PN CD

OBSTETRICAL & GYNAECOLOGICAL
NURSING
CLINICAL DEMONSTRATION
ON
POSTNATAL ASSESSMENT
PRESENTED TO
DR.S.USHA. M.Sc. (N), Ph.D.,
LECTURER,
GCON,
CUDDALORE.
PRESENTED BY
MRS. SUGANYA.S.,
M.Sc. (N), I YEAR,
GCON,
CUDDALORE.
POSTNATAL ASSESSMENT
INTRODUCTION
The postnatal period, or puerperium, is defined as the period

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.
DEFINITION
Postnatal examination is the systematic examination done in

order to the assess the general physical and mental status of the
mother.
EQUIPMENTS
Sterile tray containing
 Drape
 Bowl with gauze piece
 Kidney tray
 Sterile pad
 Bowl with antiseptic solution
 Artery forceps
 Thumb forceps
Clean tray containing
 Vital sign tray

 Torch to visualize eyes, ear, mouth
 Stethoscope to auscultate the chest and bowel sound
 Bowl with cotton or gauze piece to clean the breast
 Paper bag to dispose the solid waste
 Inch tape to measure the fundal height
 Pen and paper to record the finding
 Mackintosh and draw sheet.
STEPS OF POSTNATAL EXAMINATION
The acronym, BUBBLEHE can serve a helpful reminder of the

elements in a postpartum assessment.
BUBBLEHE STANDS FOR
B-Breast
U-Uterus
B-Bladder
B-Bowel
L-Lochia
E-Episiotomy
H-Homan's sign
E-Emotional status
BREASTS
 Usually enlarged, soft and warm and contain only small amount
of colostrum .
 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,

oedematous, and hypotonic from the effects of labor.
 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 distension should not be present after recent emptying.
 When bladder distension 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
caesarean 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.
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 colourless (lochia

alba).
 Educate the woman regarding her next menstrual period, when

will 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.
 Check rectal area. If haemorrhoids 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.
 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

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.
CONCLUSION
Puerperium is the period following child birth during which the
body tissues especially the pelvic organs revert approximately to the
pre-pregnant state both anatomically and physiologically. During the
postpartum period assessment of maternal condition must be done on
a regular basis and a progress record to be maintained.
BIBLIOGRAPHY
1. Annamma Jacob, (2012). “A comprehensive Textbook of

Midwifery & Gynaecological nursing". 2nd ed. New Delhi : Jaypee
Brother's medical publishers (P) Ltd.
2. D C. Dutta , (2004). "Text book of obstetrics".3 rd ed. New
Delhi: New central book agency.
3. Marie Elizabeth.(2005).”Midwifery For Nurses”.2nd ed.CBS
Publisher’s & Distributers (P)ltd..
4. Poonam Sachdeva, Swaraj Batra. ”Essentials Of
Obstetrics” .2nd ed. Thieme .
5. S. Kamalam.(2006).” Essentials Community Health Nursing
Practice”.1st ed.New Delhi: Jaypee Brother's Medical Publishers (P)
Ltd.

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OBSTETRICAL & GYNAECOLOGICAL

The postnatal period, or puerperium, is defined as the period

Postnatal examination is the systematic examination done in

Clean tray containing

 Vital sign tray

STEPS OF POSTNATAL EXAMINATION

The acronym, BUBBLEHE can serve a helpful reminder of the

BUBBLEHE STANDS FOR

 The nipples should be intact without redness, tenderness, cracks,

 The mother may experience breast engorgement (enlargement

 The mother may be prescribed analgesics for breast discomfort

 Palpate the uterus. It generally takes 6 weeks for complete

 The fundal height will be 13.5 cm above symphysis pubis.

 Immediately after delivery, the uterus weighs about 100 g,

 If uterus is not involuted properly, check for infection, fibroids

 In the immediate postpartum period, the bladder is congested,

 Inspect and palpate the bladder simultaneously while checking

 Talk to mother about proper perineal care. Explain that she

 Bladder distension should not be present after recent emptying.

 When bladder distension does occur, a pouch over the bladder

 It is imperative that the first three postpartum voiding be

 Early ambulation and comfort facilitates urination.

 For clients who cannot urinate, a straight catheterization may be

 Question patient daily about bowel movements. She must not

 Encourage patient to drink extra fluids.

 Have patient select fruits and vegetables from her menu.

 Assess the amount and type of lochia on pad in relations to the

 From 10-15 days, it should become thin and colourless (lochia

 Educate the woman regarding her next menstrual period, when

 Discuss family planning at this time.

 Inspect episiotomy incision thoroughly using flashlight if

 Check for REEDA sign.

 Check rectal area. If haemorrhoids are present, the doctor may

 Check the incision at area for proper wound healing, infection,

 If the surrounding skin is warm to touch and the patient

 Press down gently on the patient's knee (legs extended flat on

 Pain or tenderness in the calf is a positive Homan's sign and

 Throughout the physical assessment, notice and evaluate the

1. Annamma Jacob, (2012). “A comprehensive Textbook of

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