T.N. delivered a healthy male infant 2 hours ago. She had a midline episiotomy. This is her sixth pregnancy
Before this delivery, she was para 4014 . She had an epidural block for her labor and delivery.
She is now
admitted to the postpartum unit.
What is important to note in the initial assessment?
Vital signs : Blood pressure might be low because of epidural; temperature might be slightly elevated
because of exertion. With an epidural, the client has an IV line, so dehydration should not be a
concern.
Fundal height and position: This patient might have an enlarged fundus because of multigravida
status. The baby's size might also be a factor.
Lochia: This might be more profuse for a multigravida and if fundus feels boggy. It should be rubra in
color.
Episiotomy: Assess for swelling, discoloration.
Urinary output: She should void in 6 to 8 hours. Encourage fluid intake to promote voiding, and
assess for urinary tract infection symptoms.
Bowel elimination: This might be sluggish for a few days. Stool softeners may be needed. Should
avoid straining.
Lower extremities: Blood pooling or clots might occur. Assess for unilateral calf swelling and
tenderness.
Breasts: For tenderness and tightness, she might need warm packs or ice packs if electing not to
breastfeed.
Assess for afterpains: The uterus is contracting—it works harder with successive deliveries. If the
woman is breastfeeding, oxytocin is released more frequently.
Emotional status: Assess T.N.'s feelings post-delivery. Inquire whether she has any questions or concerns
regarding her physical or emotional well-being. Remind her that it is important for her to also care for
herself and not just her infant. This is her fifth child; inquire about her support system after discharge.
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