after birth Mother is passive and dependent Follows decisions

Hesitates to make decisions

 Still preoccupied with her needs

May have the need to talk about her perceptions on labor and birth

Food and sleep are her major needs

She is taking in information that helps her to identify the infant

EMOTIONS
Taking-Hold
2nd or 3rd day after birth May be concerned about controlling her bodily functions May worry about the quality of her milk and her babys needs and her ability to nurse her child

EMOTIONS
If her baby spits up, she may view it as a personal failure May also feel that the nurse can take care of her child more than her Mothers require assurance that she is doing well as a mother More independent and adjusts more rapidly Allow the mother to perform actual infant care

Reinforce all positive actions

EMOTIONS
Letting-Go
Phase when mother returns home
Must accomplish 2 kinds of separation:
Realize and accept the physical separation from her baby Relinquish former role of a childless person

EMOTIONS
Maternal Role Attainment
Anticipatory Stage Formal Stage Informal Stage Personal Stage

Anticipatory Stage:
Occurs during pregnancy
Looks to role models, especially her own mother

Formal Stage
Occurs when the child is born
Still influenced by the guidance of others Acts what she believes others expects her to do

Informal Stage
Begins to make her own decisions
Begins to develop her own style of mothering Finds ways of functioning that works well for her

Personal Stage
The woman in this phase is already comfortable with the notion that she herself is a mother

 Postpartum Blues
Transient periods that occurs during the first few days Naturally resolves in 10 to 14 days, but evaluation should be done if symptoms persists

 Manifestations:
Tearfulness Anorexia Difficulty sleeping

Factors:
Changing hormone levels Insecurity Psychological adjustments Unsupportive environment

Feeling of letdown

Manifestation
Breasts Uterus Uterus is slightly boggy; not well contracted; pale and boggy upon laparotomy With indwelling catheter intact with initial drainage of 10mL, concentrated; UO=40 cc/hr (2 hours after)

Bladder

Bowel
Lochia Episiotomy Skin Homans Sign Emotion