Podcast
Questions and Answers
What is the primary purpose of abdominal examination during the post-natal period?
What is the primary purpose of abdominal examination during the post-natal period?
How does the fundal height change during the first postpartum week?
How does the fundal height change during the first postpartum week?
What type of lochia is characterized by red discharge due to high amounts of blood?
What type of lochia is characterized by red discharge due to high amounts of blood?
What is the correct documentation for a fundus that is firm with light massage, positioned two fingerbreadths above the umbilicus?
What is the correct documentation for a fundus that is firm with light massage, positioned two fingerbreadths above the umbilicus?
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What should be done if the uterus is found to be boggy during the post-natal assessment?
What should be done if the uterus is found to be boggy during the post-natal assessment?
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What characterizes lochia serosa?
What characterizes lochia serosa?
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Which assessment indicates a moderate amount of lochia?
Which assessment indicates a moderate amount of lochia?
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Why is it important for a mother to empty her bladder before assessing involution?
Why is it important for a mother to empty her bladder before assessing involution?
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What indicates a heavy amount of lochia during assessment?
What indicates a heavy amount of lochia during assessment?
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Which nursing action aids in accurately locating the fundus during palpation?
Which nursing action aids in accurately locating the fundus during palpation?
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Study Notes
Abdominal Examination (Postnatal Period)
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Postpartum assessments are crucial, using the BUBBLE-HE framework (Breasts, Uterus, Bladder, Bowels, Lochia, episiotomy/incissions, Legs homans' sign, Emotions, Bonding).
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Breasts: Assess nipples (everted, flat, inverted), breast tissue (soft, firm, etc.), temperature, and color.
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Uterus: Note location (midline or deviated), tone (firm or boggy), and the last time the bladder was emptied. Document color, odor, and amount of urine. Assess for clots/free flow.
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Bladder: Document the last time the patient emptied their bladder (spontaneously or via catheter). Assess if palpable or nonpalpable.
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Bowels: Note the date/time of last bowel movement (BM), presence of flatus, and hunger.
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Lochia: Assess color, amount, and presence of clots. Document type (e.g., lochia rubra, serosa, alba).
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Incisions/Episiotomies: Examine for pain, varicosities, warmth, discoloration, pedal pulses, sensation, and movement.
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Legs (Homans' sign): Check for calf pain during dorsiflexion of the foot.
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Emotions & Bonding: Observe patient-family interaction, effects of exhaustion, interaction with infant, etc., and note unique characteristics of the situation (e.g., "taking in" phase).
Postnatal Abdominal Examination Definition
- Abdominal palpation during the immediate postpartum period helps assess uterine involution, prevents complications from a relaxed fundus, and checks for discharge after delivery.
Objectives of Postnatal Fundal Assessment
- Evaluate involution (the returning of the uterus to its pre-pregnancy size).
- Prevent the uterus from becoming boggy and soft.
- Determine the uterus's position and consistency.
- Prevent hemorrhage and shock.
Descent of the Fundus
- The uterus should be firm, well-contracted, and in the midline.
- Immediately after delivery, the fundus should be at or below the level of the umbilicus.
- The fundal level descends gradually at a rate of about 1 fingerbreadth daily.
- By the end of the first week, it's midway between the umbilicus and symphysis pubis.
- By the second week, it's behind the symphysis pubis.
- Thereafter, it becomes a pelvic organ.
Postpartum Uterine Massage
- Keep the non-dominant hand above the symphysis pubis and use the dominant hand to massage the fundus until it's firm.
Lochia
- Lochia is the uterine discharge after childbirth.
- It's usually alkaline, fleshy-smelling, and more copious than menstrual flow.
- It contains blood, fibrin, leucocytes, decidual tissue, vaginal cells, peptone, cholesterol, and numerous non-pathogenic bacteria
Types of Lochia
- Lochia Rubra: Reddish discharge, containing blood, shreds of decidua, and other products. It lasts approximately the first 3-7 days post-delivery.
- Lochia Serosa: Pink-yellow discharge, with less blood and more serum. It lasts approximately 7-14 days post-delivery.
- Lochia Alba: Creamy or white discharge, containing leukocytes and mucus. It's the final stage, lasting approximately 10-14 days post-delivery.
Lochia Assessment Tips (amount)
- Scant/light: 1-2 inch stain
- Moderate: approximately 2-4 inch stain
- Heavy: More than 4-inch stain or saturated pad in 1 hour
Postpartum Assessment Techniques
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Explain the procedure to reduce anxiety.
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Ensure privacy and ask the patient to empty their bladder if necessary.
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Gloves are necessary.
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Position the patient in a supine position with knees slightly flexed.
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Palpate the fundus using the flat part of the fingers of one hand, keeping the other hand above the symphysis pubis.
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Document fundus consistency and location (e.g., firm, 2 fingerbreadths above umbilicus).
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Record findings accurately in the patient's chart.
Perineal Care
- Ice packs (first 24 hours)
- Warm sitz baths
- Topical agents (e.g., Epifoam)
- Gentle wiping from front to back
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Description
This quiz focuses on the essential components of postpartum abdominal assessments using the BUBBLE-HE framework. Participants will evaluate aspects such as breasts, uterus, bladder, and lochia to ensure comprehensive postnatal care. It is vital for healthcare providers to accurately perform these assessments for better maternal health outcomes.
