POSTPARTUM

• What is the focus of the assessment during the first 24 hours postpartum?

  Regular assessment of vaginal bleeding, uterine contractions, fundal height, temperature, heart rate, and blood pressure
• Why is blood pressure checked shortly after birth?

  To monitor the mother's cardiovascular status
• What does the acronym BUBBLE HE stand for in postpartum maternal physical assessment?

  B – Breast, U – Uterine fundus, B – Bladder function, B – Bowel function, L – Lochia, E – Episiotomy, H – Homan’s sign, E – Emotion
• What are the key components to assess in the breast during postpartum assessment?

  • Inspect for redness and engorgement
  • Palpate to determine if soft or filling
  • Check nipples for pressure sores, cracks, or fissures
  • Evaluate nipple shape: everted, flat, or inverted
• When does engorgement typically occur postpartum?

  Engorgement occurs 2-3 days postpartum
• What is colostrum?

  Colostrum is the first milk produced by the mammary gland
• How does breastfeeding affect uterine contractions?

  Breastfeeding encourages uterine contraction due to the release of oxytocin
• What are normal findings for nipples postpartum?

  Nipples should be soft, pliable, intact, and everted
• What should be assessed regarding the uterine fundus?

  Assess for firmness, location, degree of contraction, and tenderness
• What is the first step in the regular assessment for the first 24 hours postpartum?

  Vaginal bleeding
• What is the normal range for the second blood pressure reading after birth?

  The second BP should be taken within six hours
• What is the BUBBLE HE acronym used for in postpartum maternal physical assessment?

  It summarizes the key areas to assess: Breast, Uterine fundus, Bladder function, Bowel function, Lochia, Episiotomy, Homan's sign, and Emotion
• When does engorgement of the breasts typically occur?

  Engorgement occurs 2-3 days postpartum
• How does breastfeeding help the uterus contract?

  Breastfeeding encourages uterine contraction due to the release of oxytocin
• Where should the uterine fundus be palpated shortly after birth?

  The fundus is palpable through the abdominal wall halfway between the umbilicus and the symphysis pubis (approximately 2cm below the umbilicus)
• How does the location of the uterine fundus change in the first 24 hours after birth?

  One hour after birth, the fundus will rise to the level of the umbilicus and stay there for 24 hours. The fundus then descends approximately 1cm per day, and by the 10th day it should no longer be palpable.
• What is the likely cause if the uterine fundus is deviated to the left or right or elevated above the level of the umbilicus?

  A distended bladder can displace the uterus, leading to a boggy uterus and increased risk of atony
• What are the normal characteristics of the uterine fundus?

  The uterine fundus should be normal in size and shape, mobile, regular, firm, in the midline, below the umbilicus, and non-tender
• What causes the "afterpains" that a woman may feel in the first few days after delivery?

  Afterpains are caused by occasional uterine contractions that help prevent excessive bleeding by compressing the blood vessels in the uterus
• What are the three stages of lochia?

  The three stages of lochia are: lochia rubra (dark red discharge, 1-3 days), lochia serosa (pink or brownish discharge, 4-7 days), and lochia alba (creamy or yellowish discharge, 7-10 days)
• What are the normal characteristics of lochia?

  Normal lochia should be odorless, with no clots, and should decrease in amount each day
• When should a postpartum woman void after delivery or Foley catheter removal?

  All postpartum mothers should void by six hours after delivery or Foley catheter removal
• Why is a distended bladder a concern in the postpartum period?

  A distended bladder can displace the uterus, leading to a boggy uterus and increased risk of uterine atony
• When should a postpartum woman have her first bowel movement?

  If the woman has not had a bowel movement by the 2nd day postpartum, she may need a stool softener or laxative
• What does the REEDA acronym stand for when assessing an episiotomy?

  REEDA stands for: Redness, Edema, Ecchymosis, Discharge, and Approximation
• What are the normal findings when assessing an episiotomy?

  The episiotomy should have minimal tenderness with gentle palpation, and there should be no hardened areas or hematomas
• What are the signs of dehydration that should be assessed in the postpartum woman?

  Signs of dehydration include dry, itchy, and dull-looking skin with poor skin turgor
• What are the three normal phases of a woman's emotional status in the postpartum period?

  The three normal phases are: 1) Taking in (immediately after delivery to 2 days postpartum), 2) Taking hold (days 2-5 postpartum), and 3) Letting go (reestablishing relationships with others)
• What is Homan's sign and why is it important to assess in the postpartum period?

  Homan's sign is an indicator of deep vein thrombosis (DVT), where pain in the calf is produced by passive dorsiflexion of the foot. It should be assessed daily in the postpartum period.
• What is postpartum blues and what are the typical characteristics?

  Postpartum blues is a normal temporary state related to hormonal changes, role definition, fatigue, or pain. It typically begins 2-3 days after delivery and may last up to 10-14 days, with the woman "crying for no reason".
• What are the key areas to assess in the maternal examination during the postpartum period?

  The key areas to assess are: sleep deprivation, ability to rest, energy level, comfort level, anxiety level, appetite, and bonding behaviors
• How does rooming-in benefit the mother-child relationship?

  The more time a woman spends with her baby in the room, the sooner she may feel competent in child care and the more likely she is to form a sound mother-child relationship
• What is the recommended care for the mother's breasts during the postpartum period?

  No soap should be used on the nipples, the breasts should be washed with water only, and a supportive bra should be worn
• What is the most important aspect of breastfeeding care to teach the mother?

  The most important aspect is teaching the mother how to assist the infant in getting the nipple and areola properly into the mouth, known as "latch-on"
• What are the key areas to assess in the postpartum maternal physical examination using the BUBBLE HE acronym?

  • Breast
  • Uterine fundus
  • Bladder function
  • Bowel function
  • Lochia
  • Episiotomy
  • Homan's sign
  • Emotion
• What are the three normal phases of a woman's emotional status in the postpartum period?

  1. Taking in (immediately after delivery to 2 days postpartum)
  2. Taking hold (days 2-5 postpartum)
  3. Letting go (reestablishing relationships with others)
• What are the three stages of lochia and their characteristics?

  • Lochia rubra (dark red discharge, 1-3 days)
  • Lochia serosa (pink or brownish discharge, 4-7 days)
  • Lochia alba (creamy or yellowish discharge, 7-10 days)
• What are the steps of the breastfeeding process that should be taught to the postpartum mother?

  • Assist the infant in getting the nipple and areola properly into the mouth (latch-on)
  • Teach different positions to hold the baby
  • Teach techniques to relax and allow for "let-down" of the milk
• What is the formula to calculate the area of a circle?

  $A =$$\pi r^2$