Case Study
The 6-Week Postpartal Assessment
Mrs. Ramirez, her mother, and Carmen arrive at the Women’s Clinic 6 weeks later for the postpartal exami-nation. Mrs. Ramirez is breastfeeding without difficulty, and reports that Carmen is gaining weight appropriately. She has had no problems and is smiling and cooing over the baby. Measurement of her weight reveals a 15-pound loss (her total weight gain during pregnancy was 26 pounds); her pulse, respirations, and BP are all within normal limits. A clean-catch urine specimen is obtained and is negative. Her hemoglobin/hematocrit levels are consistent with her prenatal values. During the interview, she has no complaints, and states that she plans to return to work in 4 more weeks. Her mother and older sister will share child care, and she will continue to breastfeed Carmen. She is still taking prenatal vitamins. She is interested in the diaphragm as a method of contraception. She has not had a menstrual period since her delivery, and reports that her lochia progressed through the normal stages of lochia rubra, lochia serosa, and lochia alba, and now has ceased. She displays no signs of postpartum depression.
Mrs. Ramirez’s physical findings include thyroid nonpalpable, breast firm and full, milk expressible, lungs clear, heart regular rhythm, no murmurs, abdomen soft, nontender, uterus nonpalpable, per-ineum intact.
Mrs. Ramirez is fitted with a diaphragm and instructed in its use and insertion and removal technique, which she is able to complete without difficulty. Because her prenatal Pap smear was normal, she is given a return appointment for 6 months for a routine follow-up visit.