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Home of the Registered Nurses (RN) and
Licensed Practical Nurses (LPN)

BUBBLE LE (POST-PARTUM ASSESSMENT AND PATIENT EDUCATION)

 1. Breast:

Assess for signs of engorgement, including fullness usually at postpartum days 3 and 4.

Assess hot, red, painful, and edematous areas, which could indicate mastitis.

Assess nipple condition and latch-on technique of women who are breastfeeding.

Breastfeeding women should wear a comfortable, well-fitted support bra. Instruct them to gently rub colostrum or breast milk into their nipples and allow the nipples to air dry after each feeding to “condition” the nipples. Mothers can prevent drying by avoiding soap when washing the nipples.

Controlling nipple pain- applying warm-water compresses, breast milk, or teabags.

Instruct bottle-feeding patients to wear a well-fitting support bra and to avoid any type of nipple stimulation until lactation is discontinued.

 2. Uterus:

Assess the fundus:

By approximately one hour post delivery, the fundus is firm and at the level of the umbilicus.

The fundus continues to descend into the pelvis at the rate of approximately 1 cm or 1 finger-breadth per day and should be nonpalpable by 10 days postpartum.

In addition, assess patients for uterine cramping and treat for pain as needed.

Patients or a family member can be taught to assess the firmness of the fundus and to provide massage in the event of a boggy uterus or excessive bleeding. Encourage patients to void before palpation of the uterine fundus because a full bladder displaces the uterus and can lead to excessive bleeding.

 3. Bowel:

Assessment of the bowel is important in all postpartum patients. It is especially vital for patients following C-sections.

Assess for the following: Bowel sounds, Return of bowel function, Flatus, Color and consistency of stool

Administer prescribed stool softeners or laxatives as needed to treat constipation and ease perineal discomfort during defecation.

Encourage patients to ambulate soon after delivery. Teach the need to eat fruits, vegetables, and other high-fiber foods daily.

Postpartum patients should consume at least 2,000 mL/day of fluid.

 4. Bladder:

Assess urination and bladder function for the following: Return of urination, which should occur within 6 to 8 hours of delivery

Patients should void a minimum of 150 mL per void “to be well-emptied 200mL”; less than 150 mL per void could indicate urinary retention due to decreased bladder tone post delivery.

Assess for signs and symptoms of a urinary tract infection (UTI)

The bladder should be nonpalpable above the symphysis pubis.

Encourage patients to drink adequate fluid each day and to report signs and symptoms of a urinary tract infection.

 5. Lochia:

Assess lochia during the postpartum period:

Saturating one pad in less than an hour, a constant trickle of lochia, or the presence of large (i.e., golf-ball sized) blood clots is indicative of more serious complications (e.g., retained placenta fragments, hemorrhage) and should be investigated immediately. A significant amount of lochia despite a firm fundus may indicate a laceration in the birth canal, which should be addressed immediately.

Foul-smelling lochia typically indicates an infection and needs to be addressed as soon as possible.

Lochia should progress from rubra to serosa to alba. Any changes in this progression could be considered abnormal and should be reported. Lochia rubra is present on days 1–3, lochia serosa on days 4–10, and lochia alba on days 11–21.

It is important to note that patients who had a C-section will typically have less lochia than patients who delivered vaginally; however, some lochia should be present.

After discharge, patients should report any abnormal progressions of lochia, excessive bleeding, foul-smelling lochia, or large blood clots to their physician immediately. Instruct patients to avoid sexual activity until lochial flow has ceased.

 6. Episiotomy/Perineum:

Assess an episiotomy or laceration of the perineum. REEDA stands for:

Redness Edema Ecchymosis Discharge Approximation

The use of ice packs during the immediate postpartum period is generally indicated.

Assess the rectal area for hemorrhoids

Various actions can aid in perineal healing.  Perineal care after each voiding, analgesics as prescribed. To avoid infection, teach patients to pat from front to back and to use a peri-bottle for gentle cleansing of the perineum after a bowel movement or urination. Instruct patients to avoid tampons and sexual activity until the perineum has healed.

Performing Kegel exercises are an important component of strengthening the perineal muscles after delivery and may be begun as soon as it is comfortable to do so.

Other recommendations: Cold sitz bath during the first 24h, Lukewarm sitz bath after the first 24h, Keep the buttocks tightened when patient sit down.

 7. Lower Extremities:

Assess for deep vein thrombosis (DVT), the lower extremities should be examined for the presence of hot, red, painful, and/or edematous areas. “NEUROVASCULAR SIGNS”

To improve circulation and prevent the development of thrombi:

Encourage patients to ambulate shortly after delivery.

Also teach them to avoid crossing the legs for long periods of time.

Keep the legs elevated while sitting.

Encourage to wear TED hose.

 8. Emotions:

Postpartum patients typically exhibit symptoms of the “baby blues” or “postpartum blues,” demonstrated by tearfulness, irritability, and sometimes insomnia. Possible causes:  hormonal fluctuations, physical exhaustion, and maternal role adjustment.

If symptoms last longer than a few weeks or if the postpartum patient becomes nonfunctional or expresses a desire to harm herself or her infant: Patient should report this to her certified nurse-midwife or physician immediately. Appropriate interventions should be implemented to protect the mother and her infant; this behavior is indicative of postpartum depression.

Postpartum mothers and their families should be taught to understand that the baby blues are a normal part of the postpartum experience. Encourage patients to rest regularly and to allow family members to care for them as needed. Instruct patients to get plenty of fresh air and gentle exercise. Acquaint patients with groups for new mothers that provide the support of others experiencing postpartum blues. Finally, teach postpartum mothers and their families about the signs and symptoms of postpartum depression.