POSTNATAL CARE

 

POSTNATAL CARE

Postnatal care, also known as postpartum care, is a critical aspect of nursing that focuses on the health and well-being of both the mother and the newborn following childbirth. This period extends from the time immediately after the birth until six weeks post-delivery. Here are key aspects of postnatal care for both the mother and baby:

Postnatal Care for the Mother:

1. Assessment and Monitoring:

   • Regular assessment of vital signs, including blood pressure, heart rate, and temperature.
   • Monitoring for signs of postpartum hemorrhage, infection, or other complications.

2. Perineal Care:

   • Providing care for the perineum, especially if there are lacerations or episiotomy.
   • Encouraging proper hygiene to prevent infection.

3. Uterine Assessment:

   • Monitoring the uterus for involution (returning to its pre-pregnancy size and position).
   • Checking for fundal height and firmness.

4. Emotional Support:

   • Assessing the mother's emotional well-being and providing support.
   • Educating on signs of postpartum depression and anxiety.

5. Breast Care:

   • Assisting with breastfeeding techniques and ensuring proper latch.
   • Addressing any breastfeeding challenges or concerns.

6. Nutritional Guidance:

   • Providing information on postpartum nutrition and hydration.
   • Addressing dietary needs, especially if breastfeeding.

7. Pain Management:

   • Administering pain medication as prescribed.
   • Recommending non-pharmacological pain relief methods.

8. Postpartum Exercises:

   • Guiding the mother on postpartum exercises to promote recovery.
   • Emphasizing pelvic floor exercises.

9. Family Planning:

   • Discussing family planning options.
   • Providing information on contraception methods.

10. Education on Warning Signs:

    • Educating the mother on signs of complications and when to seek medical attention.
    • Providing contact information for follow-up care.
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Postnatal Care for the Baby:

1. Initial Assessment:

   • Conducting a thorough physical examination of the newborn.
   • Checking vital signs, weight, and gestational age assessment.

2. Feeding Assistance:

   • Assisting with breastfeeding or formula feeding.
   • Monitoring feeding patterns and diaper output.

3. Umbilical Cord Care:

   • Instructing parents on proper care of the umbilical cord stump.
   • Monitoring for signs of infection.

4. Temperature Regulation:

   • Ensuring the baby is appropriately dressed and maintaining a stable body temperature.
   • Monitoring for signs of hypothermia or hyperthermia.

5. Jaundice Monitoring:

   • Assessing for jaundice and implementing phototherapy if necessary.
   • Educating parents on recognizing signs of jaundice.

6. Newborn Screening:

   • Facilitating required newborn screening tests.
   • Explaining the purpose and significance of these tests.

7. Immunizations:

   • Ensuring the baby receives recommended vaccinations.
   • Educating parents on the importance of immunizations.

8. Parental Bonding:

   • Encouraging skin-to-skin contact between the baby and parents.
   • Promoting bonding and attachment.

9. Education on Care at Home:

   • Providing parents with information on caring for the newborn at home.
   • Addressing common concerns and questions.

10. Follow-Up Care:

    • Scheduling and coordinating follow-up appointments for the baby.
    • Offering guidance on well-baby checkups and immunization schedules.

Postnatal care is a collaborative effort involving healthcare providers, nurses, and families. It aims to ensure a smooth transition for both the mother and baby into the postpartum period, promoting health, well-being, and a positive family experience.

PPH MGT

1. CALL FOR HELP

2. E²R²C³P³P

E- IV line and give Ergometrine 0.5mg IV and Oxytocin 40-80iu/ltr

E- Elevate the bed

R- Rub the uterus

R- Remove any clots/Placenta

C- Check for any tear in the vagina

C- Cross match blood

C- Catheterize

If still bleeding (repeat ergometrine)

P- Prostaglandin (Misoprostol 1mg po stat)

P- Pack with hydrostatic balloon 300-600cc

If still bleeding, get to OT quickly.

P- Press on Aorta

P- Proceed to laparatomy, tie tourniquet around uterus or do hysterectomy.

Nursing Management of Postpartum Hemorrhage (PPH)

Postpartum hemorrhage (PPH) is a life-threatening emergency that requires immediate and systematic management. The following notes outline the nursing management of PPH based on the PPH MGT protocol, which includes CALL FOR HELP and the E²R²C³P³P approach.

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1. CALL FOR HELP

• Immediate Action: As soon as PPH is suspected, call for help from the multidisciplinary team, including:

  • Obstetrician

  • Anesthetist

  • Midwives

  • Hematologist

  • Blood bank staff

• Activate Emergency Protocols: Ensure the emergency trolley and PPH kit are available.

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2. E²R²C³P³P Approach

E - IV Line and Administer Medications

• Establish IV Access: Insert two large-bore IV cannulas (16G or 18G) for rapid fluid resuscitation.

• Administer Medications:

  • Ergometrine 0.5mg IV: Causes uterine contraction (contraindicated in hypertensive patients).

  • Oxytocin 40-80 IU/Liter: Infuse IV to maintain uterine tone.

• Monitor Vital Signs: Continuously monitor blood pressure, pulse, and oxygen saturation.

E - Elevate the Bed

• Trendelenburg Position: Elevate the patient’s legs to improve venous return and maintain blood pressure.

• Left Lateral Position: If the patient is hypotensive, this position helps improve cardiac output.

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R - Rub the Uterus

• Bimanual Uterine Massage:

  • Place one hand on the abdomen and the other in the vagina.

  • Firmly rub the uterus to stimulate contractions and expel clots.

• Monitor Uterine Tone: Ensure the uterus remains firm and well-contracted.

R - Remove Clots/Placenta

• Inspect for Retained Placenta or Clots:

  • Perform manual removal of the placenta if retained.

  • Remove any clots from the uterine cavity to prevent atony.

• Ensure Complete Delivery: Confirm that the placenta and membranes are fully expelled.

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C - Check for Vaginal or Cervical Tears

• Inspect for Trauma:

  • Examine the vagina, cervix, and perineum for lacerations.

  • Repair any tears immediately to control bleeding.

• Use Adequate Lighting: Ensure proper visualization of the birth canal.

C - Crossmatch Blood

• Order Blood Products:

  • Crossmatch for 2-4 units of packed red blood cells (PRBCs).

  • Prepare fresh frozen plasma (FFP) and platelets if coagulopathy is suspected.

• Monitor Hemoglobin and Hematocrit: Assess for signs of anemia or hypovolemia.

C - Catheterize

• Insert Foley Catheter:

  • Monitor urine output (aim for >30 mL/hour).

  • Empty the bladder to prevent uterine displacement and improve contraction.

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If Bleeding Persists (Repeat Ergometrine)

• Repeat Ergometrine 0.5mg IV: If the uterus remains atonic and bleeding continues.

• Monitor for Side Effects: Nausea, vomiting, and hypertension.

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P - Prostaglandin (Misoprostol 1mg PO Stat)

• Administer Misoprostol: 1mg orally or rectally to enhance uterine contractions.

• Alternative: Carboprost (Hemabate) 250mcg IM if available.

P - Pack with Hydrostatic Balloon

• Uterine Tamponade:

  • Insert a hydrostatic balloon catheter (e.g., Bakri balloon) into the uterine cavity.

  • Inflate with 300-600cc of sterile saline to apply pressure and control bleeding.

• Monitor for Rebleeding: Ensure the balloon remains in place and effective.

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If Still Bleeding, Proceed to OT

• Prepare for Surgery:

  • Transfer the patient to the operating theater immediately.

  • Ensure blood products and surgical instruments are ready.

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P - Press on Aorta

• Aortic Compression:

  • Apply firm pressure on the abdominal aorta to reduce blood flow to the uterus.

  • This is a temporary measure while preparing for definitive treatment.

P - Proceed to Laparotomy

• Surgical Interventions:

  • Uterine Artery Ligation: Tie off the uterine arteries to reduce blood flow.

  • B-Lynch Suture: Compress the uterus with sutures to control bleeding.

  • Hysterectomy: As a last resort, perform a hysterectomy if bleeding cannot be controlled.

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Additional Nursing Responsibilities

1. Fluid Resuscitation:

   • Administer crystalloids (e.g., Normal Saline or Ringer’s Lactate) to maintain circulation.

   • Avoid overhydration to prevent pulmonary edema.

2. Monitor for Shock:

   • Assess for signs of hypovolemic shock (tachycardia, hypotension, cold clammy skin).

   • Administer oxygen via face mask (10-15 L/min).

3. Documentation:

   • Record all interventions, medications, and patient responses.

   • Document blood loss (quantify using visual estimation or weighing pads).

4. Emotional Support:

   • Provide reassurance to the patient and family.

   • Explain procedures and keep them informed.

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Summary

The nursing management of PPH requires a rapid, systematic, and multidisciplinary approach. The E²R²C³P³P protocol ensures that all critical steps are taken to control bleeding, stabilize the patient, and prevent complications. Early recognition, effective communication, and prompt intervention are key to saving lives in PPH cases.