skills lab APGAR too

Bubblesh

Breasts

uterus

bladder

bowels

lochia

episiotomy/perineum

swollen homans (homans sign)

head emotional status

Breasts

• What you do: Inspect and palpate. Ask about pain with feeding. Check nipples and skin.

• Expected: Breasts soft first 2 days, then filling/firm as milk comes in. Nipples intact, not cracked. Colostrum or milk may be present.

• Abnormal: Engorgement, redness, warmth (mastitis), cracked/bleeding nipples, inverted nipples that make feeding hard.

Uterus

• What you do: Palpate fundus with one hand supporting lower segment, the other pressing down just above umbilicus. Note height and firmness.

• Expected: Firm, midline, at or slightly below umbilicus immediately after birth; descends ~1 cm per day. Should not be boggy.

• Abnormal: “Boggy” (soft) fundus → uterine atony (risk for hemorrhage). Deviated to the side (often due to full bladder). Fundus higher than expected = retained tissue or poor contraction.

Bladder

• What you do: Ask about voiding; palpate for distension if needed. Look for output if Foley in place.

• Expected: Able to void spontaneously within hours after birth. Bladder should not be palpable after void.

• Abnormal: Difficulty voiding (due to swelling/trauma), overdistension, residual urine, frequent small voids. A full bladder can displace uterus → increased bleeding.

bowels

Lochia

• What you do: Inspect peripad and bed linen. Ask about flow, clots, odor. Estimate amount (scant, light, moderate, heavy). ask if she has changed her period pad

• Expected:

  • Rubra (dark red, 1–3 days)

  • Serosa (pink/brown, 4–10 days)

  • Alba (yellow/white, up to 6 weeks)

  • Should be no foul odor. Small clots are normal.

• Abnormal: Saturating >1 pad/hour, foul odor (infection), large clots, return to bright red bleeding after it had lightened.

Episiotomy/ perineum (or incision if c-section)

• What you do: Inspect perineum/incision using REEDA scale (Redness, Edema, Ecchymosis, Discharge, Approximation). Ask about pain.

• Expected: Some swelling and tenderness normal. Incision well-approximated, no discharge. Hemorrhoids may be present but not severe.

• Abnormal: Severe pain, hematoma (bulging, blue, very tender), infection (redness, pus, separation), uncontrolled bleeding.

swelling/extremitires (used to be homans sign)

• What you do: Inspect and palpate legs for swelling, warmth, redness, tenderness. Check pedal pulses.

• Expected: Mild edema common, especially in lower extremities. Pulses palpable, no pain or redness.

• Abnormal: Unilateral swelling, warmth, redness, pain → possible DVT. Severe edema may suggest preeclampsia if BP elevated.

Heart.head (emotional status and bonding)

• What you do: Observe interaction with baby, ask about feelings, screen for mood.

• Expected: “Baby blues” (tearfulness, mood swings) are common but mild and resolve within 1–2 weeks. Positive bonding (eye contact, holding, responding to baby’s needs).

• Abnormal: Flat affect, disinterest in baby, persistent sadness, signs of postpartum depression or psychosis (delusions, thoughts of harm). Needs urgent attention.

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radial pulse

Radial, apical pulse

• Pulse scale

  • 1+=weak

  • 2+=normal

  • 3+=bounding

• Is it regular or irregular

Radial

• On radial side of arm. Count for 30 seconds. Thumb side

apical pulse

apical 

• It is the 5th intercostal space mid clavicularly

• Find sternal notch (middle of neck)

• Go donw till felt boney prominence

• Go to second intercostal space midclavicularly

• Go down from there until 5th place

if persons breasts are larg you hvae to get them to lift up

you need stethescope 

catheter placement

this is a straight catheter meant to be removed after bladder is drained

• They are a risk for infections

• Perform hand hygiene imeeditaley before adn after insertion

• Insert using sterile technique

• Wash hands and don clean gloves

• Explain procedure

• Positioning

  • Women: Frog leg position

  • Men: supine legs extended

• Use packet of wipes to cleanse periurethal area

• Remove gloves and apply hand sanitixzer

• Open csr wrap using aseptic technique

• Then don sterile gloves

• Place underpad beneath patient shiny side down

• Position drape over patient (hole should be open to genitalia)

• Then saturate three foam swabsticks in povidone iodine

• Lubricate catheter

• Use non dominant hand to grab genitalia (you should not move this hand and cannot touch anything sterile with it now)

• Use swab only once

• Women

  • Wipe downwards towards perineum with one swab stick

  • Repeat for left and right side then down the center

• For male patients

  • Start at the urethra working outwards circularly

• Insert catheter

  • Encourage to relax pelvic muscles like when urinating

  • Not not ask to push

  • take a slow deep breath in and out

  • Advance catheter on breath out

• When catheter tip has entered bladder urine will be visible

• Document according to hospital

• remove on breath out

how do you know when baldder is empty

stream flows, slows, drips, then stops

if stopped sooner than expected gently advance catheter may be pressed against bladder wall

APGAR and scoring

appearance

pulse

grimace

activity

respiration

• 0–3 → Severe distress, immediate resuscitation needed

• 4–6 → Moderate difficulty, may need help

• 7–10 → Generally healthy, normal adaptation

appearance 

Body pink, extremities may be slightly blue initially

0=blue/pale

1= body pink, extremities blue

2= completel

Pulse

Palpate brachial/femoral pulse or auscultate0=absent

1=<100 bpm

2= > or equal to 100 bpm

Grimace

reflec irratibiliyt (response to stimulants)

Stimulate via mild pinch or suction

0 = no response

1 = grimace/ facial movement

2 = cry or active withdrawal (normal)

Activity

muscle tone

Observe posture and movement

0=limp

1 = some flexion

2 = active motion

respirations

breathing effort

Respiration

Observe chest rise or listen

0 = absent

1 = slow/irregular

2 = good, crying