The postpartum period is the time after birth when the body recovers from pregnancy. The biggest early danger is postpartum hemorrhage, often from a uterus that does not contract well. Your priorities are checking the fundus and bleeding, managing pain, and teaching self-care and newborn care.
A · AssessmentD · DiagnosisP · PlanningI · InterventionE · Evaluation
Each care plan below follows the nursing process (ADPIE).
CARE PLAN 1 · NURSING DIAGNOSIS
ASSESSMENT
Risk for Bleeding
Risk factors
PLANNING · EXPECTED OUTCOMES- Uterine atony
- Full bladder pushing the uterus up and to the side
- Long labor, large baby, or multiple births
- Retained placental pieces or tears
Short-term goals
- Fundus stays firm, midline, and at or below the umbilicus
- Lochia is no more than moderate with no large clots
Long-term goals
- Client recovers without hemorrhage and knows when to seek help at home
- Fundus height, firmness, and position
- Lochia amount, color, and clots
- Vital signs, watching for rising heart rate and falling BP
- Bladder fullness
| INTERVENTION | RATIONALE |
|---|---|
| Massage a boggy fundus until firm while supporting the lower uterus | Massage helps the uterus contract and squeeze blood vessels closed. |
| Help the client empty her bladder | A full bladder keeps the uterus from contracting well. |
| Give uterotonics such as oxytocin as ordered | These medications make the uterus contract. |
| Report saturating a pad in 15 minutes, or about 1 pad per hour, right away | Heavy bleeding signals possible hemorrhage. |
| Teach the normal lochia changes from red to pink to white | The client can then spot abnormal bleeding at home. |
EVALUATION
- Fundus is firm and midline
- Lochia is within the expected amount
- Vital signs are stable
- Client describes when to call the provider
CARE PLAN 2 · NURSING DIAGNOSIS
PLANNING · EXPECTED OUTCOMES
ASSESSMENT
Acute Pain
Related to
- Uterine cramping
- Perineal tear or episiotomy
- Incision after cesarean birth
- Breast engorgement
As evidenced by
- Pain rating above the client's goal
- Grimacing or guarding
- Trouble resting or caring for the baby
Short-term goals
- Client rates pain at or below her goal within 1 hour of treatment
Long-term goals
- Client manages pain at home and cares for her newborn
- Pain location, rating, and type
- Perineum using REEDA (redness, edema, ecchymosis, drainage, approximation)
- Incision if cesarean
- Breasts and nipples
| INTERVENTION | RATIONALE |
|---|---|
| Give pain medications as ordered | Comfort helps rest, healing, and bonding. |
| Apply ice packs to the perineum in the first 24 hours | Cold lowers swelling and pain. |
| Teach sitz baths and peri bottle use | Warm water and gentle cleaning soothe and prevent infection. |
| Explain that cramping may be stronger while breastfeeding | Breastfeeding releases oxytocin, which contracts the uterus. |
EVALUATION
- Client rates pain at or below her goal
- Perineum is healing without signs of infection
- Client uses comfort measures
Quick answers
The fundus is boggy and displaced to the right. What should the nurse do first?
Massage the fundus and help the client empty her bladder. A full bladder often pushes the uterus to the side.
What is normal lochia right after birth?
Lochia rubra, which is dark red, for about the first 3 days, then it becomes pinkish brown and later white.
For learning only. Individualize every care plan to your client, and follow your program, current guidelines, provider orders, and facility policy.