Lesson plan on

Postnatal exam and

postnatal exercise

Submitted to- Mrs. Mikki

Submitted by- Ms Sneha Sehrawat
Msc nursing Ist year
(OBG)
Rufaida College of Nursing
IDENTIFICATION DATA

NAME:

Ms. Sneha Sehrawat

CLASS:

MSc Nursing Ist Year

SUBJECT:

Obstetric and gynecology Nursing

TOPIC:

Postnatal examination and postnatal exercises

GROUP:

BSc Nursing 3rd Year classroom

SIZE OF THE GROUP:

DURATION:

30 mins

PLACE:

Demonstration Lab

METHOD OF TEACHING:

Demonstration

AV AIDS USED:
DATE:
TIME:
LANGUAGE:

English

SUPERVISOR:

Mrs. Mikki

PREVIOUS KNOWLEDGE:

Students have previous knowledge no previous knowledge regarding the topic.

GENERAL OBJECTIVE

After the class, students will be able to:

Acquire knowledge of topic- POSTNATAL EXAMINATION AND EXERCISE.
Vocalize their learning about the topic .
Able to conduct postnatal examination on the client.
Understand the role of nurses in postnatal examination.
Teach the client how to perform postnatal exercises.
Disseminate the knowledge in the community.

Student teacher will be able to :1.

Develop confidence in facing the group.

2.

Develop confidence in teaching.

3. Develop skills in demonstrating the procedure.

4. Develop good knowledge about the Topic.
5. Develop skills in demonstrating the procedure

Time

Specific
Objectives

Contents

Teaching Learning
Activities with A.V.aids

Evaluation

1min

INTRODUCTION
Whether the birth is at
home or in a hospital
setting, the midwife is
primarily concerned with
the observation of health
of the postpartum mother
and the new baby, as such
it has been common
practice to have an
overall frame work upon
which to base the
assessment of mothers
state of health.
The postnatal
examination is done
immediately after
childbirth to ensure
maternal well being to
avoid any unanticipated
postnatal complications.

.
1 min.

.
ANNOUNCEMENT OF
THE TOPIC : Today I
am going to demonstrate
post natal examination
and postnatal exercise.

After this
teaching
session the

student will be
able to :

1 min.

3 min

To define the
postnatal
examination.

Enlist the
objectives &
time of doing
the post natal
examination.

DEFINITION It is a thorough &

systematic examination of post natal
mother and advise given to mother and
family

Student teacher defines

the post natal
examination with flash
cards.

OBJECTIVES

Student teacher briefs the

group about the
objectives & the time for
the post natal
examination with the help
of the transparency .

1.To identify the needs of the mother &

to plan the care accordingly.
2. To prevent any complications.

What do
you mean
by post
natal
examination
?

3. To educate the mother & the family for

self care.
4. To observe the condition of the mother.
5. To ensure maternal well being in
postnatal period.
6.Help the mother adjust to the changes
that have occurred as a result of
pregnancy, delivery, and childbirth.
7.Assess health status of mother and
newborn.
8. Provide guidance and information
about breastfeeding and care of the
newborn.
9.Provide immunization for the mother:
postpartum rubella or RH prophylaxis if
indicated.

2 min

To gain
knowledge

TIME OF DOING POST NATAL

The student teacher turn

establishes information

When
mother

regarding
appropriate
time of doing
postnatal
examinations.

EXAMINATION
1.Soon after delivery .

regarding appropriate
time for doing postnatal
examinations.

2. Daily( till hospitalized).

3. At the time of discharge.
4. Between 6-8weeks after delivery.

3 min.

To enlist the
general
instructions
while doing the
procedure.

GENERAL INSTRUCTIONS
1. Privacy should be maintained &
mother should be exposed minimally.
2. Give proper explanation about
procedure to gain confidence.
3. Nursing and scientific principles to be
kept in mind while doing procedure.
4. Maintain asepsis, perineum is to be
examined in the last.
5. Post natal advice is to be given to the
mother in the last.
6. Mother should be asked to empty her
bladder before it.
8.Assess carefully and correlate the
findings theoretically.

The student teacher

enlists general
instructions about
postnatal examination
with the help of the
flashcards.

should be
examined
after
delivery?

5 min.

Explain the
articles used
and their use .

ARTICLES REQUIRED FOR

EXAMINATION
Article

Rational

Hand washing
article

To prevent cross
infection

Examination
table/ bed

To lie the mother

comfortably

Good lighting

To visualize the
area

Screen

To provide
privacy

Vital tray

To check B.P &

T.P.R

Weight machine

To check the
weight of mother

Urine
examination tray

To detect any
abnormality

Lubricant

For P.V
examination

Kidney tray with

paper bag

To collect soil
material

Tape measure

To check the
fundal height

Sterilized tray
To check the
with Dressing sets perennial stitches
& a pair of gloves
& pad
Sponge holding
forceps

To clean the
perineum

Simss speculum

To retract the
vagina

Cuscos speculum

To exam the
cervix

Student teacher enlists the

required article by
showing to the group one
by one with
demonstration method of
teaching.

Vaginal retractor

30
min.

Develop skills
in performing
the procedure.

To retract the
anterior vaginal
wall retractor

STEPS OF PROCEDURE FOR

EXAMINATION OF POSTNATAL
MOTHER :
1.Explain procedure to mother to gain
confidence
2.Ask the mother to empty the bladder
3.Collect the articles bring them to bed
side
4. Collect urine specimen for
examination
5. Wash hands
6.Screen the mother
7.Give comfortable position to the
mother
8.Check weight B.P & T.P.R
9.Cover the mother with sheet & expose
the area needed
10. Do the physical examination
sequence wise:* HEAD & HAIR
a. Hygiene
b. Pediculosis
c. Dandruff
* EYES

What is the
use of
Simss
speculum

Student teacher
demonstrates the
procedure over the
client/dummy.

a. Infection
b. Jaundice
c. Anemia
d. Visual disturbances

*MOUTH
a. Clean
b. Artificial dentures
c. Salivary glands
* EAR
a. Infection
b. Hearing defect
*NOSE
a. Infection
b. Polyp
c.DNS
*THROAT
a. Enlargement of gland
*HANDS & NAILS
a. Normal
b. Deformity
c. Size
e. Shape
d. Symmetry

*BREAST
a. Symmetry

b. Size and shape

c. Soft & secreting
d. Cracked or retracted nipples
e. Lymph nodes enlargement
f. Lump
*AXILLA
a. Lymph node enlargement
*ABDOMEN
a. Soft
b. Distended
c. Uterus contracted/relaxed
d. Fundal height
*LEG
a. Size
b. Symmetry
c. Any deformity
d. Swelling, varicose veins
e. Signs of thrombophlebitis
*PERENEUM
a. Condition of vulva
b. Lochia
c. Infection
d. Condition of episiotomy
11. Make the mother comfortable
12.Record their observations and report
any deviation from the normal
13.Dismantle the articles after cleaning
and replace them.

What is the
benefit to
emptying
bladder
before
performing
postnatal
examination
?

POSTNATAL EXERCISESE
2 min

2 min

To describe
postnatal
exercise.

Group will be
able to
understand the
importance of
exercises
postnatally

Exercises performed during postnatal

period after childbirth which reduces the
risk of developing and/or dying from
heart disease, diabetes, colon cancer and
breast cancer.Reduces high blood
pressure or the risk of developing high
blood pressure, high cholesterol or the
risk of developing high
cholesterol.Reduces body weight or body
fat, depression and anxiety, improves
psychological well-being and sleep
quality.Builds and maintains healthy
muscles, bones, and joints.

IMPORTANCE OF POST-NATAL
EXERCISES.
Exercises helps the muscles to regain the
former tone and strength. These
exercises should be started as soon after
delivery as possible in order to improve
the circulation, strengthen pelvic floor.
and abdominal muscles and prevent long
term problems. Muscles of good tone are
more elastic and will regain their former
length more efficiently and more quickly
after being stretched than muscles of poor
tone.

Student teacher describes

postnatal exercise with
lecture method.

Student teacher explains

the importance of
postnatal exercises

Why the
postnatal
exercises
are
important?

5 min.

Group will be
able to know
about different
types of
postnatal
exercises &
how to perform
those exercises

TYPES OF EXERCISES
1.Circulatory exercises
2.Pelvic floor exercises
3.Abdominal exercises
CIRCULATORY EXERCISES
These exercises are done very frequently
in the immediate postnatal period to
improve circulation, to reduce edema and
prevent deep vein thrombosis. If edema
is present, the foot of the bed may be
raised slightly.
1. FOOT EXERCISES : Sitting or lying
with knees straight, bend and stretch the
ankles briskly 12 times. Keeping the
knees still, circle both ankles in as big a
circle as possible, 12 times in each
direction.
2. LEG TIGHTENING : Pull both feet
upwards at the ankle and press the back
of the knees down on to the bed, hold
breathing normally, then relax. Repeat
the process 5 times.
3. DEEP BREATHING : Taking 2 or 3
deep breaths, after performing foot and
leg exercises, also helps to improve veins
returns.

PELVIC FLOOR EXERCISE

The pelvic floor muscles have been under
strain during pregnancy and stretched
during delivery and it may be both
difficult and painful to contract these
muscles postnatal. Mothers should be
encouraged to try the exercises as often
as possible in order to regain full bladder
control, prevent prolapse and ensure

Student teacher explains

various tips of postnatal
exercises and showing
over the client how to
perform these exercises.

normal sexual satisfaction for both

partners in the future. The exercise can
be linked to, and performed during ,
every day activities such as feeding,
bathing, nappy changing and after each
visit to the toilet.
1. Advise the mother to contract the
pelvic floor when coughing, laughing,
lifting or squinting down.
2. Sit, stand or lie with legs slightly apart.
Close and draw up around the back
passage as though preventing the bowel
action, then repeat around the front, two
passages as though preventing the flow of
urine. Hold as strongly as possible, for as
many seconds as possible, breathing
normally throughout. Relax and rest for
3 sec. Repeat 4 times at any one time.
3.Mother can test the strength of pelvic
floor muscles 8 to 12 weeks after the
delivery by jumping with full bladder and
coughing deeply 2 or 3 times. There
should be no leakage of urine. If leakage
is present, more intense exercise is
required and retesting is done 4 weeks
later.

ABDOMINAL MUSCLE EXERCISE

All the abdominal muscles need
exercising and stretching to regain tone
as soon as possible after delivery, in order
to protect the spine, prevent back
problems and help the mother regain her
former figure.
1. Abdominal retraction :
In back lying with knees bent, sitting or
standing , draw in the abdominal muscles
and hold for a count of 4, breathing
normally. Repeat 6 times. This is a very

simple exercise for the abdomen and can

be performed very frequently.
2. Transverses exercise :
Sit comfortably or kneel on all four, with
a level of spine. Breathe in and out, then
gently pull in the lower part of abdomen
below the umbilicus, keeping the spine
still and breathing normally. Hold for
upto 10 sec. then relax gently. Repeat
upto 10 times. This exercise tones the
deep transverse abdominal muscles
which are the main postural support of
the spine and will help to prevent back
ache in the future.
3.Pelvic tilting:In half line position with both knees bend
and feet resting resting on floor, tighten
& pull the abdomen, tighten the muscle
of buttock & press small of the back
downwards on the supporting surface.
Hold the contraction for couple of sec,
while breathing normally then relax.
Repeat 5times.
4. Curl ups:In back line, with one pillow tilt the
pelvis back and hold it in that position
while lifting head forward & reaching
towards the knees with the hands. Breath
normally, then slowly lower the head &
shoulders back on the pillow before
relaxing the pelvis tilt. Repeated 4times,
increasing the no. 12times over 6weeks.
This exercise must always be done with
knees bend & with pelvis tilting first.
6. Knee rolling:In back line with knees bent, pull in
abdomen & roll both knees over to the
left as for as comfortable, keeping
shoulders flat. Returns knees to the

center & relax the abdomens. Pelvic

tighten again repeated exercise to the
right side before returning knees to the
center & relaxing. This exercise can be
repeated up to 10times, progressing up to
20 times over the following 6weeks.
7. Hip hitching or leg shortening:It is performed in back line with one
knee bend & other knee straight. Slide
the heal of the straight leg downwards
thus lengthening the leg. Shorten the
same leg by draining the hips up to
words the ribs on the same side.
Repeated 6-10times hipping abdomen
pulled in. Change to the opposite side.
8. Oblique curls up:In back line with both knees bend up tilt
pelvis backwards & lift head &
shoulders forward reaching with left
hand in direction of right ankle while
breathing normally slowly lower back to
pillow and relax abdominal completely.
Repeated to the left side with right
hand,reapeting 6times, it can be
increased up to 12 in 6 weeks.
EXERSICE FOLLOWING AN
ASSISTED DELIVRY:Mothers who have under gone a forceps
delivery or ventouse extraction will
usually have sutures and may have
brusing and odema of the perineum.
These mothers may well benefit from
some form of pain relief & may not feel
exercising.How ever circulatory & pelvic
floor exercises should be encourage for
there healing effect. The comfortable
resting position are side line and prone
line for the pillow under the hips and
another under head & shoulders.
EXERCISE FOLLOWING

What are
different
types of
exercises?

CAESAREAN DILIVERY:Vigorous foot & leg exercise For

circulation are extreme important
following cesarean delivery especially if
this have been performed under epidural
anesthesia 2 or 3 deep breaths regularly
when mother is immobile will help to
improve ventilation. Deep breathing is
followed by huffing will help to
loosening the secretions.
To ease back ache & flatulence the pelvic
tilting & knee rolling exercise can be
practice gently after 24 hours. Pelvic
floors exercise curls ups and hip hiching
should done after four to fifth days .
EXERSICE FOLLING STILL BIRTH
OR NEONATAL DEATH:Special efforts need to be made to offer
their mothers who had have sad
experience of still birth, neonatal death
who have ill baby, the exercise & advises
about normal daily living activities, may
be given on one to one basis rather than
a group situation preferably.
POSNATAL CARE OF THE BACK:During early postnatal period the pelvis
and joints are still fragile because of
hormonal influence on ligaments & can
remain so for up to 6 months.It is
important to discuss:a. Position for hanging/ bathing a
baby which avoid stooping and
carrying heavy tubes of water.
b. Comfortable position to feed the
the baby.
c. Lifting should be minimize to
min.

How does
exercise
helps post
cesarean
section?

1 min

SUMMARY ;Today we have discussed

the postnatal
examination, its
importance, objectives,
points to remember. We
learnt pre-requisites to be
prepared before
conducting postnatal
examination and also
demonstrated the
procedure. We discussed
postnatal exercise, its
importance and its
different types.

2 min

CONCLUSION:It is very important to do

postnatal examination to
a mother immediately
after delivery & it should
followed up daily and
after 6weeks to detect
early complications.After
giving clinical teaching/
demonstrating to the
group I hope they will be
able to perform the same
skillfully
in
future.Postnatal care is
the attention given to the
general
mental
and
physical welfare of the
mother and infant. Care
should be directed toward
prevention, and early
detection and treatment,
of complications and
diseases. In addition,
postnatal care should

include
counseling,
advice, and services on
breastfeeding,
family
planning, immunization,
and maternal nutrition

BIBLIOGRAPHY: Brown Linda K. A text book of

midwives, 12 edition, Edinburg:
Church living stone, 1993, P.P
635639.
Cooper Margate A text book of
midwives, 14 edition Toronto, church
living stone, 2003,P.P 46162.
Nursing procedure manual, Rufaida
collage of nursing ,Jamia Hamdard.
Betty R, Mayer midwifery A
textbook of midwife, Baillien
Boyle R, Hay-Smith EJ, Cody JD, et
al Pelvic floor muscle training for
prevention and treatment of urinary
and fecal incontinence in antenatal
and postnatal women. Cochrane
Database System Rev. 2012 Oct 17.