So, ready for the nutshell.
Here we go.
The postpartum assessment.
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.
BUBBLE-DEB is our
pneumonic for remembering
the elements of the
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.
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.
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.
The bladder should
And the client should really
void about every 2 hours
to make sure that the
bladder stays empty.
Bowel sounds may be diminished for
clients who have a cesarean birth,
but it should return to pretty
much normal by 2-3 days.
The lochia should be no more
than about a moderate amount,
and the clot should be fairly small,
definitely smaller than a golf ball.
If the uterus is boggy,
or floppy and not firm,
The first intervention is
always to massage the uterus.
So give it a good massage,
and hopefully it'll firm back up.
The lochia goes from
rubra to serosa to alba.
And hopefully by day
28, there's no more.
Patients who have
So if they've had issues
with varicose veins before,
they're going to be at
increased risk for DVT.
Also, clients who might have been pushing
for a long time or had a cesarean birth
are definitely going to
be at increased risk.
So we want to make sure
that we check for that.
The nurse really should spend
some time with the client
to make sure that they're not
exhibiting signs of depression.
And we should observe how the
client is interacting with the baby.
Taking in, taking
hold, letting go
describes the progression
of normal role attainment.
Postpartum teaching should happen really
the minute the client hits the door,
even before the baby is delivered,
and it should be ongoing throughout.
It's a lot of information to get the
last 15 minutes before you leave.
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.
The Edinburgh depression
scale can be administered
to set a baseline for monitoring
for postpartum depression,
or any other kind of depression.
And partners and family members really
should be included in the teaching.
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.
You did it.
And now you know how to
assess a postpartum client.