Transfer from the Recovery Area

After the initial recovery period has been completed, the woman may be transferred to a postpartum room in the same or another nursing unit. In facilities with labor, delivery, recovery, postpartum (LDRP) rooms, the woman stays in the same room; the nurse who provides care during the recovery period usually continues caring for the woman. In many settings women who have received general or regional anesthesia must be cleared for transfer from the recovery area by a member of the anesthesia care team. In other settings a nurse makes the determination.

In preparing the transfer report, the recovery nurse uses information from the records of admission, labor and birth, and recovery (Fig. 19-1). Information communicated to the postpartum nurse includes identity of the health care provider; gravidity and parity; age; anesthetic used; any medications given; duration of labor and time of rupture of membranes; whether labor was induced or augmented; type of birth and repair; blood type and Rh status; group B streptococcus status; status of rubella immunity; human immunodeficiency virus (HIV), hepatitis B, and syphilis serology test results; other infections identified during pregnancy (e.g., chlamydia, gonorrhea) and whether these were treated; intravenous infusion of any fluids; physiologic status since birth; description of fundus, lochia, bladder, and perineum; sex and weight of infant; time of birth; name of pediatric care provider; chosen method of feeding; any abnormalities noted; and assessment of initial parent-infant interaction.

Most of this information is also communicated to the nurse on the mother/baby unit or the nursing staff in the newborn nursery if the infant is transferred to that unit. In addition, specific information should be provided regarding the infant’s Apgar scores (see Chapter 23), weight, voiding, and stooling and whether fed since birth. Nursing interventions that have been completed (e.g., eye prophylaxis and vitamin K injection) and identification procedures (e.g., footprints, armbands) must be recorded.

Planning for Discharge

From their initial contact with the postpartum woman, nurses prepare the new mother for the time when she will return home. Planning for discharge begins with the first interaction between the nurse, the woman, and her family and continues until they leave the hospital or birthing facility (Fig. 19-2).

The length of stay after giving birth depends on many factors, including the physical condition of the mother and the newborn, mental and emotional status of the mother, social support at home, patient education needs for self-management and infant care, and financial constraints.

Women who give birth in birthing centers may be discharged within a few hours, after the woman’s and infant’s conditions are stable. Mothers and newborns who are at low risk for complications may be discharged from the hospital within 24 to 36 hours after vaginal birth. This short time frame is often called early postpartum discharge, shortened hospital stay, or 1-day maternity stay. Early discharge was popular in the late 1980s and early 1990s, but concerns related to the health and well-being of mothers and newborns led to legislation promoting longer hospital stays. The passage of the Newborns’ and Mothers’ Health Protection Act of 1996 provided minimum federal standards for health plan coverage for mothers and their newborns (AAP Committee on Fetus and Newborn, 2010). Under this Act all health plans are required to allow the new mother and newborn to remain in the hospital for a minimum of 48 hours after an uncomplicated vaginal birth and for 96 hours after a cesarean birth, unless the attending provider in consultation with the mother decides on early discharge.

Ongoing Physical Assessment

Ongoing assessments are performed throughout hospitalization. In addition to vital signs, physical assessment of the postpartum woman focuses on evaluation of the breasts, uterine fundus, lochia, perineum, bladder and bowel function, vital signs, and legs (Table 19-1).

Routine Laboratory Tests

Several laboratory tests may be performed in the immediate postpartum period. Hemoglobin and hematocrit values are often evaluated on the first postpartum day to assess blood loss during birth, especially after cesarean birth. In some hospitals a clean-catch or catheterized urine specimen may be obtained and sent for routine urinalysis or culture and sensitivity, especially if an indwelling urinary catheter was inserted during the intrapartum period. In addition, if the woman’s rubella and Rh status are unknown, tests to determine her status and need for possible treatment should be performed at this time.

Nursing Interventions

Based on the available data (e.g., medical record) and assessment findings, the nurse plans with the woman which nursing measures are appropriate and which are to be given priority. The nursing plan of care includes periodic assessments to detect deviations from normal physical changes, measures to relieve discomfort or pain, safety measures to prevent injury or infection, and teaching and counseling measures designed to promote the woman’s feelings of competence in self-management and newborn care. The spouse or partner, and other family members who are present can be included in the teaching. The nurse evaluates continuously and is ready to change the plan if indicated. Almost all hospitals use standardized care plans as a base. Nurses individualize care of the postpartum woman and neonate according to their specific needs (see Nursing Care Plan). Signs of potential problems that may be identified during the assessment process are listed in Table 19-1.

Nurses assume many roles while implementing the nursing plan of care. They provide direct physical care, education about mother and baby care, counseling, and anticipatory guidance. Perhaps most important of all, they nurture the woman by providing encouragement and support as she begins to assume the many tasks of motherhood. Nurses who take the time to “mother the mother” do much to increase feelings of self-confidence in new mothers. Nurses are careful to include the woman’s spouse or partner and other primary support persons in education and counseling.

The first step in providing individualized care is to confirm the woman’s identity by checking her wristband. At the same time the infant’s identification number is matched with the corresponding band on the mother’s wrist and in some instances the father’s or partner’s wrist. The nurse determines how the mother wishes to be addressed and notes her preference in her record and her nursing care plan.

The woman and her family are oriented to their surroundings. Familiarity with the unit, routines, resources, and personnel reduces one potential source of anxiety—the unknown. The mother is reassured through knowing whom and how she can call for assistance and what she can expect in the way of supplies and services. If the woman’s usual daily routine before admission differs from the routine of the facility, the nurse works with the woman to develop a mutually acceptable routine.

Nurses discuss infant security precautions with the mother and her family because infant abductions are an ongoing concern. Between 1983 and 2012, 130 infants were abducted from health care facilities in the United States; most (58%) of the babies were taken from the mother’s room (National Center for Missing and Exploited Children, 2012). The Joint Commission (1999) calls for hospitals to have a management plan to prevent infant abductions. Such a plan might include security devices such as access control to the unit, closed-circuit television, computer monitoring systems, and electronic infant security systems in which tamper-proof tags are placed on the neonate immediately after birth and removed at the time of hospital discharge. The mother should be taught to check the identity of any person who comes to remove the baby from her room. Hospital personnel usually wear picture identification badges. On some units all staff members wear matching scrubs or special badges that are unique to the perinatal unit. As a rule the baby is never carried in a staff member’s arms between the mother’s room and the nursery but rather is always wheeled in a bassinet, which also contains baby care supplies. Patients and nurses must work together to ensure the safety of newborns in the hospital environment (Vincent, 2009).

Prevention of Infection

Nurses in the postpartum setting are acutely aware of the importance of preventing infection in their patients. One important means of preventing infection is maintenance of a clean environment. Bed linens should be changed as needed. Disposable pads should be changed frequently. Women should wear shoes when walking about to avoid contaminating the linens when they return to bed. A sitz bath or heat lamp used by more than one patient must be scrubbed after each woman’s use. Personnel must be conscientious about their hand hygiene to prevent cross-infection. Standard Precautions must be practiced. Staff members with colds, coughs, or skin infections (e.g., a cold sore on the lips [herpes simplex virus type I]) must follow hospital protocol when in contact with postpartum patients. In many hospitals staff with open herpetic lesions, strep throat, conjunctivitis, upper respiratory infections, or diarrhea are encouraged to avoid contact with mothers and infants by staying home until the condition is no longer contagious. Visitors with signs of illness are not permitted to enter the postpartum unit.

Perineal lacerations and episiotomies can increase the risk of infection as a result of interruption in skin integrity. Proper perineal care helps prevent infection in the genitourinary area and aids the healing process. Educating the woman to wipe from front to back (urethra to anus) after voiding or defecating is a simple first step. In many hospitals a squeeze bottle filled with warm water or an antiseptic solution is used after each voiding to cleanse the perineal area. The woman should change her perineal pad from front to back each time she voids or defecates and wash her hands thoroughly before and after doing so (Box 19-1).

Box 19-1   Interventions for Episiotomy, Lacerations, and Hemorrhoids

Explain procedure and rationale before implementation.

Cleansing

• Wash hands before and after cleansing perineum and changing pads.

• Wash perineum with mild soap and warm water at least once daily.

• Cleanse from symphysis pubis to anal area.

• Apply peripad from front to back, protecting inner surface of pad from contamination.

• Wrap soiled pad and place in covered waste container.

• Change pad with each void or defecation or at least 4 times per day.

• Assess amount and character of lochia with each pad change.

Ice Pack

• Apply a covered ice pack to perineum from front to back:

• During first 24 hours to decrease edema formation and increase comfort.

• After first 24 hours following birth as needed to provide anesthetic effect.

Squeeze Bottle

• Demonstrate use and assist woman; explain rationale.

• Fill bottle with tap water warmed to approximately 38° C (100.4° F) (comfortably warm on wrist).

• Instruct woman to position nozzle between her legs so squirts of water reach perineum as she sits on toilet seat. Explain that it will take whole bottle of water to cleanse perineum.

• Remind her to blot dry with toilet paper or clean wipes.

• Remind her to avoid contamination from anal area.

• Apply clean pad.

Sitz Bath

Built-In Type

• Prepare bath by thoroughly scrubbing with cleaning agent and rinsing.

• Pad with towel before filling.

• Fill one-third to one-half full with water of correct temperature 38° to 40.6° C (100.4° to 105.1° F). Some women prefer cool sitz baths. Ice is added to water to lower temperature to level comfortable for woman.

• Encourage woman to use at least twice a day for 20 minutes.

• Place call bell within easy reach.

• Teach woman to enter bath by tightening gluteal muscles and keeping them tightened and then relaxing them after she is in bath.

• Place dry towels within reach.

• Ensure privacy.

• Check woman in 15 minutes.

Only gold members can continue reading. Log In or Register to continue

Share this:

• Click to share on Twitter (Opens in new window)
• Click to share on Facebook (Opens in new window)

Related

Related posts:

1. High Risk Perinatal Care: Gestational Conditions
2. 21st Century Pediatric Nursing
3. Labor and Birth Processes
4. Newborn Nutrition and Feeding

Stay updated, free articles. Join our Telegram channel

Join