Postnatal care

Question 1

Describe the star day?

Answer 1

The day of birth where you do observations on mum and do the baby check

Question 2

What do you do on day 1?

Answer 2

Observations, mum and baby check

Question 3

What do you do on day 2?

Answer 3

Observations, mum and baby check

Question 4

What do you do on day 3?

Answer 4

Baby’s weight if breastfed

Question 5

What do you do on day 5?

Answer 5

Mum and baby check, baby weight and new born blood spot is offered

Question 6

What do you do on day 10?

Answer 6

Mum and baby check, baby weight, hand over to health visitor is all okay

Question 7

Why is emotional and psychological wellbeing important?

Answer 7

Midwives role is to provide support. Birth debrief important. Consider; baby blues, sociological aspects, culture aspects. Don’t forget the partner!

Question 8

Maternal vital signs pulse range

Answer 8

(60) 70 - 80 (100) bpm

Question 9

what can pulse that is out-with the normal range indicate?

Answer 9

stress, pain, infection, haemorrhage

Question 10

Maternal vital signs blood pressure range

Answer 10

(140) 100/60 (90) mmHg

Question 11

What can blood pressure outwith the normal range indicate?

Answer 11

stress, (increase)

haemorrhage (decrease)

Question 12

Maternal vital signs temperature range

Answer 12

35.8- 37.3

Question 13

What can a raised temp mean?

Answer 13

infection

Question 14

Maternal vital signs respiratory rate

Answer 14

12- 20 times a min

Question 15

What can an increased respiration rate indicate?

Answer 15

pain, increase
anaemia (shortness increase)
infection increase

Question 16

What should you be doing in a postnatal visit looking at the breasts?

Answer 16

Ask how breasts feel: soft, full, painful, nipple pain, bleeding
Full milk supply usually arrives by 3 days postnatal (same time as baby blues)
Offer advice and support regarding common breast problems: bleeding, engorgement, mastitis, thrush

Question 17

What should you expect from the uterus post natal?

Answer 17

Gradual reduction in size of uterus until no longer palpable
After pains

Question 18

What is lochia?

Answer 18

Blood produces immediately after birth
As involution continues, stale blood, lanugo, vernix, decidua exit
The shade and density individual to women
Assessment should include asking is lochia is more or less, lighter or darker, any clots, any nasty smells, how often she changes her pad

Question 19

Perineal assessment

Answer 19

injury to the perineum affects most women
can have long term social, physchological and physical health consequences
pain/discomfort can disrupt breastfeeding
physical examination only if indicated or requested
To alleviate pain or discomfort, oral analgesia , localised cooling (icepacks)

Question 20

Cesarean section wound assessment

Answer 20

ask mum how it feels
check the wound is healing, clean and dry?
Redness inflammation, seeping, bruising
may need to remove dressing and stitches

Question 21

What should you be vigilant for in wounds?

Answer 21

fever, raised temperature, shivering, pain, offensive blood loss, heavy blood loss

Question 22

bladder and bowels

Answer 22

Minor changes to bladder and bowel habits resolve with first few days
Give reassurance about first bowel movement
urinary and bowel symptoms such as incontinence should be investigated

Question 23

What should you be vigilant for in bladder and bowels?

Answer 23

Burning, stinging, frequency in urination, raised temp,

UTI might need treated

Question 24

Legs

Answer 24

ask about comfort of the legs, especially the calf
Observe any oedema to the legs- an be normal as the body gets rid of extra-circulating fluid
encourage mobility
raise legs

Question 25

vigilant legs

Answer 25

any unilateral (one sided) called oedema
stiffness/ pain or red raised area
breathless ness
could be a blood clot in the legs deep vein thrombosis (DVT) or pulmonary embolism (PE)

Question 26

Record keeping

Answer 26

Clear, accurate records of observations should be documented
key tool in safeguarding the health and wellbeing of mother and baby

Question 27

Health promotion in post natal care

Answer 27

pelvic floor exercised for long term health
exercise
contraception
relationship building with baby

Question 28

What is looked at in the first examination after birth -24 hours

Answer 28

skin
head
face
neck
chest and abdomen
anus
genitalia
limbs, hands and feet
spine

Question 29

What does the detailed examination of a new born entail?

Answer 29

NIPE
Neonatal and infant physical examination

Performed by paediatrician or trained midwife with 72 hours after birth

looking for signs of congenital heart disease, cataracts, dysplasia of the hips and undescended testes

Heart, eyes, hips, genitalia, neurological reflexes

Question 30

What is in the daily examination of the new born?

Answer 30

baby appears well
good muscle tone
clear skin
cries lustily
feeds well
keeps warm
sleeps
wet and dirty nappies

Question 31

Breathing in baby

Answer 31

Diaphragm, chest and abdomen rise and fall is synchrony
Explain to parents babies breathing is erratic, shallow and irregular with brief 10-15 second period of apnoea
RR 30-60 in one minute normal, check RR by placing hand on abdomen
Breathe through nose

Question 32

Temp in baby

Answer 32

babies find it difficult to maintain their temperature as they adapt to inter uterine life

Observe temperature by placing a hand on the abdomen or using thermometer 36.5-37.5

Discuss with parents optimal room temp of 18-21
clothing appropriate to temp

Question 33

Skin baby

Answer 33

babys skin should be insoected for rashes, seotic spots, excoriation (damage)

colour of the skin, normal for ethnicity, no yellowing

seborrhoeic dermatitis (cradle cap)
erythema toxicum (e-tox)
Necrotising umbilical stump
Milia (milk spots)
Vernix

Question 34

wet and dirty nappies

Answer 34

breastfeeding babies may only pass urine once a day for the first few days
babies that are well will pass stool every day
stools will change in colour

Question 35

What other things could you mention in a postnatal visit?

Answer 35

postnatal support groups
breastfeeding support groups
safe sleeping -reduce risks of SIDS
child safety- smoking, car seat safety, pets in house, keeping calm when baby is crying 
child protection- raise concerns