📘 POSTPARTUM NURSING CARE

(Highly Important for GNM, BSc Nursing, Midwifery, NHM, AIIMS, NORCET, GPSC & Staff Nurse Exams)

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✅ 1. Introduction / Definition

Postpartum (Puerperium) Nursing Care refers to the care given to the mother after the delivery of the baby—from the birth of the placenta until about 6 weeks postpartum—when the mother’s body returns to its pre-pregnant state.

Nursing care focuses on monitoring physical recovery, psychological well-being, bonding, breastfeeding, and complication prevention.

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✅ 2. Objectives of Postpartum Nursing Care

• Promote safe physical recovery of the mother
• Prevent and detect postpartum complications
• Support breastfeeding and infant care
• Educate the mother on nutrition, hygiene, and rest
• Address psychological adjustment and maternal role

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✅ 3. Phases of Postpartum Period

Phase	Time Frame	Key Features
Immediate Phase	First 24 hours	Watch for PPH, vitals, fundus, lochia
Early Phase	Day 2 to Day 7	Breastfeeding, uterine involution, ambulation
Late Phase	1 week to 6 weeks	Full uterine involution, return of menstruation

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✅ 4. Key Components of Postpartum Nursing Care

🔸 A. Physical Assessment

• Vital Signs: Every 15 min for 1st hour, hourly for 4 hours, then 4–8 hourly
• Fundal Height: Should descend 1 cm/day; should be firm, midline
• Lochia:
  • Rubra: 1–3 days (red)
  • Serosa: 4–10 days (pink/brown)
  • Alba: 10–14 days (white/yellow)
• Perineal Inspection: Episiotomy wound, swelling, hematoma
• Bladder Function: First void within 6 hours of delivery
• Bowel Function: Assess for constipation or hemorrhoids
• Breast Examination: Engorgement, cracks, proper latch

Key Areas of Postpartum Assessment (BUBBLE-HE):

🔍 Component	📋 Nursing Focus
B – Breasts	Check for engorgement, cracks, and proper latching
U – Uterus	Palpate fundus for firmness and position (involution)
B – Bladder	Ensure spontaneous urination; monitor for distension
B – Bowel	Monitor bowel sounds, passage of stool, flatus
L – Lochia	Assess amount, color (Rubra → Serosa → Alba), and odor
E – Episiotomy/Perineum	Inspect for swelling, hematoma, stitches, infection
H – Homan’s Sign	Assess for DVT (calf pain on dorsiflexion)
E – Emotional Status	Observe for postpartum blues, bonding, mood changes

🔸 B. Emotional & Psychological Support

• Monitor for postpartum blues, depression, anxiety
• Encourage expression of feelings
• Support bonding and maternal role adaptation

🔸 C. Promote Breastfeeding

• Assist in correct positioning and latch
• Educate about exclusive breastfeeding
• Prevent and manage nipple soreness or mastitis

🔸 D. Encourage Mobility and Hygiene

• Early ambulation to prevent DVT
• Perineal hygiene with antiseptic wash
• Promote adequate sleep and nutrition

🔸 E. Family Education and Discharge Advice

• Teach danger signs: fever, foul lochia, excessive bleeding
• Guidance on self-care, contraception, and follow-up
• Educate on newborn care and immunization schedule

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✅ 5. Common Postpartum Complications to Monitor

Complication	Signs to Monitor
Postpartum Hemorrhage (PPH)	Heavy bleeding, soft uterus, hypotension
Infection (Puerperal Sepsis)	Fever, foul-smelling lochia, abdominal pain
Mastitis	Painful, red, swollen breast, fever
Urinary Retention	Infrequent or painful urination
Deep Vein Thrombosis (DVT)	Calf pain, swelling, warmth
Postpartum Depression	Persistent sadness, loss of interest

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✅ 6. Golden One-Liners for Quick Revision

• Fundus should be firm, midline, and descend 1 cm/day
• Lochia rubra lasts up to 3 days postpartum
• First void should occur within 6 hours after delivery
• Early ambulation reduces the risk of DVT and constipation
• Postpartum blues resolve within 2 weeks; depression lasts longer
• PPH is the leading cause of maternal mortality postpartum

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✅ 7. Top 5 MCQs for Practice

1. What is the normal duration of lochia rubra postpartum?
a) 1–2 days
b) 3–5 days
c) 1–3 days
d) 10 days
Correct Answer: c) 1–3 days
Rationale: Lochia rubra is red and occurs during the first 1–3 days.

2. Which finding requires immediate nursing action in a postpartum woman?
a) Fundus firm and midline
b) Voiding every 4 hours
c) Lochia with foul smell
d) Mild breast engorgement
Correct Answer: c) Lochia with foul smell
Rationale: It indicates possible puerperal infection.

3. What should the nurse encourage first after normal vaginal delivery?
a) Complete bed rest
b) Oral contraceptive
c) Early ambulation
d) Water restriction
Correct Answer: c) Early ambulation
Rationale: Reduces risk of DVT and promotes bowel movement.

4. The uterus returns to the non-pregnant state by:
a) 1 week
b) 2 weeks
c) 4–6 weeks
d) 2 months
Correct Answer: c) 4–6 weeks
Rationale: Full involution usually completes by 6 weeks.

5. Which sign suggests postpartum depression rather than blues?
a) Tearfulness for 2 days
b) Fatigue
c) Lack of interest in baby for >2 weeks
d) Mood swings on Day 3
Correct Answer: c) Lack of interest in baby for >2 weeks
Rationale: Longer duration and functional impairment suggest depression.