CRITICAL PATHWAY | for the Postpardial Period -- cont'd
Category First 4 Hours 4-8 Hours Past Birth 8-24 Hours Past Birth
Nursing care management and reports Ice pack to perineum to decrease swelling and increase comfort Straight catheter pm X 1 if distended or voiding small amounts If continues unable to void or voiding small amounts, insert Foley catheter and notify CNM/physician Sitz baths prn If woman Rh- and infant Rh+, RhoGAM work up; obtain consent; complete teaching Determine rubella status Obtain consent for rubella vaccine if indicated; explain purpose, procedure, implications of vaccine Obtain hematocrit Continue sitz baths prn May shower if ambulating without difficulty DC saline lock if present Administer rubella vaccine as indicated Expected Outcomes: Using sitz bath; voids qs; lab work WNL; performs ADL without sequelae
Activity Assistance when OOB first time, then Ambulate ad lib Rests comfortably between assessments Encourage rest periods Ambulate ad lib; may leave birthing unit after notifying staff of plan to ambulate off Up ad lib Expected Outcomes: Ambulates ad lib
Comfort Institute comfort measures:
  • Perineal discomfort: peri-care; sitz D baths, topical analgesics
  • Hemorrhoids: sitz baths, topical analgesics, digital replacement of external B hemorrhoids; side-lying or prone position
  • Afterpains: prone with small pillow
B under abdomen; warm shower or sitz baths; ambulation
  • Administer pain medication
Continue with pain management techniques Offer alternative pain management options: distraction with music, television, visitors; massage; warmed blankets or towels to affected area; using breathing techniques when infant latches on to breast and/or during cramping until medication’s action is felt Continue with pain management techniques Expected Outcomes: Comfort level <3 on 1-10 scale Verbalizes alternative pain management options
Nutrition Regular diet Fluid > 2000 ml/day Continue diet and fluids Continue diet and fluids Expected Outcomes: Regular diet/fluids tolerated
Elimination Voiding large amounts straw-colored Voiding large quantities May have bowel movement Same Expected Outcomes: Voiding qs; passing flatus or bowel movement
Medications Pain medications as ordered Methergine 0.2 mg q4th PO if ordered Stool softener Tucks pad pm, perineal analgesic spray Continue meds Lanolin to nipples PRN; tea bags to nipples if tender; saline flush to Luer local adaptor (if present) q8h or as ordered May take own prenatal vitamins Continue medications RhoGAM and rubella vaccine administered as indicated Expected Outcomes: Vaccines administered; pain controlled
Discharge planning/ home care Evaluate knowledge of normal postpartum and newborn care Evaluate support systems Discuss typical newborn schedule; plan for periods of rest Birth certificate paperwork completed Evaluate plans for transporting newborn; car seat available Review discharge instruction sheet/checklist Describe postpartum warning signs and when to call CNM/physician Provide prescriptions. Gift packs given appropriate for bottle- or breastfeeding Arrangements for baby pictures as de- Postpartum and newborn visits scheduled Expected Outcomes: Discharged home; mother verbalizes postpartum warning s/s, follow-up appointment times/dates