Postpartum Exams Flashcards by Alicia Majcher

Newborn Exam

Posture
Skin
Head
Face
Eyes
Nose
Mouth
Ears
Neck
Chest
Abdomen
Male Genitals
Female Genitals
Upper extremities
Lower extremities
Back
Anus

How well did you know this?

Not at all

Perfectly

Vital Signs

Temp = 36.5- 37.5
Pulse = 110-160
RR = 30-60bpm
BP = (60-80)/(40-50)

How well did you know this?

Not at all

Perfectly

NB - posture

Normal = flexed, symmetric movement

Abnormal = flaccid, hypertonic, asymmetric movement

How well did you know this?

Not at all

Perfectly

NB Skin

normal = pink, acrocyanosis, milia, lanugo, vernix caseosa, erythema toxicum, cafe au lait spots, blue nevus, port wine stain, strawberry hemangioma, stork bite

Abnormal = cyanosis (circumoral or central), jaundice, pallor, mottling, harlequin sign

How well did you know this?

Not at all

Perfectly

NB Head

Normal = fontanels are soft and flat, suture lines, caput succedanum, molding
Measure the head! should be 2cm larger than the chest.
reflexes : blink, suck, rooting reflex, and the fencer’s pose, startle reflex (dropped down & loud noise)

Abnormal = cephalohematoma, bulging or sunken fontanels

How well did you know this?

Not at all

Perfectly

NB Face

Normal = symmetric size, shape, and movement

Abnormal = asymmetry; check over the bony prominence or in the eyes for jaundice.

How well did you know this?

Not at all

Perfectly

NB eyes

Normal = symmetric size and shape, clear sclera, blue-gray iris, PERLLA, transient crossed eyes

Abnormal = conjunctivitis, hemorrhage, tears present

How well did you know this?

Not at all

Perfectly

NB Nose

Normal = nose breather
Abnormal = nose flaring

How well did you know this?

Not at all

Perfectly

NB Mouth

Normal = pink, moist lips and mucous membranes; tongue is movable; hard and soft palate are intact; epstein pearls

Abnormal = cleft palate, thrush, protruding tongue, circumoral cyanosis.

How well did you know this?

Not at all

Perfectly

NB Ears

normal = firm pinna, quick recoil. The top of the ear / pinna should be above the top of the eye.

Abnormal = low set ears, tags, hearing loss

How well did you know this?

Not at all

Perfectly

NB neck

Normal = short, creased, moves freely
Abnormal = webbing

How well did you know this?

Not at all

Perfectly

NB chest

Normal = barrell shaped, symmetrical, breast engorgement (sometimes some discharge = witch’s milk, caused by withdrawal of hormones)
HR –> 1 minute; 110-160 bpm; murmur is normal right after birth
measure the chest! Head should be up to 2cm larger than the chest.

Abnormal = respiratory distress, retractions, grunting, clavicular fracture (crepitus or a click as we palpate, or the baby’s arm doesn’t move symmetrically)

How well did you know this?

Not at all

Perfectly

NB Abdomen

Normal = round, soft, 3 vessel cord, bowel sounds present

Abnormal = absent bowel sounds, distended abdomen

How well did you know this?

Not at all

Perfectly

NB Male Genitals

Normal = meatus centered, testes descended

Abnormal = undescended testes, hypospadias, phimosis, hydrocele

How well did you know this?

Not at all

Perfectly

NB Female Fenitals

normal = swollen labia at term, mucus discharge, pseudomenses

abnormal = vaginal tag

How well did you know this?

Not at all

Perfectly

NB Upper extremities

Normal = full range of motion, symmetrical motion (look for a broken clavicle)

Abnormal = asymmetrical movement or Erb’s palsy

NB Lower Extremities

Normal = full range of motion, symmetrical leg length and gluteal folds, negative Barlow and Ortolani maneuver

Abnormal = club foot, uneven movement, leg length, or gluteal folds, positive Barlow or Ortolani’s maneuver.

NB Back

normal = spine is intact and flexible

Abnormal = Pilonidal dimple, tuft of hair (suggests spina bifida)

NB Anus

Normal = patent, passes meconium in the first 24 hours.

Mother Assessment

BUBBLE EAR
B –> Breasts
U = Uterus / abdomen
B = Bowel
B = Bladder
L = Lochia
E = Episiotomy / Laceration / perineum

E = Extremities (mild edema)
A = attachment / emotions
R = Rubella / Rhogam

Mother - Breasts (Lactating)

Normal = soft/filling, nipples erect and intact, colostrum present.

Teaching = benefits of breastfeeding, frequency (10-12/24 hours), positions and latch techniques, add 500 calories to prepregnancy diet, offer lactation consultation.

Report = flat/inverted nipples, nipple trauma, engorgement, unable to feed.

Mother - Breasts (non-lactating)

Normal = soft/filling

Teach = wear a sports bra, avoid breast stimulation, ice packs/analgesics for comfort, signs of mastitis.

Abnormal= signs of mastitis

Uterus / Abdomen

Normal = firm fundus, midline, at or below the umbilicus.
for C section - clean, dry intact, REEDA

Teaching = uterine involution is promoted with breastfeeding, voiding, and fundal massage. Fundus descends 1cm per day and returns to the pelvis by day 10.

Abnormal = Boggy uterus, excessive bleeding, multiple clots, displaced uterus, uterine tenderness, fever, malaise, chills, foul smelling lochia

Mother - Bowel

Normal = abdomen is soft, non-distended, flatus and bowel sounds are present.

Teaching = encourage early ambulation, high fiber diet, fluids, stool softeners prn

Abnormal = distended abdomen, reduced bowel sounds, no flatus

Mother - Bladder

Normal = bladder should be nonpalpable. Voids within 6 hours after birth (at least 150mL/void) Teaching = at least 3000mL/day, night sweats. Signs of a UTI. Abnormal = inability to void.

Mother - Lochia

Normal = scant to moderate amount of lochia. Rubra: dark red, days 1-3 Serosa: pink, day 3-10 Alba: yellow, after day 10 Teaching: involution process, uterine massage, and return of menses. Nonlactatin is at 6-8 weeks Lactating: amenorrhea while exclusively breastfeeding Abnormal = excessive bleeding, saturating one pad in less than one hour, constant trickle of lochia or large clots, lochia with foul odor.

Episiotomy / laceration / perineum

Normal = perineum with mild edema or bruising; episiotomy or laceration should be in tact. Teaching = peri bottle use for pericare, ice packs, tucks/sprays or sitz bath use for discomfort and hemorrhoid care, kegel exercises to strengthem the perineal muscles; avoid sex and tampons until lochia has ceased and the perineum has healed (4-6 weeks) Abnormal = hematomas, excessive edema, episiotomy or laceration not well approximated, hemorrhoids

Mother - Extremities

Normal = mild edema Teaching = signs of a DVT, apply TED hose or SCDs Abnormal = excessive edema, pain in the calf

Mother - attachment / emotions

normal = touching, holding, naming, asking questions, and participating in the care of the newborn Teaching = self care and rest. Review Postpartum blues (<2 weeks and normal) versus Postpartum depression (> 3 weeks and abnormal, needs counseling) Abnormal = lack of interest in newborm, symptoms of postpartum depression, suicidal thoughts, or inability to care for themselves or the infant.

Rubella / Rhogam

Normal: review rubella immunity review blood type and antibody screen (Rh status) Teaching = Administer MMR if Rubella non-immune. Administer Rhogam within 72 hours if mom is Rh (-) and baby is Rh (+)

Mother vital signs

temp = 37- 37C or 98.6 - 100.4F HR = 50-90 bpm (report <50 or >120) RR = 12-20 (report <10 or >30) O2 = >95% BP = return to 1st trimester. between 90-160 Systolic and >100 diastolic urine output >30mL/hr