CLINICAL SPECIALITY-I
CLINICAL DEMONSTRATION
LESSON PLAN
ON
POSTNATAL ASSESSMENT
SUBMITTED TO SUBMITTED BY
Mrs. Niksy Abraham Rency Mol Jaboi
Sister Tutor M.Sc. Nursing, I year
CON, JIPMER CON, JIPMER
LESSON PLAN
Name of the student : Rency Mol Jaboi
Topic : Demonstration on Postnatal assessment
Method of teaching : Clinical Demonstration cum teaching
Group : B.Sc. IV Year
Date :
Time : 12- 1 pm
Venue : Postnatal Ward
Duration of teaching : 1 hour
GENERAL OBJECTIVE
At the end of the class students will be able to gain knowledge about postnatal assessment and develop positive attitude towards the same and they
will apply this skill in their clinical practices.
SPECIFIC OBJECTIVE
At the end of the class students will be able to:
define postnatal examination
enlist the purposes of postnatal assessment
define the period of postnatal assessment
list down the equipments used for postnatal assessment
discuss the steps of postnatal assessment
SPECIFIC TIME TEACHING &
OBJECTIVE CONTENT LEARNING ACTIVITY EVALUATION
AND AV AIDS
To introduce the topic INTRODUCTION
The postnatal period, or puerperium, is defined as the
period beginning about one hour after the delivery of
the placenta and extending through the next 6 weeks.
The client should receive care after labor and delivery,
when the pelvic organs return to their pre-pregnant
condition. This period of involution typically takes 6-8
weeks, though it may take much longer for some
organs to return to normal. A postnatal examination 6-
12 weeks after confinement is offered to all women so
that any abnormalities can be detected and corrected.
To define postnatal DEFINITION Student teacher defines Define postnatal
examination postnatal examination with assessment
Postnatal examination is the systematic examination the help of lecture.
done in order to assess the general physical and mental
status of the mother.
To enlist the purposes PURPOSES OF POSTNATAL EXAMINATION Student teacher enlists the Enlist the purposes of
of postnatal assessment purposes of postnatal postnatal assessment.
To Promote Physical and emotional well-being. assessment with the help of
To restore the health status of the mother. lecture.
To prevent infections and complications.
To define the period of
postnatal assessment PERIOD OF POSTNATAL ASSESSMENT Student teacher defines the Define the period of
period of postnatal postnatal assessment
Immediate: 24 hours after delivery assessment with the help of
Early: Up to 7 days lecture.
Late: Up to 6 weeks
SPECIFIC TIME CONTENT TEACHING & EVALUATION
OBJECTIVE LEARNING ACTIVITY
AND AV AIDS
To list down the EQUIPMENTS Student teacher lists down List down the
equipments used for the equipments used for equipments used for
postnatal assessment Sterile tray containing postnatal assessment with postnatal assessment.
1) Drape the help of demonstration.
2) Bowl with gauze piece
3) Kidney tray
4) Sterile pad
5) Bowl with antiseptic solution
6) Artery forceps
7) Thumb forceps
Clean tray containing
1) Vital sign tray
2) Torch to visualize eyes, ear, mouth
Stethoscope to auscultate the chest and bowel
sound
3) Bowl with cotton or gauze piece to clean the
breast
4) Paper bag to dispose the solid waste
5) Inch tape to measure the fundal height
6) Pen and paper to record the finding
7) Mackintosh and draw sheet
To discuss the steps of STEPS OF POSTNATAL EXAMINATION Student teacher discusses Discuss the steps of
postnatal assessment the steps of postnatal postnatal assessment
HISTORY COLLECTION assessment with the help of
Review antepartum and intrapartum history demonstration.
Receive report
Determine educational needs
Consider religious and cultural factors
Assess for language barriers
Family profile-support person, no. of children,
occupation, educational Status, socioeconomic
status.
SPECIFIC TIME CONTENT TEACHING & EVALUATION
OBJECTIVE LEARNING ACTIVITY
AND AV AIDS
Pregnancy history-para, gravid, EDD, any
pregnancy complication.
Delivery history-data and time of delivery,
duration of labor, type of delivery, labor
complications.
Baby condition: Birth weight, sex, any
difficulty at birth, breastfeeding and congenital
anomalies.
PREPARATION OF THE PATIENT AND
ENVIRONMENT
Maintain privacy with adequate drapes and
screens.
Adequate lighting provided.
Comfortable bed or examination table.
Room should be warm without draughts.
Prepare the patient physically and mentally
with adequate explanation.
Explain the procedure to the patient to allay the
anxieties to win confidence and cooperation.
PROCEDURE
Treat the mother and ask how she is feeling
whether she feels tired/not 0 Assess mothers Rh
factor. If Rh negative administer immunoglobulin
within 72 hours of delivery.
Vaccination: If mother is not vaccinated for
rubella, vaccine can be given and pregnancy can be
avoided for next 3 months.
Record the vital signs
After 24 hours, the temperature should be
normal.
SPECIFIC TIME CONTENT TEACHING & EVALUATION
OBJECTIVE LEARNING ACTIVITY
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A temperature greater than 100.4˚F and rapid
pulse suggests excessive bleeding and puerperal
infection.
Blood pressure should remain stable. Fall in BP
indicates hypovolemic shock. Hypovolemia can
indicate postpartum hemorrhage. Hypervolemia
could indicate preeclampsia
Pulse: Bradycardia of 50-70 bpm is normal
Tachycardia is not considered a normal
occurrence and may indicate excessive blood
loss
Respiration: Should remain stable and within
normal range
Height and weight measurement
General physical examination
Nourishment: Well-nourished or
undernourished Body build: Thin or obese
Healthy: Healthy/unhealthy
Activity: Active/dull, tired
Mental status
Consciousness-conscious, delirious talking
incoherently
Look-anxious/worried/depressed
Body posture- Lordosis/kyphosis/scoliosis
Movement-any limb
Skin condition:
Color-pallor/jaundice/cyanosis/flushing
Texture-moist/dry
Texture-smooth/ rough
SPECIFIC TIME CONTENT TEACHING & EVALUATION
OBJECTIVE LEARNING ACTIVITY
AND AV AIDS
Skin turgor-hydrated/dehydrated
Temperature-warmth/cold/clammy
Lesions-macula/papules/vesicles/wounds
Presence of-spider nevi. palmar erythema,
superficial varicosities
Hyperpigmentation of-areola nevi, linea nigra,
chloasma
Head and face:
Scalp: Cleanliness, Condition of the hair.
Dandruff, pedicle
Face
Pale/flushed/puffiness/fatigue/pain/fear/anxiety
Eyes
Eyebrows-normal/absent
Eyelashes-infection/sticky
Eyelids-edema/lesions
Eyeballs-sunken/protruded
Conjunctive-pale/red/purulent discharge
Sclera-jaundiced
Cornea or iris-irregularities and abrasions
Pupils-dilated/constricted/reaction to light
Vision-normal/myopia/hyperopia
Ears
External ear-any discharges/cerumen
Tympanic membrane
perforations/lesions/bulging
Hearing-hearing acuity
Nose
External nares-crusts or discharges
Nostrils-inflammation of mucous
membrane/septal deviation
SPECIFIC TIME CONTENT TEACHING & EVALUATION
OBJECTIVE LEARNING ACTIVITY
AND AV AIDS
Mouth and pharynx
Lips-redness, swelling, crusts
Odor of the mouth-angular stomatitis, foul
smelling
Teeth-discoloration and dental caries
Mucus membrane-ulceration and
bleeding, swelling, pus formation
Tongue-pale, dry lesions, sordes, tongue
tie, etc.
Neck
Lymph nodes-enlarged, palpable
Thyroid gland-enlarged
Range of motion-flexion, extension and
rotation
Chest and thorax:
Shape, symmetry of expansion, posture.
Breath sounds-wheezing. rales,
crepitation, pleural sub etc.
Heart sound-size and location murmurs
BUBBLEHE STANDS FOR
Breast Lochia
Uterus Episiotomy
Bladder Homan's sign
Bowel Emotional status
SPECIFIC TIME CONTENT TEACHING & EVALUATION
OBJECTIVE LEARNING ACTIVITY
AND AV AIDS
BREASTS
Usually enlarged, soft and warm and contain only
small amount of colustrum.
The nipples should be intact without redness,
tenderness, cracks, or blisters.
The mother may experience breast engorgement
(enlargement and filling of breasts with milk)
which may begin as a tingling sensation in the
breasts, 2-4 days after the delivery.
The mother may be prescribed analgesics for
breast discomfort and manual expression of milk
and stimulation of nipples to be avoided.
UTERUS
Palpate the uterus. It generally takes 6 weeks for
complete physiologic involution of the uterus.
The fundal height will be 13.5 cm above
symphysis pubis.
Make the patient feel her uterus as explained about
the process of involution.
Immediately after delivery, the uterus weighs
about 100 g, measuring 8-10 cm, which is 2-3
times the non-pregnant state.
If uterus is not involuted properly, check for
infection, fibroids and lack of tone.
Unsatisfactory involution may result if there are
retained bits of placenta inside the uterus.
BLADDER
In the immediate postpartum period, the bladder is
congested, edematous, and hypotonic from the
effects of labor.
SPECIFIC TIME CONTENT TEACHING & EVALUATION
OBJECTIVE LEARNING ACTIVITY
AND AV AIDS
Inspect and palpate the bladder simultaneously
while checking the height of the fundus.
Talk to mother about proper perineal care. Explain
that she should wipe from front to back after
voiding and defecating.
Bladder distention should not be present after
recent emptying.
When bladder distention does occur, a pouch over
the bladder area is observed, felt upon palpation;
mother usually feels need to urinate.
It is imperative that the first three postpartum
voiding be measured and should be at least 150 cc.
Frequent small voiding with or without pain and
burning may indicate infection or retention.
Early ambulation and comfort facilitates urination.
For clients who cannot urinate, a straight
catheterization may be done after considering
individual circumstances such as the degree of
bladder distension, location of displaced uterus,
amount of bleeding, amount of fluid or 'IV intake
since last voiding and techniques used to
encourage voiding. In case of cesarean delivery, an
indwelling catheter is kept in place for 24 hours.
BOWEL
Question patient daily about bowel movements.
She must not become constipated. If her bowels
have not functioned by the second postpartum day,
mild laxative can be started.
Encourage patient to drink extra fluids.
Have patient select fruits and vegetables from her
menu.
SPECIFIC TIME CONTENT TEACHING & EVALUATION
OBJECTIVE LEARNING ACTIVITY
AND AV AIDS
LOCHIA
Assess the amount and type of lochia on pad in
relations to the number of postpartum days.
First 1-4 days of postpartum, one should find a
very red lochia similar to the menstrual flow
(lochia rubra). During the next few days (5-9
days), it should become watery serous (lochia
serosa).
From 10-15 days, it should become thin and
colorless (lochia alba).
Educate the woman regarding her next menstrual
period, when win it probably begin and when she
can resume sexual relationship.
Discuss family planning at this time.
Notify the doctor if the lochia looks abnormal in
color or contains clots other than small ones.
EPISIOTOMY
Inspect episiotomy incision thoroughly using
flashlight if necessary, for better visibility.
Check for REEDA sign.
R- Redness(hyperaemia)
E- Edema
E- Ecchymosis
D- Discharge
A- Approximation of the wound edges
Check rectal area. If hemorrhoids are present, the
doctor may want to start on sitz bath and local
analgesic medication. Reassure patient and answer
questions she may have regarding pain,
cleanliness, and coitus.
SPECIFIC TIME CONTENT TEACHING & EVALUATION
OBJECTIVE LEARNING ACTIVITY
AND AV AIDS
Check the incision at area for proper wound
healing, infection, inflammation, and suture
sloughing.
If the surrounding skin is warm to touch and the
patient complains of discomfort, notify the doctor.
HOMAN’S SIGN
Press down gently on the patient’s knee (legs
extended flat on bed) and ask her to flex her foot.
Pain or tenderness in the calf is a positive Homan’s
sign and indication of thrombophlebitis. Physician
should be notified immediately.
EMOTIONAL STATUS
Throughout the physical assessment, notice and
evaluate the mother’s emotional status.
Explain to the mother and to her family that she
may cry easily for a while and that her emotions
may shift from high to low.
The changes are normal and are probably caused
by the tremendous hormonal changes occurring in
her body and by her realization of new
responsibilities that accompany each child’s birth.
AFTER CARE
Place the patient comfortably.
Replace the articles to the utility room.
Record the findings in the nurse’s record.
Report to the doctor if any abnormal findings
were found.
SPECIFIC TIME CONTENT TEACHING & EVALUATION
OBJECTIVE LEARNING ACTIVITY
AND AV AIDS
To summarize the topic SUMMARY
Today I demonstrated how to do postnatal assessment
and discussed about the purposes, preparation, and
procedure and after care of the patient.
To conclude the topic CONCLUSION
The postnatal period, or puerperium, is defined as the
period beginning about one hour after the delivery of
the placenta and extending through the next 6 weeks.
A postnatal examination 6-12 weeks after confinement
is offered to all women so that any abnormalities can
be detected and corrected and treated as early as
possible so as to reduce the risk to the mother as well
as the baby.
BIBLIOGRAPHY
1. Swan D. Obstetrics Nursing Procedure Manual. New Delhi. The Health Science Publishers.2017.
2. Anamma J. A comprehensive textbook of midwifery. 2nd ed. Jaypee Brothers Medical Publishers. 2008
3. Mudaliar A L. Clinical obstetrics. 10th ed. University’s press India Pvt.Ltd. 2008. 358
4. Dutta.D.C.Textbook of Obstetrics.7thed.London.New Central Book Agency(P)Ltd;2011.
5. Elizabeth M.Midwifery for Nurses.2nded.New Delhi. CBS Publishers and Distributors Pvt Ltd;2013.
6. Seth.S.S.Essential of Obstetrics.2nded.Jaypee Brothers Medical Publishers(P)Ltd;2011.
7. Cooper.M,Fraser.D. Textbokk for Midwives.15thed.New York. Churchill Livingstone Elsevier;2009.
