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Define postpartum.

The 6 week period between the birth of the baby and the return of the reproductive organs to their prepregnant state.


What are the goals of care for the postpartum period

- prevent infection, and excessive bleeds
- maintain uterine tone
- promote comfort and rest, ambulation, nutrition, knowledge of breast care and integration of newborn to the family


What is done during intermediate postpartum assessment?

1-2 hours post-delivery (4% PPH – watch BP)
VS – every 15 minutes x 4
Hydration/nutrition- ensure hydration, no food right after section
Breastfeeding- within 30 min
BUBBLE – 6 point postpartum check
Breasts, uterus, bladder, bowel, lochia, perineum (episiotomy or laceration)
Problems during labour and delivery
Use of anesthesia


What does bubble assessment stand for?

BUBBLE – 6 point postpartum check
Breasts, uterus, bladder, bowel, lochia, perineum (episiotomy or laceration)


What is assessed in regards to breasts?

- day 1 colostrum, day 3-5 engorgement and care of


What is assessed in regards to uterus?

- Uterine tone, placement and fundus location
- Assess involution of the uterus


What is assessed in regards to bowel?

promote bowel movement (usually 2-3 days after birth)Assess for presence of hemorrhoids, pain, bleeding
Treatment: sitz baths (epson salts in water), positioning (recommend side laying), TUCKS (small pad that is saturated with an astringent such as witch hazel)


What is assessed in regards to bladder?

Assess for distention
Encourage regular emptying
Assess amount of urine on first void
Measure urine output for several voids (6-8 hrs post delivery)
Teach Kegel exercises


What is assessed in regards to lochia?

Lochia rubra – red, 2-3 days
Lochia serosa – pink – brown – 3-7 days
Lochia alba – white or yellow – day 10 to 2-6 weeks after birth
- Should have no foul odour
- monitor type and amount


What should teaching in regards to lochia include?

Teaching should include:
Once lochia changes to serosa – it should not be rubra again
Seek help if fever, pain, tenderness, foul-smelling vaginal discharge or difficulty urinating occurs


What is the acronym REEDA used to assess?

episiotomy or laceration
- Redness, edema, ecchymosis, drainage, approximation (2 edges of the incision are approximation)


What is assess for the episiotomy or laceration?

- Redness, edema, ecchymosis, drainage, approximation (2 edges of the incision are approximation)


What nursing intervention are done for episiotomy or laceration?

Ice pack to decrease swelling and pain (12-24 hours)
Prevent infection (proper wiping, squeeze bottle)
Promote healing (sitz baths, ice packs, side-lying, sitting on a pillow, analgesics)


WHy is there are risk of thrombophlebitis?

Decreased mobility, increased clotting factors, dehydration


How can you prevent thrombophlebitis?

Early ambulation, encouraging fluids, support hose with varicose veins


WHat does assessment for thrombophlebitis include?

Redness pain with walking in calf muscle, swelling, positive Homan’s sign (PAIN WITH DORSIFLEXION OF THE CALF)
If you suspect a DVT (deep vein thrombosis) – do not move patient – notify doctor - document


Why should someone assist the mother to the bathroom for the first time after birth?

risk of orthostatic hypotension


What is the assessment protocol for C/S?

Assessment protocol for post anesthetic/epidural/epimorph
VS, pain, LOC (level of consciousness), movement of legs, incision, IV (check IV site to make sure it is still in the vein not in interstitial space: medications), voiding, bowel sounds


What nursing interventions are done for C/S?

Abdominal incision – splinting, dressing, lifting
Pain management for incisional pain
Respiratory assessment and DB exercises
Special positioning for breastfeeding
Will need extra rest and help post C/S


What is considered for future pregnancies?

- Rh and rubella


What is the criteria for early discharge?

- Normal HgB – no fainting, dizzy spells
- Safe ambulation
- No foul odour to lochia with normal blood loss
- Firm fundus and appropriate placement of uterus
- At least one void with appropriate emptying of bladder
- Pain controlled by oral medication
- No signs of infection
- Plan for postpartum check up (2 wks for C/S, 6 wks for vag) and well baby visit (1-2wks)


Who promotes healthy baby initiative and that every newborn in the province receives screening?

Ontario Ministry of Health and Long-Term Care –


What are Rubin's 3 phases of adjustment?

Day 1-2
Focus on self, basic needs, excited and talkative
Day 2 – 10 days or several weeks
Focus on care of baby and competent mothering
Desire to take charge, eager to learn, possible blues
Focus forward movement of family as unit with interacting members
Reassertion of relationship with partner