Postpartum Exams

Question 1

Newborn Exam

Answer 1

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

Question 2

Vital Signs

Answer 2

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

Question 3

NB - posture

Answer 3

Normal = flexed, symmetric movement

Abnormal = flaccid, hypertonic, asymmetric movement

Question 4

NB Skin

Answer 4

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

Question 5

NB Head

Answer 5

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

Question 6

NB Face

Answer 6

Normal = symmetric size, shape, and movement

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

Question 7

NB eyes

Answer 7

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

Abnormal = conjunctivitis, hemorrhage, tears present

Question 8

NB Nose

Answer 8

Normal = nose breather
Abnormal = nose flaring

Question 9

NB Mouth

Answer 9

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.

Question 10

NB Ears

Answer 10

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

Question 11

NB neck

Answer 11

Normal = short, creased, moves freely
Abnormal = webbing

Question 12

NB chest

Answer 12

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)

Question 13

NB Abdomen

Answer 13

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

Abnormal = absent bowel sounds, distended abdomen

Question 14

NB Male Genitals

Answer 14

Normal = meatus centered, testes descended

Abnormal = undescended testes, hypospadias, phimosis, hydrocele

Question 15

NB Female Fenitals

Answer 15

normal = swollen labia at term, mucus discharge, pseudomenses

abnormal = vaginal tag

Question 16

NB Upper extremities

Answer 16

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

Abnormal = asymmetrical movement or Erb’s palsy

Question 17

NB Lower Extremities

Answer 17

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.

Question 18

NB Back

Answer 18

normal = spine is intact and flexible

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

Question 19

NB Anus

Answer 19

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

Question 20

Mother Assessment

Answer 20

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

Question 21

Mother - Breasts (Lactating)

Answer 21

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.

Question 22

Mother - Breasts (non-lactating)

Answer 22

Normal = soft/filling

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

Abnormal= signs of mastitis

Question 23

Uterus / Abdomen

Answer 23

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

Question 24

Mother - Bowel

Answer 24

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

Question 25

Mother - Bladder

Answer 25

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.

Question 26

Mother - Lochia

Answer 26

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.

Question 27

Episiotomy / laceration / perineum

Answer 27

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

Question 28

Mother - Extremities

Answer 28

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

Question 29

Mother - attachment / emotions

Answer 29

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.

Question 30

Rubella / Rhogam

Answer 30

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 (+)

Question 31

Mother vital signs

Answer 31

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