Component Task: Examination of The Puerperal Client

This is an assessment of the client after delivery by the midwife in the lying-in ward, before discharge and at the Postnatal Clinic. This is to ensure her well-being physiologically, physically and psychologically.

Aims

·         Detect and prevent complication early

·         Provide prompt management for any anomalies detected

·         Provide counselling in the post-partum period

·         Provide support for client and family

Types

·         Immediate examination

·         Subsequent examination

Requirements

a.      Blood Pressure apparatus

b.      Thermometer

c.      Pulse oximeter

d.      Timer with second hand

e.      Sanitary pad

f.        Sterile gloves

g.      Gynaecological gloves

h.      Urethral Catheter

i.         Uterotonic drugs

j.         Sterile Gallipot

k.       Antiseptic lotion (Methylated spirit, Savlon, Dettol, Hibitane)

l.         Sponge holding forceps (Sterile)

m.   Sterile swabs

n.      Intravenous Fluids (Normal Saline, Ringers Lactate)

o.      Intravenous cannula (various sizes)

p.      Suturing set

q.      Oxygen apparatus

Steps

1.        Establish rapport (Refer steps)

2.      Explain procedure (Refer steps)

3.      Ask client to empty the bladder

4.      Provide privacy and put client into the dorsal position

5.      Perform hand hygiene

6.      Examine the hair and scalp

7.       Examine the conjunctiva, mouth, nose and ears

8.      Examine the arms, hands and checks capillary refill of fingernail bed

9.      Examine breasts and inspect for establishment of lactation, excluding breast engorgement, cracked and sore nipples

10.    Inspect the abdomen, palpate uterus and measure fundal height

11.      Perform hand hygiene and put on gloves

12.    Instruct client to flex her knees and open her thighs exposing the vulva

13.    Remove perineal pad using one hand

14.    Inspect the lochia (colour, amount, odor)

15.    Discard soiled perineal pad

16.    Inspect vulva and perineum

17.    Clean vulva and perineum and apply fresh perineal pad using the other hand

18.    Remove gloves and perform hand hygiene

19.    Assist client to re-dress and assume a desired position in bed

20.  Educate and encourage client on good perineal hygiene

21.    Express appreciation and communicates findings to client

22.  Dispose off used items and decontaminate instruments

23.  Record findings into Maternal and Child Health Record Book (Manual/ Electronic)

24.  Report findings to officer-in-charge