Postpartum Assessment

Question 1

Acronym for postpartum assessment

Answer 1

BUBBLE HE

Breast
Uterus
Bladder
Bowel
Lochia
Episiotomy/perineum
Hemorrhoids/ Homans sign
Emotional status

Question 2

What’s the main question you ask before examining the breasts?

Answer 2

Breast-feeding or bottlefeeding

This will guide what you teach as you go through the exam

Question 3

How do you examine the breast?

Answer 3

Inspect the breasts, noting reddened areas or engorgement

Inspect nipples for fissures, cracks or inversion

Palpate the breast lightly for softness, slight firmness associated with filling or tightness of engorgement, warmth or tenderness

Question 4

Teachings for breast feedings moms?

Answer 4

Use supportive bra

Keep nipples dry and watch for fissures or cracks

Watch for reddened or tender spots on breast

Additional teaching during breast-feeding attempts as needed

Question 5

What are some teachings for non-breast-feeding moms?

Answer 5

Use supportive bra

Avoid breast stimulation

Apply cold packs

Apply cold, raw cabbage leaves inside bra

Question 6

How do you assess the uterus?

Answer 6

Palpate the position of the fundus in relation to the umbilicus

Is the fundus firm or boggy?

Is fundus in midline?

Inspect abdominal incision for patients with a C-section using REEDA mnemonic

Excessive pain may indicate infection

Question 7

What is REEDA

Answer 7

Redness

Edema

Ecchymosis

Discharge

Approximation (glued together)

Question 8

What are some uterus teachings?

Answer 8

Fundal position

How to determine firmness

How to massage her fundus

Question 9

Where should the fundus be located?

Answer 9

At or below umbilicus and in the midline

Question 10

What does a boggy uterus mean?

Answer 10

To relaxed, prone to bleeding

Question 11

What is a sign of bladder distention?

Answer 11

A boggy uterus, displaced uterus, or palpable bladder

Question 12

What are some bladder teachings?

Answer 12

Tips to facilitate elimination
-out of bed
-pouring warm water and perineum
-Running water in the sink
-Encourage relaxation and breathing

Encourage frequent voiding

Increase the amount of water she drinks

Question 13

When does bowel movements return after childbirth?

Answer 13

2-3 days

Question 14

What are some bowel teachings?

Answer 14

Help re establish normal bowel pattern
-encourage ambulation
-Encourage fluids
-Encourage fresh fruits/vegetables/fiber in diet

Stool softeners

Question 15

How do you assess the lochia

Answer 15

Assess for character, amount, odor, and clots

Assess for rubra, serosa, and alba

Question 16

Clots and heavy bleeding may be caused by what?

Answer 16

Clot and heavy bleeding may be caused by uterine relaxation, retained placenta fragments, or an unknown cervical laceration

Question 17

What are some teachings regarding lochia?

Answer 17

Inform patient of the normal changes with color and characteristics

Effect of position changes

Hygienic measures

Patience who have a C-section may experience less bleeding

Question 18

What do we mean by effects of position changes regarding lochia teachings?

Answer 18

As patient rest in a horizontal position, lochia may pull in vagina, and patient may notice setting gush or discharge as she sits or stands

Question 19

How do we inspect episiotomy/perineum?

Answer 19

Inspect perineum area for REEDA

Redness
Edema
Ecchymosis (bruising)
Discharge (draining)
Approximation (of wound edges)

Question 20

Episiotomy teachings?

Answer 20

Discuss the type of episiotomy or laceration patient has

Sutures will dissolve on its own

Ice packs

Sitz baths

Peri bottle after voiding and BM

Kegel exercises

Topical sprays or foam for pain control

Question 21

What are postpartum women increased risk for?

Answer 21

Thrombophlebitis

Thrombus formation (PE)

Question 22

If a thrombophlebitis occurs, where is the most likely site?

Answer 22

The woman’s legs

Question 23

What predisposes a patient for thrombophlebitis

Answer 23

Hypercoagulability

Severe anemia

Obesity

Traumatic delivery

Question 24

How do we assess for thrombophlebitis?

Answer 24

The nurse should have the woman stretch her legs out, with the knees slightly flexed and the legs relaxed. The nurse then grabs the foot and dorsiflexes it sharply. The second leg is assessed in the same way.

There should be no discomfort or pain

Question 25

What is a positive Homans sign?

Answer 25

If there is pain, the nurse notifies the healthcare provider that the woman has a positive Homans sign

Question 26

What is an important aspect of preventing thrombophlebitis

Answer 26

Early ambulation

Question 27

If the mother is unable to get up soon after delivery, what can we do to prevent thrombophlebitis

Answer 27

Sequential compression devices

Question 28

How do you assess a patient’s emotional status?

Answer 28

Assess amount of rest the patient is getting

Assess if patient emotions are appropriate for the situation

Fatigue can cause what appears to be disinterest in the newborn

Appropriate nursing measures are indicated if the woman is bothered by normal postpartum discomforts such as after pains, diaphoresis, episiotomy, or hemorrhoidal pain

Question 29

What are some emotional status teachings?

Answer 29

Promote rest and gradual return to activity

Promote adequate nutrition

Encourage new mother to ask for help, before she becomes overwhelmed or exhausted