Getting Ready for OB Clinicals: Postpartum Physical Assessment

Remember….. when assessing a maternity patient, you complete a regular head-to-toe assessment (cardiac, resp, GI, etc) but then make it maternity-focused. That means you add the elements covered under BUBBLE-HE…..

BUBBLE-HE Breasts/nipples Uterus Bladder Bowels Lochia Episiotomy -Homan’s Sign -Emotional/bonding

BUBBLE-HE B: Breasts and Nipples Bottle-feeding or nursing? If bottle-feeding, have patient wear a supportive bra 24/7 to prevent milk from coming in (engorgement) Assess breasts Soft, engorged, filling, tender/non-tender, any tissue breakdown, blood blisters

BUBBLE-HE U: Uterus 1) Tone: firm or boggy (squishy/spongy)? 2) Location: i) Is the fundus midline or does it deviate to the right or left (due to a full bladder)? ii) Where is the fundus in relation to the umbilicus? -ff @u (fundus firm @ the umbilicus) -ff u/2 (fundus firm 2cm below umbilicus) -ff 1/u (fundus firm 1cm above umbilicus)

Uterine Involution (Returning to Pre-pregnancy State)

Fundal Massage

Fundal Assessment

Remember…. When assessing the fundus: Ensure pt.’s bladder is empty Ensure the bed is lowered Ensure the head of the bed is flat Ensure the patient is lying supine on the bed with her knees bent The lower uterus must be stabilized with one hand before the fundus can be assessed correctly with the other Always look at the amount of lochia expressed with fundal massage Wear gloves

BUBBLE-HE B: Bladder Able to void spontaneously within 6-8 hours of vaginal birth? Epidurals commonly cause urinary retention Assess for frequency, burning or urgency (UTI?) Bladder distention A full bladder displaces the uterus, prevents involution (contraction of the uterus) and puts the patient at great risk for hemorrhage May require catheterization

BUBBLE-HE B: Bowels Active bowel sounds in all four quadrants Bowel movement Flatus (in C-Section patients) Assess C-section incision site: REEDA Redness Edema or swelling Ecchymosis or bruising Drainage Approximation of wound edges

BUBBLE-HE L: Lochia Color (lochia rubra, serosa, alba) Rubra is dark red, sanginous Serosa is pink, sero-sanginous Alba is a creamy, yellowish discharge Amount (scant, light, moderate, heavy) Odor: infection? C/section patients usually have less lochia. This is normal C-section fundal assessments are gentle. Otherwise very painful for the patient!

Assessing Lochia Amount

BUBBLE-HE E: Episiotomy Assess entire perineum (area from the opening of vagina to the rectum) Perineum may be intact, lacerated or required an episiotomy Assess the episiotomy using: REEDA Redness Edema or swelling Ecchymosis or bruising Drainage Approximation (of laceration/episiotomy)

Assessing the Perineum

Proper Technique for Assessing the Perineum Wear gloves Have patient lie on her side; have her turn away from you Have her lift her top leg This will provide an unobstructed view of the entire perineum (vagina to rectum) Be sure to assess for hemorrhoids also Commonly develop as a result of pushing in L&D

BUBBLE-HE H: Homan’s Sign Dorsiflex the foot Assess for sharp, knife-like pain in the calf area If present, also assess pedal pulses, diameter, edema, warmth, redness and inflammation Advise patient not to get out of bed; report to attending physician. Anticipate orders (ultrasound/MRI/CT/venography)

BUBBLE-HE E: Emotional Determine emotional status Normal “baby blues” Bonding Interacting appropriately with baby? Providing infant care? Evidence of postpartum blues or depression? Report to MD and anticipate a referral to social work/psych

Assessment Videos Visit the Canvas course (OB section) to locate the link to Youtube videos demonstrating newborn and maternity patient head-to-toe physical assessments