i need help rewriting and making sure my paper flows all together…. i need help rewriting

i need help rewriting and making sure my paper flows all together…. i need help rewriting and making sure my paper flows all together. i added my intro and the 3 parts i need to do for the postpartum bubble-her assessment. i somehow need to make everything alittle more shorter than what it is since its too long. please help! Intro: The initial nursing assessment, the first step in the five steps of the nursing process, involves the systematic and continuous collection of data; sorting, analyzing, and organizing that data; and the documentation and communication of the data collected (Torrey, 2021). The postpartum nursing assessment is an essential aspect of care to identify early signs of complications in the woman who has just given birth. The nurse focuses on assistance for families to maximize their adjustment, surveillance for maladaptation, education, consultation, and collaboration as needed. The postpartum period is a time of transition for women. The end of the pregnancy and childbirth initiates physiologic changes as many-body systems return to their nonpregnant states. Postpartum assessment includes vital signs and physical and psychosocial assessments. It begins within an hour after the woman gives birth and continues through discharge. During the first hour, a woman gets assessed every 15 minutes, the second hour every 30 minutes, the first 24 hours every 4 hours, and after 24 hours every 8 hours. During each assessment, nurses must consider risk factors that may lead to complications such as infection or hemorrhage during the recovery period. Nurses need a firm grasp of normal findings to recognize abnormal results and intervene appropriately. BUBBLE-HER is the physical examination of the postpartum assessment. Physical examination of the postpartum woman focuses on assessing the breasts, uterus, bladder, bowels, lochia, episiotomy, homan’s signs, emotions, and rhogam.                                                                BUBBLE-HERBreast Assessment includes evaluating the breast in the postpartum period. The first step is to determine if the new mamma is breastfeeding or bottle-feeding; this will guide the evaluation and patient education. Inspect the breasts for size, contour, asymmetry, engorgement, or erythema. Check the nipples for cracks, redness, fissures, or bleeding, and note whether they are erect, flat, or inverted. Flat or inverted nipples can make breastfeeding challenging for both mother and infant. Cracked, blistered, fissured, bruised, or bleeding nipples in the breastfeeding woman generally indicate that the baby is improperly positioned on the breast. Palpate the breasts lightly to ascertain if they are soft, filling, or engorged, and document your findings. For not breastfeeding women, use a gentle, light touch to avoid breast stimulation, which would exacerbate engorgement. Lactogenesis is initially triggered by the delivery of the placenta, which results in falling levels of estrogen and progesterone with the continued presence of prolactin. If the mother is not breastfeeding, the prolactin levels fall and return to normal within 2 to 3 weeks. As the milk starts to come in, the breasts become firmer; this is charted as “filling.” Engorged breasts are hard, tender, and taut. Ask the woman if she is having any nipple discomfort. Palpate the breasts for any nodules, masses, or areas of warmth, which may indicate a plugged duct that may progress to mastitis if not treated promptly. Any discharge from the nipple should be described and documented if the colostrum is not creamy yellow or foremilk, which is bluish-white. Breast milk matures over the first week and contains all necessary nutrients in the neonatal period. Breast milk continues to change throughout breastfeeding to meet the changing demands of the growing infant. The decision to breastfeed or bottle-feed is highly personal. While the benefits of breast milk nutritionally and physiologically outweigh those of formula, it may not always be possible or in the best interest of the mom and baby to breastfeed. The nurse’s role is to educate the mom and support the family in whatever choice is made. Breastfeeding teaching positioning is holds- chest to chest or tummy to tummy in some way, grab under the breasts and push down and out taking the milk ducts and pushing it forward, make a C-Hold around the areola get a nice significant drop of colostrum on the nipple tickle the lip with the nipple, shove as much breast as possible into the mouth once it’s open, 5 to 15 minutes at first to prevent soreness, start with the last breasts that were used the previous feeding, and try to feed every 2 hours.UterusAssess the fundus (top portion of the uterus) to determine the degree of uterine involution. If possible, have the woman empty her bladder before assessing the fundus and auscultate her bowel sounds prior to uterine palpation. If the client has had a cesarean birth and has a patient-controlled anesthesia (PCA) pump, instruct her to self-medicate prior to fundal assessment to decrease her discomfort. Using a two-handed approach with the woman in the supine position with her knees flexed slightly and the bed in a flat position or as low as possible, palpate the abdomen gently, feeling for the top of the uterus while the other hand is placed on the lower segment of the uterus to stabilize it. The fundus should be midline and should feel firm. A boggy or relaxed uterus is a sign of uterine atony, loss of muscle tone in the uterus, This can be the result of bladder distention. One to 2 hours after birth, the fundus is typically between the umbilicus and the symphysis pubis. Approximately 6 to 12 hours after birth, the fundus is usually at the level of the umbilicus. If the fundal height is above the umbilicus, which would be an abnormal finding, investigate this immediately to prevent excessive bleeding. Frequently, the woman’s bladder is full, thus displacing the uterus up and to either side of the midline. Ask the woman to empty her bladder, and reassess the uterus again. Normally, the fundus progresses downward at a rate of 1 cm per day after childbirth and should be nonpalpable by 10 to 14 days postpartum. By day 14, the uterus has descended below the rim of the symphysis pubis and is no longer palpable. Nursing Considerations is that A boggy fundus may be a sign of uterine atony, which places the patient at risk for developing a postpartum hemorrhage and other complications. Also, fundal location that lies out of range with anticipated location according to postpartum status may be another indication. The nurse should perform a uterine massage, which promotes blood movement out of the uterus, and also encourage the patient to void, as a full or distended bladder can impede uterine involution and contractions. The nurse is often in the position as the first member of the health care team to learn of these warning signs and therefore must take swift action if an issue is suspected. Bladder Assess the bladder for distention and adequate emptying after efforts to void. Palpate the area over the symphysis pubis. If empty, the bladder is not palpable. Palpation of a rounded mass suggests bladder distention. Also, percuss the area; a full bladder is dull to percussion. Lochia drainage will be more than expected if the bladder is full because the uterus cannot contract to suppress the bleeding. Diuresis as much as 3,000 mL/day begins within 12 hours after childbirth and continues for several days—a single voiding maybe 500 mL or more. By 21 days postpartum, the diuresis is usually complete. Many postpartum women do not sense the need to void even if their bladder is full. In this situation, the bladder can become distended and displace the uterus upward and to the side, which prevents the uterine muscles from contracting properly and can lead to excessive bleeding. Urinary retention resulting from decreased bladder tone and emptying can lead to urinary tract infections and postpartum hemorrhage. Nurses must monitor clients for signs of urinary tract infections, including fever, urinary frequency and urgency, difficult or painful urination, and tenderness over the costovertebral angle. Women who received regional anesthesia during labor are at risk for urinary tract infections due to continuous urinary catheterization to prevent urinary retention during childbirth, which is thought to delay fetal descent. They also experience difficulty voiding and loss of sensation and must wait until it returns to feel a full bladder several hours after childbirth. Nursing Interventions for the bladder is teaching mom always to bring the bottle, which is used for perineal irrigation, to the restroom to use rather than toilet paper; the bottle is filled with warm water from the faucet and occasionally mixed with an antiseptic or analgesic solution if ordered by the provider or permitted by hospital policy. The contents are sprayed on the area following each void/bowel movement rather than toilet paper. Teach mom to use Tuck’s Pads, which contain witch hazelDermaplast is a topical spray that may be applied to help control pain. A straight catheter may need to be used if mom doesn’t void within an acceptable time.  Health Science Science Nursing NURS 3518 Share QuestionEmailCopy link Comments (0)

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