Checking perineum during assessments?

AmiK25 · Mar 14, 2005

I had a baby last year and I had an epis and a third degree. I also had a low platelet count that just kept dropping during the pregancy (ended up being induced to stop platelets from dropping more). Do you know that the only person who ever checked my perineum was a nursing student (not to knock students b/c we were all students once ourselves) who was in her first week on OB. I don't know about you, but when I was a student in OB, I didn't have a clue what I was doing.

SmilingBluEyes · Mar 14, 2005

techs and students CANNOT be held responsible for assessments, including those of the perineum. Any place allowing this is violating a standard of basic care. RN's cannot delegate this one away to NON-licensed people.

camay1221_RN · Mar 15, 2005

I just had a baby a month ago and was very supprised at was not done. I had a 4th degree tear/epesiotomy and some of the nurses did not even know about it much less look at my perineum. I am assuming that they just didn't have a very good shift report. First night there I had to wait almost 2 hours for pain meds! Also, in the 2 days that I was in PP my fundus was not checked once (except by MD) and no one asked about my bleeding, how many pads I was going through or if I was having any pain. I guess that I am just use to working in an ICU/ER setting where shift report and patient changes are very improtant. Let's just say I was VERY unhappy with my PP experiance.

austin heart,

I can certainly see why you were unhappy with your PP experience! It is deplorable to think they even made you wait for pain meds at all! Pain control should have been addressed before it was even an issue! I'm sorry you had to go through that.

Zhlake · Mar 15, 2005

Just a question.....why do you take people to the bathroom THREE times? Why are they not getting up by themselves?

We do this too. The first three times that someone voids after a vag deliery a nurse helps her to the bathroom and we measure the void. After those 3 times then they are free to go by themselves.

SmilingBluEyes · Mar 15, 2005

I have seen people faint HOURS after delivery.....however most do well after the first time up. Anyone who is shaky is told to call for help when they need to use the restroom.

NurseFirst · Mar 16, 2005

For several reasons: (1) moms can be very sleepy and weak the first few times either from exhaustion or from meds, (2) we want to be sure that they can void without problems due to swelling and irritation, (3) we want to see the amount of bleeding (is it too much or too little or just right?) and (4) the amount of bleeding and fluid loss can often lead to hypotension and hypotension can lead to dizziness and dizziness often leads to moms passed out on the floor and a baby crying in the crib. No fun writing up that incident report! Hope that helps explain why. :)

And....drum roll...#1 reason to help Mom to the bathroom--all that relaxin still left in her system!!!

NurseFirst

Student Nurse

BETSRN · Mar 16, 2005

We do this too. The first three times that someone voids after a vag deliery a nurse helps her to the bathroom and we measure the void. After those 3 times then they are free to go by themselves.

My point in questioning the THREE times was that in a normal, healthy woman who has been up (with nursing's assistance) the first time and has DONE FINE (voids, walks around her room,etc), there is no need to assist her additional times and/or measure. If there are problems with excessive blood loss, dizziness, etc., of course someone should assist the patient more than once, but in the absence of a problem, there is no need to stick to such a hard and fast rule. In this day and age of large patient loads, etc., it is ridiculous to waste the manpower helping someone who does not need help to empty her bladder!! Why measure her urine all those times? If she is voidng without difficulty, her lochia is not increasing, her fundus is firm and at or below her unbilicus, most likely she is emptying her bladder.

I guess I feel this way because in my 20 years of nursing I have never worked anywhere that stuck to such outmoded guidelines. I believe assessing each situation (instead of sticking to some rule of three) is thinking outsi the box (or maybe using critical thinking skills).

WE are nurses, NOT robots who have to all do things the same way.

SmilingBluEyes · Mar 16, 2005

Betsy, this is not "outmoded" if people have noticed their patients fall and/or faint, despite getting up to the restroom, then the wise and thing (in their case) to do, is help them up once or twice more. I do think prudence is wise in OB like anyplace. Personally, I have found a fair number of patients who DO still feel shaky or even may collapse, getting up despite being walked once. I don't see anything wrong with preventing falls, if they have occurred in the past..... And yes, relaxin is present and can cause people to be "loose jointed" and shaky, so there is a good reason, alone, why maybe some feel walking them to the bathroom 2 or 3 times after delivery is wise. Another reason is the use of regional anesthesia....some don't get their "legs" for HOURS after a delivery, I have seen this myself time and again. Nothing frightens a patient more than collapsing and possibly hurting herself in trying to walk those first hours after delivery. If I can prevent this, I will, myself, no matter how outmoded it may seem to others.

RNmommy · Mar 18, 2005

We also assist vags to the BR 2-3 times before we want her doing it herself. We have a 99% epidural rate and it is fairly common for a woman to need to void more than once before she has her legs back. I have personally kept several patients from hitting the floor on her second or third time up.

To address the OP, I assess the perineum q shift and prn for complaints. I, too, have patients say "Turn over? What for? None of the other nurses made me do that". Then when I look at the flow sheet, a peri assessment is charted :rolleyes: