Explain the pathophysiology and physiological adaptations for clients who have an uncomplicated postpartum period.
Explore the nursing care of clients who have an uncomplicated postpartum period.
Apply the nursing process using clinical judgment functions while providing care to clients who have an uncomplicated postpartum period.
Expected Maternal Physiological Adaptations
Vital Signs
Neurological System
Endocrine System
Placental Hormones
Pituitary Hormones
Thyroid
Pancreas/Liver
Insulin
Glucose
Cardiovascular System
Cardiac Output
Varicosities
Hematological Systems
Blood Volume
Hemoglobin & Hematocrit
Pulmonary/Respiratory Systems
Pulmonary Function
Hemodilution
Hemodilution is the dilution of blood components.
It occurs during the immediate postpartum period due to the mobilization of extravascular fluid back into the bloodstream.
Blood Loss
A drop in hemoglobin and hematocrit levels may not be an accurate guide to blood loss.
Nurses should assess for blood loss through other methods.
Gastrointestinal System
Peristalsis
Constipation
Hemorrhoids
Anal Incontinence
Renal System
Kidney Function
Postpartum Diuresis
Bladder
Voiding
Distention
Urinary Incontinence
Reproductive System
Involution of the Uterus
Fundus
The fundus is assessed in postpartum clients to monitor the involution of the uterus and identify potential complications such as uterine atony or retained placental fragments.
Fundal Assessment
Expected findings during a fundal assessment include:
Firm and midline
Located at or slightly below the umbilicus in the immediate postpartum period.
Lochia
Lochia is the vaginal discharge after childbirth, containing blood, mucus, and uterine tissue.
Lochia rubra: Dark red, first 3 - 4 days postpartum
Lochia serosa: Pink to brown, days 4-10 postpartum
Lochia alba: White or yellow, days 10-14 postpartum
Other Reproductive System Changes
Cervix
Ovaries
Vagina
Perineum & Pelvic Musculature
Breasts
Colostrum
Hyperlactation
Hypolactation
Musculoskeletal System
Muscle Tone
Joint Hypermobility
Integumentary System
Chloasma/Melasma
Hyperpigmentation of Areola
Linea Nigra
Striae Gravidarum
Hair Loss
Nursing Care of Postpartum Clients: Physical Assessment
Vital Signs
Blood Pressure
Increased: Consider Pre-eclampsia
Decreased: Consider Hemorrhage
Temperature
Increased: Over 38° C – Consider Infection
Heart Rate
Increased: Consider Hemorrhage
Respiratory Rate
Increased: Consider Anxiety or Compromised Respiratory Status
Decreased: Consider Use of Opioid Pain Medications
Breasts & Nipples
Breasts
Inspection & Palpation
Primary Engorgement
Secondary Engorgement
Nipples
Inspection
Breast feeding & Latching
Breastfeeding
Benefits of breastfeeding for the client include:
Uterine involution
Weight loss
Reduced risk of ovarian and breast cancer
Enhanced bonding with the infant.
Uterine Tone
Lochia
Perineum
Lacerations
Episiotomy
Rectal Area
Hemorrhoids
Urinary Elimination
Abdomen
Lower Extremities
Perineal Trauma
Perineal trauma refers to injuries to the perineal area during childbirth, such as lacerations or episiotomy.
It can occur due to factors such as:
Large infant size
Rapid delivery
Use of forceps or vacuum.
Other Physical Assessments
Energy Level
Pain Management
Afterpain
Perineal Pain
Pain related to Cesarian Birth
Communication
Psychosocial Aspects
Impact of Birth Experience
Client & Family
Maternal/Paternal Stress
Positive Birth Experience
Parent-Newborn Interaction
Adapting to Parenthood
Cultural Beliefs and Practices
Rooming In
Benefits of ‘rooming in’:
For the parent(s)? Promotes bonding, facilitates breastfeeding, and increases parental confidence.
For the newborn? Enhances bonding, promotes breastfeeding, and allows for close monitoring of the newborn.
SDOH
Social determinants of health (SDOH) affect adapting to parenting by influencing access to resources, support systems, and healthcare services.
Culture
Nurses can determine individual postpartum cultural beliefs and customs by: