LESSON PLAN

ON
POSTNATAL ASSESSMENT
LESSON PLAN

Name of the student : DELPHY VARGHESE

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 : 20 min.

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
TIME SPECIFIC TIME TEACHING & AV AIDS
EVALUATIO
OBJECTIVE CONTENT LEARNING
N
ACTIVITY

To list down the EQUIPMENTS Student teacher List down the

equipments lists down the equipments
used for Sterile tray containing equipments used used for
postnatal 1) Drape for postnatal postnatal
assessment 2) Bowl with gauze piece assessment with assessment.
3) Kidney tray the help of
4) Sterile pad demonstration.
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

STEPS OF POSTNATAL EXAMINATION

To discuss the HISTORY COLLECTION Discuss the
steps of  Review antepartum and intrapartum Student teacher steps of
postnatal history discusses the steps postnatal
assessment  Receive report of postnatal assessment
assessment with
 Determine educational needs
the help of
 Consider religious and cultural factors
demonstration.
 Assess for language barriers
 Family profile-support person, no. of
children, occupation, educational Status,
 socioeconomic status.

 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.
  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
  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/an
xiety
 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

 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
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.

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.
 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.

To summarize the SUMMARY

topic Today I demonstrated how to do postnatal assessment
and discussed about the purposes, preparation, and
procedure and after care of the patient.

CONCLUSION
To conclude the topic 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.