OB Postpartum Assessment

Questions and Answers

What does BUBBLE stand for in the postpartum assessment?

Uterus (correct)

Lochia (correct)

Breast (correct)

Bowel (correct)

Bladder (correct)

Episiotomy (correct)

What should be assessed regarding the breasts?

4 quadrants & tail of Spence, size/shape, temperature, areola, nipple condition.

Why must you ask if mom is breastfeeding?

It changes breast assessment and feeding instructions.

What is engorgement?

When breasts are painfully overfull of milk due to more milk production than the baby uses. Signup and view all the answers

What should you assess when breastfeeding?

Maternal positioning, latching, and feeding technique & pattern. Signup and view all the answers

What are key assessment points for the uterus?

Fundal height, placement (midline), firmness, and post-delivery pain. Signup and view all the answers

What common reason might cause the uterus to be not midline?

A full bladder. Signup and view all the answers

What should you do for a boggy uterus?

Massage the uterus to encourage contracting. Signup and view all the answers

What does a boggy uterus indicate?

It feels spongy and suggests the uterus is not contracting properly, which can lead to bleeding. Signup and view all the answers

What is the normal descent rate of the fundus postpartum?

Approximately 1 cm per day. Signup and view all the answers

What does Pitocin dilution refer to?

Hourly infusion with minute titration. Signup and view all the answers

What should be assessed in a C-section patient?

Incision type, closure, and dressing condition. Signup and view all the answers

What does the REEDA scale assess?

Redness, edema, ecchymosis, drainage, approximation. Signup and view all the answers

What action should be taken if you see loose dressing or drainage?

Do not remove the first dressing; secure it and mark drainage. Signup and view all the answers

What factors should be monitored when assessing fundal height in C-section patients?

Incisional pain, vital signs, and amount of bleeding. Signup and view all the answers

What is the positioning and timing for uterine assessment?

In semi-Fowler's position with an empty bladder. Signup and view all the answers

What is key when assessing fundal height?

Stabilize the uterus at the pubis bone to prevent prolapse. Signup and view all the answers

How do you assess the uterus and lochia?

Press down firmly on the fundus to expel lochia/clots and document size and amount. Signup and view all the answers

What does lochia assessment include?

Vaginal bleeding types: Rubra, Serosa, Alba; color, amount, and odor. Signup and view all the answers

What should be assessed regarding bowel function?

Bowel sounds in all four quadrants and dietary plan. Signup and view all the answers

What to assess regarding the bladder?

Placement/quality, intake/output, Foley catheter condition. Signup and view all the answers

What is the importance of the first void after delivery?

The first time getting out of bed should be with assistance, and 150-200 ml urine is normal. Signup and view all the answers

What is considered a normal fluid loss postpartum?

High void and diuresis are normal, along with edema and IV fluids. Signup and view all the answers

What is the proper positioning for episiotomy assessment?

Side-lying or low semi-Fowler's with knees slightly flexed. Signup and view all the answers

What should be assessed following an episiotomy?

Location, suture approximation, hematomas, varicosities, edema, and signs of infection. Signup and view all the answers

What should you assess if there is no episiotomy?

Lacerations, pain level, and perineal care needs. Signup and view all the answers

What is a sits bath?

Sitting on a basin of warm water on the toilet to promote circulation and soothe. Signup and view all the answers

What are tucks pads used for?

Soaked in witch hazel to promote healing and provide astringent properties. Signup and view all the answers

What does the acronym HEB stand for?

Bonding Signup and view all the answers

What indicates a positive Homan's sign?

Pain in the calf upon dorsiflexion, indicating thrombophlebitis. Signup and view all the answers

What does emotional assessment include in postpartum care?

Assessment of emotional state for postpartum depression vs. postpartum blues, affect, and relationships. Signup and view all the answers

How can bonding be assessed postpartum?

By observing parental adaptation to the role and responses to the infant needs. Signup and view all the answers

What should be documented regarding bonding?

What you observe, such as the mother holding the baby close and interacting. Signup and view all the answers

What additional considerations might influence bonding assessment?

Past experiences, cultural mores, religious practices, and education level regarding parenting. Signup and view all the answers

Study Notes

Postpartum Assessment Overview

BUBBLE acronym stands for: Breast, Uterus, Bowel, Bladder, Lochia, Episiotomy.

Breast Assessment

Evaluate the four quadrants and tail of Spence for size, shape, and temperature.
Examine areola and nipples, ensuring no sores, cracks, and check for Montgomery's tubercles.
Determine if the mother is breastfeeding, impacting breast assessment and education regarding engorgement if bottle feeding.

Engorgement

Occurs when breasts are painfully overfull with milk, often when milk production exceeds the baby's intake.

Breastfeeding Evaluation

Assess maternal positioning, latching if breastfeeding, and feeding techniques and patterns.

Uterine Assessment

Check fundal height, midline position, and firmness; avoid bogginess which may indicate poor contraction.
Post-delivery pain assessed on a scale from 0 to 10; treat as ordered.
Normal descent of the uterus is approximately 1 cm per day postpartum.

Managing Uterine Concerns

A full bladder is a common reason the uterus may not be centered.
For a boggy uterus, massage to encourage contraction and stabilize before applying pressure.

C-Section Specifics

Examine Pfannenstiel incision, type of closure, and dressing conditions.
Assess fundal height based on incisional pain and overall vitals and bleeding.

Lochia Assessment

Monitor vaginal bleeding categorized as Rubra, Serosa, or Alba based on color, amount, and odor; nothing should remain in the vagina until Alba stops.

Bowel and Bladder Assessment

Check bowel sounds in all quadrants and adjust dietary plans accordingly.
Bladder assessment includes position, quality, input and output, foley size and patency, and reasons for straight catheterization.

First Void

The initial void after childbirth should be done with assistance; normal volume is 150-200 ml.

Fluid Loss Postpartum

High urine output and diuresis are normal, often due to edema and IV fluids administered during labor and delivery.

Episiotomy Assessment

Assess episiotomies for location, suture approximation, and signs of infection or hematomas.
For those without episiotomies, assess for lacerations and pain management strategies.

Comfort Measures

Sits baths promote circulation and healing through warmth.
Tucks pads, soaked in witch hazel, help with healing and provide astringent properties.

HEB Assessment

Homan's Sign checks for thrombophlebitis through leg extension and dorsiflexion of the foot; pain indicates a positive sign.
Emotional assessment focuses on postpartum depression (PPD) symptoms and relational dynamics.
Bonding assessment observes interaction style, infant attachment, and adaptation to new parenting roles.

Charting and Documentation

Document observable behaviors for bonding clearly, avoiding evaluative statements; e.g., "mom holds baby close" instead of "mom bonding well."
Consider cultural, religious, and educational backgrounds during bonding assessments.

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Description

Test your knowledge on the postpartum assessment using the BUBBLE HEB framework. This quiz covers key areas including breast, uterus, bowel, bladder, lochia, and episiotomy. Perfect for OB nursing students and professionals!

OB Postpartum Assessment - BUBBLE HEB