This plan of care focuses on the client who is discharged within 30 hr of delivery. It is to be used in conjunction with CP: The Client at 4 Hours to 2 Days Postpartum.
CLIENT ASSESSMENT DATA BASE
Circulation
BP remains at same level as pregnant readings (slightly below baseline).
Pulse between 60 and 90 bpm.
Superficial varicosities may be visible in lower extremities.
Ego Integrity
May feel isolated, anxious, depressed, or fatigued, even though early discharge had been desired by client
May report stressors (e.g., employment, financial, living situation), concerns about personal abilities and assumption of mothering role
Elimination
Voiding 100 ml or greater in amount, without suprapubic tenderness or retention.
Probably has not experienced a return of normal bowel habits.
Hemorrhoids varying in size and number may be present.
Abdominal musculature may be weak and of “bread dough” consistency.
Food/Fluid
Weight reduced by 10–12 lb following delivery.
Physiological edema may still be present.
Pain/Discomfort
Discomforts associated with episiotomy, perineal trauma, hemorrhoids, or afterpains.
Breast tenderness/engorgement may occur between days 3–5 postpartum.
Uterine contractions diminishing daily in frequency and intensity.
Safety
Lochia rubra moderate in amount with fleshy odor; may increase during breastfeeding.
Striae may be present on abdomen, breasts, and thighs.
Perineum or site of episiotomy repair may be edematous with good approximation of wound edges.
Sexuality
Breasts soft, nontender, and free of masses
Nipples soft and free of fissures or lesions
Uterus firm, midline, and located at or just below the umbilicus (uterus is larger in multipara or in client with overdistension)
Social Interactions
May now report lack of/or inadequate support systems; concerns regarding roles of individual family members, role mastery, or disequilibrium (especially in blended family)
DIAGNOSTIC STUDIES
Routine assessment may include CBC or Hb/Hct and UA, and culture and sensitivity, as indicated by physical findings.
NURSING PRIORITIES
1. Determine postpartum status of client.
2. Promote optimal physical and emotional well-being.
3. Facilitate client’s/couple’s positive adaptation to parenting roles, family growth, and autonomy.
CLIENT ASSESSMENT DATA BASE
Circulation
BP remains at same level as pregnant readings (slightly below baseline).
Pulse between 60 and 90 bpm.
Superficial varicosities may be visible in lower extremities.
Ego Integrity
May feel isolated, anxious, depressed, or fatigued, even though early discharge had been desired by client
May report stressors (e.g., employment, financial, living situation), concerns about personal abilities and assumption of mothering role
Elimination
Voiding 100 ml or greater in amount, without suprapubic tenderness or retention.
Probably has not experienced a return of normal bowel habits.
Hemorrhoids varying in size and number may be present.
Abdominal musculature may be weak and of “bread dough” consistency.
Food/Fluid
Weight reduced by 10–12 lb following delivery.
Physiological edema may still be present.
Pain/Discomfort
Discomforts associated with episiotomy, perineal trauma, hemorrhoids, or afterpains.
Breast tenderness/engorgement may occur between days 3–5 postpartum.
Uterine contractions diminishing daily in frequency and intensity.
Safety
Lochia rubra moderate in amount with fleshy odor; may increase during breastfeeding.
Striae may be present on abdomen, breasts, and thighs.
Perineum or site of episiotomy repair may be edematous with good approximation of wound edges.
Sexuality
Breasts soft, nontender, and free of masses
Nipples soft and free of fissures or lesions
Uterus firm, midline, and located at or just below the umbilicus (uterus is larger in multipara or in client with overdistension)
Social Interactions
May now report lack of/or inadequate support systems; concerns regarding roles of individual family members, role mastery, or disequilibrium (especially in blended family)
DIAGNOSTIC STUDIES
Routine assessment may include CBC or Hb/Hct and UA, and culture and sensitivity, as indicated by physical findings.
NURSING PRIORITIES
1. Determine postpartum status of client.
2. Promote optimal physical and emotional well-being.
3. Facilitate client’s/couple’s positive adaptation to parenting roles, family growth, and autonomy.
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