Postpartum Assessment

Question 1

Bubble

B- Breast assessment

Answer 1

Should be soft 1-2 days after delivery, milk on day 3

Nipples should be everted, can be red/cracked/sore = ointment safe for baby too

Question 2

Bubble

U- Uterine assessment

Answer 2

Fundal height/tone defends 1cm/day

Should be firm (fist) and at midline (umbilicus)

Question 3

If uterus is above umbilicus what might that indicate

Answer 3

Full bladder cause deviation may need cath

Encourage void first

Question 4

Fundal check

Answer 4

Supine knees flexed or straight
One hand symphysis pubis (prevents prolapse)
Feel for funds with flat part of fingers
Note position and observe perineum for blood flow/clots
GET RN/instructor if BOGGY (should be firm; massage to get firm)

Question 5

Bubble

L- Lochia assessment

Answer 5

Color, amount, and clots
Bleeding after birth is normal should be rubra (bright red) day 1-3 then serosa 4-10 days then alba 10-21
Small clots normal (measure and chart)
Shouldn’t have bad odor but smells “fleshy”
Moderate flow NOT heavy

Question 6

Bubble

B- Bladder assessment

Answer 6

Should NOT be palpable (only feel if distended)
Void 6-8 hours after delivery (300-400ml/void)
Urine should be clear/yellow
Note & measure clots (blood or placenta?)

Question 7

1 reason for hemorrhage

Answer 7

Atonic uterus (not contracting due to distended bladder)

Question 8

What signs distended bladder

Answer 8

Excessive lochia, fundus displaces above midline, bulge of bladder above symphysis, freq voids of less than 150 ml

Question 9

Bladder condition immediately postpartum

Answer 9

Bladder and urethra edematous, hypotonic bladder (this why don’t push with foley in)

Produce diuresis > 3000ml 24-48 hrs after giving birth

Question 10

Bubble

B- Bowel assessment

Answer 10

Soft abdomen, + bowel sounds/flatus (depends on when last ate), check for hemorrhoids, date last BM, note discomfort/pain, prevent constipation

Nausea/vomit common remind to slow down while eating

Question 11

Bubble

E- episiotomy
How to assess episiotomy

Answer 11

Lay on side and lift upper buttock to see perineum

Look for REEDA 
R- redness
E- edema
E- ecomosis (bruising/hematoma)
D- drainage (incision shouldn't) 
A- approximation

Question 12

Help with episiotomy/hemorrhoids

Answer 12

Sits bath, ticks pads for hemorrhoids 
Peri bottle (warm water spraying from back) 
Ice perineum first 24 hours 
Analgesia 
Topicals

Question 13

Degrees of episiotomy lacerations

Answer 13

First- superficial
Second- skin to muscle
Third- to anal sphincter
Fourth- through anal sphincter to rectal mucosa

Question 14

Bubble

E- extremities

Answer 14

DVT signs (unilateral edema, warmth, redness) 
Pedal pulses 
Deep tendon reflexes 
Sensation/motion
Orthostatic hypotension 
Varicose veins

Question 15

Immediate postpartum SN actions

Answer 15

Vitals every 15 min for first 1-2 hours
Temp at least once in first 1 hr
Shaking/chattering teeth (hormonal) 
Fundus/lochia checks every 15 mins then 30 mins then 2-3 hrs, 4 hrs, 8hrs
Assess pain, sensation of extremities

Question 16

Bubble assessment

Answer 16

Breast 
Uterus
Bladder
Bowel
Lochia
Episiotomy, emotional, extremities, education