Postpartum Exams Flashcards
Newborn Exam
Posture
Skin
Head
Face
Eyes
Nose
Mouth
Ears
Neck
Chest
Abdomen
Male Genitals
Female Genitals
Upper extremities
Lower extremities
Back
Anus
Vital Signs
Temp = 36.5- 37.5
Pulse = 110-160
RR = 30-60bpm
BP = (60-80)/(40-50)
NB - posture
Normal = flexed, symmetric movement
Abnormal = flaccid, hypertonic, asymmetric movement
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
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
NB Face
Normal = symmetric size, shape, and movement
Abnormal = asymmetry; check over the bony prominence or in the eyes for jaundice.
NB eyes
Normal = symmetric size and shape, clear sclera, blue-gray iris, PERLLA, transient crossed eyes
Abnormal = conjunctivitis, hemorrhage, tears present
NB Nose
Normal = nose breather
Abnormal = nose flaring
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.
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
NB neck
Normal = short, creased, moves freely
Abnormal = webbing
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)
NB Abdomen
Normal = round, soft, 3 vessel cord, bowel sounds present
Abnormal = absent bowel sounds, distended abdomen
NB Male Genitals
Normal = meatus centered, testes descended
Abnormal = undescended testes, hypospadias, phimosis, hydrocele
NB Female Fenitals
normal = swollen labia at term, mucus discharge, pseudomenses
abnormal = vaginal tag
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
