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MOTHER DISCHARGE INSTRUCTIONS WORKSHEET
Dani 5/24/07
Nursing Diagnosis: Knowledge deficit: Self care r/t the postpartum period (in the hospital and at
home) associated with recent birth.
Goal: The patient will verbalize or demonstrate understanding of postpartum self-care by 12 noon on
5/24/07 AEB:
1. Proper breast care
2. proper perineal care
3. proper nutrition
4. prevention of infection
5. stating signs/symptoms of infection
6. stating signs/symptoms of hemorrhage
7. proper bowel/bladder care
8. postpartum exercises
9. contraceptive information
10. pain control
Mothers Data
Pt. Initials: XYZ age: 25 Gravida: 4 Para: 5 Ab: 0
Delivery date: 00/00/0000 Delivery Time: 0336 & 0355
Vaginal: Epistomy: N/A Lacerations: N/A
C-section; type of abdominal incision: N/A
Breastfeeding______ Bottle feeding X
Fundus: 2” below umbilicus
Lochia: Moderate amount of Rubra
Spontaneous or manual removal of placenta: Manual
Time membranes ruptured: 5/21/07 at 0330
Blood loss during delivery: 1000 ml
Signs of Hematoma: No signs of hematoma on perineum
Medications: Colace, Ferrous sulfate, Ibuprofen
Foley: N/A Urine color: Clear yellow
Hemorrhoids: Mild BS: Present X4 BM: 5/24/07 X 1
Vital signs: 97.9*F, 82, 14, 138/71 (left arm, semi-fowlers), 100% O2
Psychological state patient is in: C.W. appeared very calm and relaxed throughout the morning.
1.
Assess prior knowledge. I asked XTZ what experience she had with infants.
a. Allows nursing staff to determine mother’s level of understanding and needs for more
information. XYZ explained that she had 3 daughters; ages 6, 4, and 2.
2.
Assess readiness to learn: I observed XYZ throughout the morning with her newborn twin boys.
She appeared very attentive to learning how to care for herself.
a. Readiness to learn is a necessary component to learning. I believe XYZ was in her
“taking-hold” stage, even though she was only 2 days PP. She was interactive with her
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Mother discharge instructions worksheet
boys and wanted to feed, change, and coo with them. While observing her with the boys,
she was adjusting quite well to the role of a new mother. She asked a lot of questions and
was very receptive in learning, as well as interacting to ask questions. I made the
information simple with easy, non-hurried examples.
3.
Teach breast care and assessment, including:
a. Self exam: Being familiar with own breasts during lactation will help in detecting any
anomalies. N/A
b. Creams that can be used on breasts: Creams block normal oil secretions. Vitamin E is fat
soluble and the breastfeeding infant may consume enough from the nipple to reach a
toxic level. Modified lanolin with reduced allergens may be used. Lanolin is beneficial in
moist wound healing. Ask mother of any allergies to wool; Lanolin is made from sheep
wool. N/A
c. Bathing habits: Avoid using soap on nipples as it tends to dry them out, however, soap
running down them from washing hair, face, neck, is permitted. N/A
d. If lactation suppression is desired, advise mother to wear a well-fitted support bra or
breast binder for at least 72 hours after giving birth. Avoid breast stimulation.
Encourage the use of ice packs 15 minutes on, 45 minutes off; or using fresh cold
cabbage leaves inside of her bra. XYZ was already wearing a well-fitted sports bra when
I went in for her BUBBLE assessment. When I spoke to her about what to expect when
her breasts become engorged, she said she had already experienced this with her
previous births and that she had used ice packs with them. She laughed when I explained
to her about the cabbage leaves; she stated “I think I’ll just stick with the ice”. I
reinforced that she shouldn’t allow warm/hot water to hit her breasts in the shower
because it could induce even more lactation. She stated that she understood.
4.
Teach fundus assessment and care, including: assess location of fundus, and massage it gently.
After her BUBBLE assessment, I explained to XYZ what exactly it was for.
a. Massaging “boggy” fundus gently helps promote contraction of the uterus and uterine
tone. I explained to XYZ that this was important for her to assess at home since she had
experienced a postpartum hemorrhage. I explained that when she felt better, that she
should feel her fundus (I explained it as the top of her uterus) when she felt better. I
explained that it should feel like a tight ball, not soft at all.
b. Explain the process of involution and teach her to assess and report any bogginess to
involve her in self-care and increase sense of self-control. I explained to XYZ that her
uterus would get smaller each day, shrinking about 1 cm per day until it was prepregnancy size. I instructed her to call her physician immediately if she felt her fundus
become “soft” or “squishy”.
5.
Teach normal lochia stages, including: Rubra, Serosa, Alba. I explained the different lochia stages
to XYZ:
a. Knowledge of the different uterine discharges will help prepare mother and give her
expectations of each stage, decreasing the chances of alarm from the different stages.
While teaching XYZ about the lochia stages, I explained to her that right now she was in
the Rubra stage, which looked like red blood. She said “I didn’t know they gave names to
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Mother discharge instructions worksheet
drainage like that!” I explained further what the serosa and alba stages would look like.
She stated that she had experienced this before and knew what to expect.
6.
Teach perineal assessment and care, including: I explained to XYZ how to care for her perineum.
a. Cleansing perineum with soap and water at least once a day; Change pad with each void
or defecation or at least 4 times each day: Helps keep perineal area free from organisms
and infections. XYZ stated that she already knew how to do this from her previous births.
b. Assess perineum for any unusual bleeding: Informs mother of postpartum expectations
and helps for her to identify any abnormalities or potential problems. I assessed
perineum. There were no tears, signs of hematoma, or lacerations noted. I explained to
XYZ that she should get a mirror and try to assess her perineum on a daily basis to
detect problems. She stated that she would try.
7.
Teach postpartum diet and fluids for mother, including: I explained to XYZ the importance of
nutrition and getting enough fluids.
a. Maintaining adequate nutrition and fluid intake. Nutrition promotes healing. Fluids
decrease the possibility of constipation. Since XYZ suffered a hemorrhage at the birth of
her twins and required a PRBC transfusion, I concentrated on foods high in iron content.
I encouraged XYZ to eat beef, liver, enriched breakfast cereals, and beans when she
arrived home. I encouraged her to drink at least 8 glasses of fluid (preferably water) a
day to maintain hydration.
8.
Teach postpartal voiding for mother, including: I discussed voiding patterns with XYZ:
a. Encourage mother to completely empty bladder when urinating (should void within 6-8
hours after birth). This prevents urinary stasis and retention, avoiding UTI’s. XYZ stated
that she understood and has been voiding “just fine” with no difficulties.
9.
Teach normal postpartal bowel patterns for mother, including: I assessed XYZ for her postpartal
bowel patterns.
a. Promoting normal bowel elimination and interventions to promote this (adequate
roughage, fluid intake, exercise, stool softeners). XYZ already had a bowel movement,
which she stated was painful. I encouraged her to take her prescribed Colace twice a day
to help keep her stool soft so it wouldn’t be so painful. She stated that she would take the
medication as prescribed.
10. Teach rest/sleep, including: I assessed XYZ for her sleep patterns.
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Mother discharge instructions worksheet
a.
b.
Try to avoid interruptions during sleep; sleep deprivation can cause depression, lethargy,
and irritability. Reducing interruptions will prevent most sleep pattern disturbances. XYZ
stated that she was aware that she needed sleep to care for her children. I told her to try
to sleep when her twins slept to help avoid exhaustion.
Avoid things or routines (Caffeine, foods that induce heartburn, fluids, and strenuous
mental/physical activity) that may interfere with sleep. I explained to XYZ to stay away
from caffeine, nicotine, and stressful activities before bedtime to help with sleep.
11. Teach postpartal exercises, including: I explained to XYZ how to exercise her pelvic floor
muscles.
a. Kegal exercises: Kegal’s help to strengthen the pelvic floor muscles. XYZ had never been
taught how to perform Kegel exercises. I explained to her that the muscle that stops the
urine flow is the muscle that she would want to use while doing Kegels. I told her she
could practice using the muscle while toileting, to try to stop the stream of the urine. I
explained that she should hold for 3 seconds and then release for 3 seconds, with 10
squeezes per day. I explained that she could do these exercises anywhere at any time. She
stated she understood and would try this.
12. Teach about postpartal blues and treatment, including:
a. Reinforce that the “blues” are normal; encourage mom to share her feelings with her
partner (feelings of being “tied down”, things her partner can do to help her). Give her
information about community resources such as La Lache League or community mental
health services. Helping mothers develop realistic expectations decreases postpartum
stress. I explained to XYZ about how she may experience the “blues” and that they were
completely normal. She stated that she never experienced them with her daughters, but
she felt weepy this time. XYZ’s newborn sons were conceived from a date-rape; I advised
that she seek counseling as soon as she was able, that she may find it helpful to deal with
the trauma of the rape.
b. Explain the difference between the “blues” and PPD. This will encourage the mother to
seek help if PPD is occurring. I explained to XYZ about the difference of PPD and the
“blues”, again, urging her to seek out help from a mental health agency due to the
trauma of the rape.
13. Teach about contraception, including: I began to talk with XYZ regarding contraception, but she
interrupted me stating that she was going to have her tubes tied in 3 weeks.
a. Ovulation may occur up to one month after birth: Knowledge allows for informed
decisions about fertility management before resuming sexual activity. I warned XYZ that
it was still possible to become pregnant after the birth of her sons. She stated that she
wasn’t having sex again until her tubes were tied. I felt that it was still necessary to
reinforce safe-sex practices; I reinforced the use of condoms along with leaving a
Planned Parenthood brochure so she could obtain free condoms.
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Mother discharge instructions worksheet
14. Give information about resuming sexual activity. I explained to XYZ of what to expect with sexual
activity.
a. After two weeks postpartum the risk of hemorrhage and infection are minimal.
Resumption of sexual activity 2-4 weeks after bleeding has stopped and epistomy has
healed is acceptable. Inform pt. that the vagina does not lubricate well for approximately
6 weeks to 6 months. XYZ stated that she understood this; however, she said “I don’t plan
on having sex for a long time”.
15. Teach non-pharmacological pain control, including: I explained to XYZ non-pharmacological pain
relief measures.
a. Ice packs for breasts and perineal area, dry heat, tub bath, pillows when sitting, lying on
side when possible: Knowledge of pain control can help reduce any discomfort. XYZ
stated that she understood and had done all of this with her previous births.
16. Teach hemorrhoid pain control, including: sitz baths, topical applications, and cold packs. I
explained hemorrhoid pain control to XYZ.
a. Knowledge of hemorrhoid and pain control will help reduce any discomfort. XYZ stated
that she would be taking the tucks pads home that the hospital provided for her.
17. Teach medications. I explained the actions of the colace, ferrous sulfate, and ibuprofen to XYZ.
a. Knowledge of medications when taking them can help the understanding of the
importance, and will allow for clarification of any uncertainties. XYZ stated that she
understood what each of the medications was for.
18. Instruct patient to call M.D. if bleeding or increased temperature occurs: I explained to XYZ
different situations in which she should contact her physician.
a. Early detection, intervention, and treatment can decrease potential problems and/or
complications. I explained to XYZ that she should contact her physician if her
temperature rose to over 100*F after the breast engorgement period for 2 days straight
because it could indicate an infection. I also spoke with her about foul-smelling lochia or
abdominal cramping that should be addressed.
19. If C-sections, teach: Incision care, respiratory care, catheter care (if applicable), other: N/A
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a.
Knowledge will help with being able to detect any abnormalities, which will help in
prevention of infections of infections or complications. N/A
The goal was met AEB:
1. XYZ stated proper breast care while suppressing lactation.
2. XYZ stated she understood proper perineum care
3. XYZ stated she understood the importance of nutrition and hydration, focusing on iron-rich foods.
4. XYZ stated she understood how to try to prevent infection.
5. XYZ stated she understood the signs and symptoms of infection.
6. XYZ stated she understood the signs and symptoms of hemorrhage, including assessing fundus
after discharge.
7. XYZ stated she understood normal bowel and bladder habits.
8. XYZ showed an understanding on how to perform Kegel exercises to strengthen her pelvic floor
muscles.
9. XYZ explained that she knew of birth control methods, and that she was getting her “tubes tied” in
3 weeks.
10. XYZ stated an understanding of pharmacological and non-pharmacological pain relief measures.
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Mother discharge instructions worksheet