Exam 2: pedi/ob: postpartum

What does BUBBLE-LEB stand for?

Breasts, Uterus, Bladder, Bowel, Lochia, Episiotomy/laceration/incision, Lower extremities, Emotions, Bonding

How do you assess the breasts postpartum?

Check if bottle or breast feeding, firmness, fullness, tenderness, nipple cracks or bleeding, meds taken, lactation history

What are the phases of milk production?

Colostrum, Engorgement, Mature milk

What is colostrum?

"Liquid gold," thick, clear, contains antibodies

When does engorgement occur and what are the symptoms?

Milk comes in 2-4 days, lasts ~48 hrs, breasts full/tender, may cause fever

What is mature milk like?

White, full of fat

How do you care for breasts if bottle feeding?

Compression/ice, avoid nipple stimulation, cabbage leaves, analgesics

How do you care for breasts if breastfeeding?

Supportive bra, frequent feedings, warmth, treat sore nipples, hydration

How do you assess the uterus postpartum?

Check fundus for firm/boggy, midline/deviated, position relative to umbilicus

What is uterine nursing care?

Massage boggy uterus, support uterine segment, analgesics, ambulation, pillow/warmth, oxytocin

How do you assess the bowel postpartum?

Check bowel sounds, flatus, last bowel movement (2-3 days post-delivery)

How do you care for the bowel postpartum?

Encourage food/fluids, manage constipation (perineal trauma, meds, diet), prevent hemorrhoids

How do you assess lochia?

Amount, type, odor, clots, pad change frequency

What are the types of lochia and their timing?

Rubra (1-3 days, red), Serosa (4-10 days, pink/pink-brown), Alba (11-21 days, white/cream)

What are abnormal lochia findings?

Egg-sized clots, pad saturated <1 hr, vaginal loss >500 mL, c-section >1000 mL, odor, infection

How do you educate patients about lochia?

Increases with activity, pooling normal

How do you assess the perineum?

Determine type and degree of episiotomy, laceration, or incision; use REEDA

What is REEDA?

Redness, Edema, Ecchymosis, Discharge, Approximation

What are the laceration degrees?

1=skin, 2=skin+muscle, 3=skin+muscle+anal sphincter, 4=extends to rectal mucosa

What is nursing care for the perineum?

Ice packs, sitz bath, pericare, analgesics, infection prevention, ambulation, topical meds

What is a low transverse C-section incision?

Preferred abdominal incision

What is a vertical C-section incision?

Not preferred for VBAC

Postpartum Complications

What defines postpartum hemorrhage (PPH) vaginally and after C-section?

Vaginal >500 mL, C-section >1000 mL

When does PPH most often occur?

Within 1 hour after birth, but can occur up to 12 weeks

What are risk factors for PPH?

Overdistended uterus (twins, macrosomia, polyhydramnios), prolonged labor, c-section, history of PPH, medications, placenta abruption/previa

What is the nursing care for PPH?

Fundal massage, IV fluids, blood products, pad counts, monitor vitals & I&O, Bakri balloon

What medications are used for PPH?

Pitocin/oxytocin (contract uterus), Methergine (vasoconstrictor if BP <140/90), Cytotec, Hemabate (avoid with asthma)

What are the 4 Ts of PPH causes?

Tone (weak uterus), Trauma (lacerations/hematomas), Tissue (placental fragments), Thrombin (clotting issues/DIC)

How do you assess lower extremities postpartum?

Redness, pain, warmth, tenderness, pedal edema

What is normal pedal edema postpartum?

Lasts a few days, clotting factors increase for 2 weeks

What is lower extremity nursing care postpartum?

SCDs, TED hose, assist ambulation, elevate legs, hydration

What are postpartum mood disorders?

Postpartum Blues, Postpartum Depression, Postpartum Psychosis

What are the signs of postpartum blues?

Onset 1-2 days, lasts 1-2 weeks, mood swings, tearfulness, irritability, able to care for baby, treated with support/rest

What are the signs of postpartum depression?

Onset 2-12 weeks, >2 weeks duration, persistent sadness, guilt, low interest, difficulty bonding, impaired functioning, treated with therapy/support/meds

What are the signs of postpartum psychosis?

Onset 2 days-2 weeks, rapid/severe mood changes, hallucinations, confusion, severely impaired functioning, risk to self/baby, treated with emergency hospitalization

What are postpartum infections?

Mastitis and Endometritis

What are the signs of mastitis?

Painful breast lump, redness, warmth, fever, malaise

How is mastitis managed?

Antibiotics, empty breast, rest, analgesics

What are the signs of endometritis?

Fever, foul lochia, malaise, abdominal cramping/tenderness

How is endometritis managed?

Antibiotics, high Fowler's to aid drainage

What vaccines are given postpartum?

Rubella (MMR), TDAP, Rhogam if indicated

Maternal Adaptation & Bonding

What is the Taking In phase?

Focus on own needs, dependent, lasts 1-2 days, asks for help

What is the Taking Hold phase?

Becomes independent, focuses on baby, praise parents, provide teaching

What is the Letting Go phase?

Relinquish previous roles/dreams, adjust to disappointment, focus shifts to others

What factors affect bonding?

Pain, fatigue, knowledge, age, temperament, support system, delivery type

How do fathers adapt postpartum?

Assess interaction, engrossment (interest in infant), often play-focused, balance work and mom's emotions

How do siblings adapt postpartum?

Regression may occur, involve in care/planning, gifts help adjustment

How do grandparents adapt postpartum?

Involvement depends on proximity and culture, often eager and supportive