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Postpartum nurses, how thorough are your shift assessments

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Our Shift assessments includes: heart,lungs, bowel sounds, homans sign, incision site, episiotomy site, hemorrhoids, tattoos, surgical scars, fundus, lochia, nipples, and edema.

I have to admit that sometimes I do not do a full head to toe on every patient due to the fact that I we often have 5 couplets and time just doesn't permits. Therefore, if I have a stable vaginal that going to be discharge with no other risk factors are complications, the most I'll do is a fundus and lochia check. Sometimes my patients are discharged before I even have time to assess them, because the OBs have rounded and cleared for them to go home. My assessment for c-sections and babies are pretty much thorough all the time.

So I'm just wondering if I'm the only one who does more of a focused assessment when juggling so many patients and things at once? How do you all manage to make sure every little box is checked off on that shift assessment ?

FLAlleycat

Specializes in L&D, Women's Health. Has 30 years experience.

Our Shift assessments includes: heart,lungs, bowel sounds, homans sign, incision site, episiotomy site, hemorrhoids, tattoos, surgical scars, fundus, lochia, nipples, and edema.

Hi . . .

Ages ago when I floated to postpartum, we also were responsible for 5 couplets. It would take me two hours to do assessments (but that did include calls for pain meds, etc). We were required assess everything you listed but old surgical scars and tattoos. Sheesh, if we had to assess tattoos, I'd be in a room for an hour! It usually took no more than 5 minutes for maternal assessment and quite often I did my education as I was doing the assessment. If there is a check box that indicates I assessed that area, I'll assess unless she's in the wheelchair going out the door and the RN from prior shift did her d/c assessment. There truly are some horror stories that involve normal vaginal deliveries. I had one who was discharged by the OB but was complaining of increasing pain. Called OB. He said discharge her; called chain of command; head OB said cancel discharge and observe. She wound up with raging infection and spent months in the hospital.

Like I said, though, we had to do a lot of teaching (what IS postpartum but teaching) and had to chart that as well. It was easy to combine mom/baby assessment with the required teaching. Just my thoughts.

JennRN423

Specializes in med-surg so far.

I graduated nursing school May 2013 and we were taught that EBP says you're not supposed to check for a Homan's sign any more. It's not extremely effective since it can show many false positives/false negatives and there's a great possibility of dislodging a clot.

This is the 1st thing I found when I googled Homan's sign. I'm sure there are plenty more (and better) articles out there on Homan's sign, but like I said this is just the very 1st one I came across.

http://nurse-practitioners-and-physician-assistants.advanceweb.com/Features/Articles/The-Homans-Sign-for-DVT.aspx

FLAlleycat

Specializes in L&D, Women's Health. Has 30 years experience.

I graduated nursing school May 2013 and we were taught that EBP says you're not supposed to check for a Homan's sign any more. It's not extremely effective since it can show many false positives/false negatives and there's a great possibility of dislodging a clot.

This is the 1st thing I found when I googled Homan's sign. I'm sure there are plenty more (and better) articles out there on Homan's sign, but like I said this is just the very 1st one I came across.

The Homans' Sign for DVT on ADVANCE for NPs & PAs

Thanks for update and reference!

chiandre

Specializes in EDUCATION;HOMECARE;MATERNAL-CHILD; PSYCH. Has 25 years experience.

Do a quick BLUBBLE-E

Breasts, Lungs, Uterus, Bladder, Bowel Function, Episiotomy and Emotional Status. It should take less than 2-3 minutes.

iPink, BSN, RN

Specializes in Critical Care, Postpartum. Has 8 years experience.

I do focused assessments, which means I'm in and out within 5 mins or less. Unless mom has a lot of questions. I do check homan's, but will look up the EBP.

We don't do couplet care at my facility but I can have up to 7-8 moms when I'm on the floor. We get rotated to be assigned in the nursery. We only do couplet care when we are extremely short staffed.

Five couplets means 10 patients and there's a lot to do in postpartum.

Sent from iPink's phone via allnurses app

I guess since I have a little exp. in working in the emergency room, I used to doing focused assessments. Sometimes I don't see the point of listening to heart/lung sounds on a vaginal mom that is on her way out the door. Often times, by time I get to asses the moms they already been seen my the OB and discharged to go home. When I have new admissions I always do full assessment . I don't know, maybe it is just me.