Post-Partum Care

Question 1

What is the BUBBLE-LE assessment?

Answer 1

• Breasts
• Uterus
• Bladder
• Bowel
• Lochia
• Episiotomy (perineotomy), including lacerations
• Lower Extremities
• Emotions: exhaustion, coping, bonding

Question 2

How much blood loss is a risk for pp hemorrhage for vaginal delivery?

Answer 2

> 500 mL

Question 3

Post partum assessment for:

Cardiovascular system?

(4)

Answer 3

1. Check BP for ortostatic hypotension
2. Check CBC (H&H)
3. Assess for DVT
4. Symptoms of chills

H&H = Hemoglobin (12-18) and Hematocrit (37-50%)

Question 4

Post Partum assessment for:

Respiratory system (2):

What additional intervention can be used to help lungs after surgery?

Answer 4

1. Respiratory rate
2. Breath sound should be clear

Incentive Spirometry

Question 5

Post partum assessment for:

Gastrointestinal system

(4)

Answer 5

1. Assess bowel sounds
2. Assess for constipation
3. Assess for hemmorhoids
4. Assess for appetite

Question 6

What is diastasis recti abdominis?

Answer 6

Separation of the rectus muscles

Question 7

What is post partum involution?

Answer 7

This is the process by which the uterus returns to its pre-pregnancy size, shape and location and the placental site heals.

Question 8

What is the approximate length of time to complete involution?

Answer 8

6 to 8 weeks post birth

Question 9

During post partum if the fundus is not midline what might be the suspected cause?

Answer 9

Possibly bladder retention, straight cath or indwelling may need to be put in place.

Question 10

What position should the patient be in during a fundal check?

Answer 10

Supine position

Question 11

What are the interventions (2) if the if the fundus feels boggy?

What should be done if intervetions fail?

Answer 11

1. Massage
2. Adminster pitocin (oxytocin) as ordered

Notify the provider

Question 12

Describe the different lochia amount findings within 1 hour.

Answer 12

• Scant < 2 in
• Light < 4 in
• Moderate < 6 in
• Heavy = complete saturation

Question 13

Describe the different colors of lochia

Answer 13

• Rubra = Bloody dark or bright red
• Serosa = pinkish brown
• Alba = yellowish white discharge

Question 14

What are the comfort intereventions for the perneum?

(3)

Answer 14

1. Topical anesthetic (dermoplast)
2. Sitz bath
3. Ice on the pernieum

Question 15

When is RhoGam required?

Answer 15

Mother is Rh- and newborn is Rh+

Question 16

When does primary postpartum hemorrhage (PPH) occur?

Answer 16

First 24 after birth

Question 17

What are uterotonics?

Answer 17

medication for the prevention of PPH during the third stage of labor

(pitocin, methergine, hemabate, cytotec)

Question 18

What are the 4 causes of Postpartum Hemorrhage?

The T’s

Answer 18

1. Tone (uterine atony; subinvolution)
2. Trauma (e.g., shoulder dystocia)
3. Tissue (retained placenta)
4. Thrombin disorders (disseminated intravascular coagulation)

Question 19

What is uterine atony?

Answer 19

decreased tone in the uterine muscles

Question 20

What is often the cause of secondary PPH?

Answer 20

Small portions of the placenta and/or membranes remain attached to the uterus or within uterus

interferes w/ involution

Question 21

Nursing interventions for PP:

Urinary system

(4)

Answer 21

1. Encourage early voiding (within 2 to 4 hours pp)
2. Assess I&O
3. Assess if urinary catheter is needed
4. Assess for S&S of infections.

Question 22

What is the difference b/w postpartum blues and depression?

Answer 22