{
  "name": "Postpartum Care",
  "slug": "postpartum-care",
  "url": "https://nursingplex.com/care-plans/postpartum-care",
  "category": "Maternal & Newborn (OB)",
  "summary": "Fourth-trimester assessment: fundus, lochia, perineum, breasts, bladder and mood.",
  "nursing_diagnoses": [
    "Risk for bleeding",
    "Acute pain",
    "Deficient knowledge",
    "Risk for infection"
  ],
  "overview": [
    "The postpartum or fourth trimester period spans birth through roughly six weeks, as the reproductive organs return toward their pre-pregnancy state. Nursing assessment follows the familiar BUBBLE-HE framework: breasts, uterus, bladder, bowel, lochia, episiotomy/perineum, Homans/extremities and emotions.",
    "Involution is measured by fundal position: firm, midline and at the umbilicus right after birth, then descending about one fingerbreadth per day until it is no longer palpable by roughly day ten. Lochia moves from rubra (days 1–3) to serosa (days 4–10) to alba (up to six weeks).",
    "The two great postpartum dangers are hemorrhage and infection, and the two most-missed problems are venous thromboembolism and postpartum mood disorders. A single postpartum nurse assessment should be able to detect all four."
  ],
  "key_facts": [
    {
      "label": "Number one hemorrhage cause",
      "text": "Uterine atony — a boggy, displaced fundus with heavy bleeding. Massage first, then medications."
    },
    {
      "label": "Displaced fundus",
      "text": "A fundus above the umbilicus and pushed to the right usually means a full bladder; have her void and reassess."
    },
    {
      "label": "Hemorrhage definition",
      "text": "Over 500 mL after vaginal birth or 1,000 mL after cesarean, or any loss causing hemodynamic change."
    },
    {
      "label": "Baby blues vs depression",
      "text": "Blues peak day 3–5 and resolve within two weeks; symptoms beyond that, or any thought of harm, means depression screening and referral."
    },
    {
      "label": "Normal vitals",
      "text": "Mild bradycardia (50–70) and a temperature up to 38 °C in the first 24 hours can be normal; a fever after 24 hours suggests infection."
    }
  ],
  "nursing_priorities": [
    "Detect and prevent postpartum hemorrhage.",
    "Prevent infection of the uterus, perineum, breasts and urinary tract.",
    "Relieve perineal, uterine and breast discomfort.",
    "Establish successful feeding and infant care skills.",
    "Screen for venous thromboembolism and mood disorders."
  ],
  "assessment": {
    "subjective": [
      "Perineal, incisional or hemorrhoid pain and afterpains",
      "Breast fullness, nipple pain or feeding difficulty",
      "Urge to void, burning, or inability to feel the bladder",
      "Constipation, gas, fear of the first bowel movement",
      "Mood, sleep, appetite, support at home and any frightening thoughts"
    ],
    "objective": [
      "Fundal height, firmness and position relative to midline and umbilicus",
      "Lochia stage, amount, clots and odor; pad saturation over time",
      "Perineum by REEDA: redness, edema, ecchymosis, discharge, approximation",
      "Breast fullness, nipple integrity, latch quality and milk transfer",
      "Voiding amount and timing; bladder scan if retention is suspected",
      "Vital signs, calf assessment, and hemoglobin trend",
      "Interaction with the infant and Edinburgh depression screening score"
    ],
    "related_factors": [
      "Uterine atony, retained placental fragments or lacerations",
      "Perineal trauma, episiotomy or hemorrhoids",
      "Hormonal shift, sleep deprivation and role change",
      "Breast engorgement and inexperienced latch",
      "Hypercoagulable state and reduced mobility"
    ]
  },
  "goals": [
    "The client's fundus will remain firm and midline with lochia appropriate to postpartum day.",
    "The client will report pain of 3/10 or less and use comfort measures independently.",
    "The client will void adequately within 6 hours of birth and empty her bladder completely.",
    "The client will demonstrate correct latch and infant care before discharge.",
    "The client will identify postpartum warning signs and when to seek care.",
    "The client will express feelings about her birth and identify at least two support resources."
  ],
  "interventions": [
    {
      "title": "Uterus and bleeding",
      "points": [
        "Assess fundus and lochia on a decreasing schedule: every 15 minutes for an hour, every 30 for the next hour, hourly, then per shift.",
        "Massage a boggy fundus with one hand supporting the lower uterine segment; express clots only after the uterus is firm.",
        "Have the woman void, then reassess a displaced fundus.",
        "Give uterotonics as ordered — oxytocin first line, then methylergonovine (avoid with hypertension) or carboprost (avoid in asthma)."
      ]
    },
    {
      "title": "Comfort and perineal care",
      "points": [
        "Apply ice packs to the perineum for the first 24 hours, then switch to sitz baths for healing and comfort.",
        "Teach front-to-back peri-bottle rinsing after every void and pad changes at least every four hours.",
        "Offer topical anesthetic sprays, witch hazel pads and scheduled NSAIDs.",
        "Encourage side-lying and pillow support for perineal pain and hemorrhoids."
      ]
    },
    {
      "title": "Breasts and feeding",
      "points": [
        "Encourage feeding on demand, 8–12 times in 24 hours, to prevent engorgement and build supply.",
        "Correct latch: wide mouth, chin to breast, areola not just nipple; break suction before removing the infant.",
        "For engorgement in breastfeeding mothers use warmth before feeds and cold after; for non-breastfeeding mothers use a supportive bra, cold packs and no stimulation.",
        "Report cracked nipples, a hard red wedge-shaped area with fever, or flu-like symptoms suggesting mastitis."
      ]
    },
    {
      "title": "Prevention and psychosocial care",
      "points": [
        "Ambulate early with assistance and assess for dizziness on first ambulation.",
        "Assess legs for unilateral swelling, warmth or pain and encourage hydration and movement.",
        "Screen mood with a validated tool before discharge and at follow-up; ask directly about thoughts of self-harm or harming the baby.",
        "Verify Rh immune globulin for Rh-negative mothers with Rh-positive infants and rubella vaccination for non-immune mothers."
      ]
    }
  ],
  "patient_teaching": [
    "Call for bleeding that soaks a pad in an hour, clots larger than an egg, or a return to bright red bleeding.",
    "Report fever, foul-smelling lochia, calf pain, chest pain, severe headache or visual changes.",
    "Expect lochia to change from red to pink-brown to white over several weeks and to stop by six weeks.",
    "Rest when the baby rests, accept help and expect emotional ups and downs in the first two weeks.",
    "Delay intercourse and tampons until bleeding stops and the provider clears it; discuss contraception before discharge.",
    "Keep the postpartum follow-up appointment even if everything feels fine."
  ]
}