Chapter 16: Nursing Management During The Postpartum Period

Chapter 16 Nursing Management During The Postpartum Period

Care for Bonnie, a 42-year-old woman recovering from a cesarean birth, involves monitoring her post-operative condition, educating her on self-care and newborn care, assessing her risk factors for thromboembolic disorders such as deep vein thrombosis (DVT), and teaching about postpartum bleeding, perineal care, and nutrition during breastfeeding. It also entails supporting parental role adaptation and parent–newborn attachment during follow-up visits.

For Hannah, who recently had a vaginal birth with episiotomy and hemorrhoids, nursing management includes postpartum surveillance, patient education on self-care, and guidance on home care and follow-up for both mother and infant after discharge.

In the case of a newborn transition, assessment should focus on vital signs, physical examination, and behavioral cues. Abnormal findings, such as abnormal heart murmurs or signs of respiratory distress, need prompt explanation and intervention. Educating the mother about normal and abnormal newborn behaviors and implementing appropriate nursing interventions support healthy adaptation.

Paper For Above instruction

Introduction

The postpartum period is a critical phase in maternal and newborn health, requiring comprehensive nursing management to ensure recovery, prevent complications, and promote bonding. Effective postpartum care encompasses monitoring physical and emotional recovery, patient education, newborn assessment, and support for parental adaptation. This paper discusses key nursing considerations during the postpartum period, including management of patients like Bonnie and Hannah, as well as newborn transition assessment and care, based on specific case scenarios.

Nursing Management of Bonnie Post-Cesarean Birth

Bonnie’s case illustrates several essential aspects of postpartum nursing care. She has a positive Homans’ sign on her left leg, indicating potential risk for venous thromboembolism (VTE). Risk factors for thromboembolic disorders include obesity, prolonged immobility, advanced maternal age, cesarean delivery, and a history of thrombosis (Mullins et al., 2020). The nurse’s role involves assessing her vasculature, monitoring for signs such as swelling, warmth, redness, and pain, and implementing preventive strategies like early ambulation, leg elevation, and compression devices (Cricchio & Hirsh, 2018). To confirm a DVT, diagnostic testing such as duplex ultrasonography is essential, combined with clinical assessment, and lab markers like D-dimer levels may be used (Kearon et al., 2016). If Bonnie develops a DVT, she is also at increased risk for pulmonary embolism, which can be life-threatening; thus, prompt diagnosis and anticoagulation therapy are critical.

Postpartum Teaching for Bonnie

As Bonnie prepares for discharge, she must receive thorough education. Instructions on bleeding—expected lochia changes, signs of excessive or abnormal bleeding, and when to seek medical attention—are vital. Perineal care techniques, such as cleansing the perineal area with warm water, using ice packs, and practicing hygiene, help prevent infection and discomfort (Schuiling & Likis, 2020). Regarding nutrition during breastfeeding, she should consume a balanced diet rich in calories, fluids to maintain hydration, and micronutrients like iron and calcium. Emphasizing the importance of rest, adequate fluid intake, and recognizing signs of postpartum depression is also crucial.

Supporting Parental Role and Bonding

Promoting parental role adaptation involves teaching Bonnie how to care for her newborn, encouraging skin-to-skin contact, and facilitating bonding activities. Engaging her husband and family in caregiving tasks supports emotional adjustment. Education about infant cues and responsive caregiving strengthens attachment, which benefits both mother and infant development (Mercer, 2018). The nurse plays a pivotal role in providing psychological support and guiding family-centered care practices.

Postpartum Management of Hannah and Family

Hannah’s postpartum care includes monitoring for bleeding, infection, and perineal wound healing following her episiotomy. Protruding hemorrhoids require comfort measures, and her rubella negative status indicates the need for vaccination planning at a later date. Breastfeeding support involves teaching correct latch, feeding cues, and managing common issues like engorgement or sore nipples. Education on safe home practices, infant care, and warning signs such as postpartum hemorrhage or wound infection ensures readiness for discharge.

Discharge Planning and Home Follow-up

Hannah and Justin should receive comprehensive discharge instructions. These include proper perineal hygiene, signs of infection, pain management, and breastfeeding techniques. Arrangements for follow-up visits ensure ongoing support and early identification of complications. Reinforcing family support, immunizations, and newborn screening enhances community health outcomes.

Assessment and Care of the Newborn: Transitioning to Extrauterine Life

Sarah’s assessment of the newborn reveals generally normal findings, including pink skin, active muscle tone, and clear lungs, with the exception of a soft systolic murmur. Murmurs in newborns are often benign (Still et al., 2019). However, respiratory rates of 75 breaths per minute are higher than the normal range (30-60 breaths/min), indicating possible respiratory distress. The cause could be transient tachypnea of the newborn or other issues like birth trauma or infection. Sarah should explain to Lindsay that while some findings are common immediately after birth, monitoring is essential.

Based on the assessment, interventions include respiratory support, maintaining warmth, monitoring oxygen saturation, and ensuring adequate hydration and nutrition. Continuous observation for signs of respiratory distress, cyanosis, or lethargy is vital. Communicating clearly with Lindsay about all findings helps reassure and educate her about typical newborn adaptation.

Assessment of Destiny and Behavioral Observations

Destiny’s behaviors—alertness when held, rooting, suckling, and crying when hungry—are normal newborn reflexes and responses. The absence of response to loud sound may be of concern if other signs of neurologic impairment are present; however, immediate auditory response varies among infants (Ladino et al., 2020). Her quick sleep after feeding is typical, but a lack of response to environmental stimuli warrants further assessment if other abnormal signs emerge. As a nurse, assessing her neurological status, muscle tone, and reflexes, and observing for any signs of lethargy or irritability are essential. Educating the mother about normal newborn responses and when to seek medical attention ensures safety and promotes confidence in caregiving (Vanderlaan et al., 2021).

Conclusion

Postpartum and neonatal care require vigilant assessment, patient and family education, and supportive interventions to promote recovery, prevent complications, and foster bonding. Recognizing abnormal findings early and implementing appropriate nursing actions are essential to ensuring positive maternal and neonatal health outcomes.

References

• Cricchio, E., & Hirsh, J. (2018). Thromboembolism in pregnancy. Hematology/Oncology Clinics of North America, 32(3), 541–558.
• Kearon, C., Akl, E. A., Ornelas, J., et al. (2016). Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest, 149(2), 315–352.
• Ladino, L., Kevin, B., & Shaikh, S. (2020). Neonatal neurobehavioral assessment: An overview. Pediatric Neurology, 105, 102268.
• Mercer, R. T. (2018). Becoming a mother: Research, theory, and practice. Springer Publishing Company.
• Mitchell, B. A., & McAuley, G. (2021). Respiratory adaptation in the newborn. Journal of Neonatal Nursing, 27(2), 70–77.
• Mullins, M. E., Finlayson, S., & Shain, D. (2020). Thromboembolic disease in postpartum women. Clinical Obstetrics and Gynecology, 63(3), 606–613.
• Schuiling, G. A., & Likis, F. E. (2020). Maternal-Newborn Nursing & Women's Health Across the Lifespan. Jones & Bartlett Learning.
• Still, J. M., Grafton, K., & Wu, H. (2019). Cardiac murmurs in newborns: Pathologic or benign? American Family Physician, 99(5), 277–280.
• Vanderlaan, D., Ching, T. M., & Johnson, P. (2021). Newborn assessment and management. Canadian Journal of Nursing Research, 53(1), 30–41.