Physiological and Psychological Changes and Assessments: In a Nutshell (Nursing)

by Jacquelyn McMillian-Bohler, PhD, CNM

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    00:01 So, ready for the nutshell.

    00:04 Here we go.

    00:05 The postpartum assessment.

    00:06 The initial assessment that we do should be completed q 15 min x 4; q 30 min x 2, q 4 hours for the first 24 hours and q 8 until they go home.

    00:20 BUBBLE-DEB is our pneumonic for remembering the elements of the postpartum assessment.

    00:26 Breast, that first B should be checked, and make sure that the breasts are filling because we want the milk to come in if the client is breastfeeding, but not engorged.

    00:35 If the client is choosing not to breastfeed, then we want to make sure they have a supportive bra and take a shower with their back to the shower and not the front.

    00:45 The uterus should be going down about a finger width every day, and it should be in the midline, that's important to make sure that we don't have hemorrhage, we don't have infection.

    00:56 The bladder should be nonpalpable.

    00:58 And the client should really void about every 2 hours to make sure that the bladder stays empty.

    01:04 Bowel sounds may be diminished for clients who have a cesarean birth, but it should return to pretty much normal by 2-3 days.

    01:13 The lochia should be no more than about a moderate amount, and the clot should be fairly small, definitely smaller than a golf ball.

    01:21 If the uterus is boggy, or floppy and not firm, The first intervention is always to massage the uterus.

    01:27 So give it a good massage, and hopefully it'll firm back up.

    01:30 The lochia goes from rubra to serosa to alba.

    01:36 And hopefully by day 28, there's no more.

    01:40 Patients who have had varicosities.

    01:42 So if they've had issues with varicose veins before, they're going to be at increased risk for DVT.

    01:48 Also, clients who might have been pushing for a long time or had a cesarean birth are definitely going to be at increased risk.

    01:55 So we want to make sure that we check for that.

    01:58 The nurse really should spend some time with the client to make sure that they're not exhibiting signs of depression.

    02:03 And we should observe how the client is interacting with the baby.

    02:08 Taking in, taking hold, letting go describes the progression of normal role attainment.

    02:16 Postpartum teaching should happen really the minute the client hits the door, even before the baby is delivered, and it should be ongoing throughout.

    02:24 It's a lot of information to get the last 15 minutes before you leave.

    02:28 You want to include care of the client and the infant during the postpartum teaching, and signs of complications like fever and pain, heavy bleeding, depressed mood or pain during urination dysuria need to be discussed.

    02:46 The Edinburgh depression scale can be administered to set a baseline for monitoring for postpartum depression, or any other kind of depression.

    02:56 And partners and family members really should be included in the teaching.

    03:00 Because sometimes when you're a new parent, hearing all that information, it's a lot and the more people that hear it, the better it is in terms of trying to remember it all.

    03:10 You did it.

    03:11 We're done.

    03:12 And now you know how to assess a postpartum client.

    About the Lecture

    The lecture Physiological and Psychological Changes and Assessments: In a Nutshell (Nursing) by Jacquelyn McMillian-Bohler, PhD, CNM is from the course Physiological and Psychological Changes and Assessments (Nursing).

    Included Quiz Questions

    1. Uterus moving upward from the umbilicus
    2. Unilateral leg swelling
    3. Engorged breasts
    4. Clots smaller than golf balls
    5. Unpalpable bladder
    1. Postpartum teaching should be ongoing.
    2. Using the Edinburgh scale gives a baseline for postpartum depression.
    3. Include care of the client and care of the infant in discharge teaching.
    4. Teach that a fever is expected and will go away on its own.
    5. Don't include the partner or family in discharge teaching.

    Author of lecture Physiological and Psychological Changes and Assessments: In a Nutshell (Nursing)

     Jacquelyn McMillian-Bohler, PhD, CNM

    Jacquelyn McMillian-Bohler, PhD, CNM

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