Editing Maternal and Newborn Nursing – LPN Flashcards (section)

== Postpartum Care ==

;BUBBLE-HE
:'''B'''reasts, '''U'''terus, '''B'''ladder, '''B'''owel, '''L'''ochia, '''E'''pisiotomy or perineum, '''H'''oman sign or leg check, '''E'''motional status. This is the routine head-to-toe framework for every postpartum check.

;Where the fundus should be and how it changes
:Firm, midline, and at or near the level of the umbilicus within a few hours after birth, then dropping about one fingerbreadth per day. It is usually no longer felt by about 10 to 14 days. Clients who had a cesarean birth still get fundal checks.

;What a '''boggy''' fundus means and the first action
:The uterus is soft and not contracting, which allows bleeding. '''Massage the fundus first''', support the lower uterus with the other hand, then reassess and report to the registered nurse if it does not firm up or bleeding continues.

;What a fundus that is high and pushed to the right means
:A '''full bladder'''. Help the client empty her bladder, then recheck the fundus. A full bladder keeps the uterus from contracting and causes extra bleeding.

;The three stages of lochia
:'''Rubra''': dark red, days 1 to 3. '''Serosa''': pinkish-brown, days 4 to 10. '''Alba''': creamy white or yellow, day 11 through about 4 to 6 weeks. The flow should get lighter over time, never heavier.

;Lochia findings that must be reported
:Soaking a perineal pad in 1 hour or less, a foul odor, large clots, or bright red bleeding that returns after the flow had already lightened. '''Always look underneath the client''', because blood collects under the buttocks.

;Why postpartum bradycardia is normal but tachycardia is not
:A pulse of 50 to 70 beats per minute is expected in the first days as the extra blood volume of pregnancy is handled by the heart. '''A fast pulse is the warning sign''' for bleeding, infection, pain, or anxiety, and it is reported.

;The postpartum fever rule
:A temperature up to 100.4 degrees F (38 degrees C) in the '''first 24 hours''' can come from dehydration and hard work. '''100.4 degrees F or higher after the first 24 hours is reported''', because it suggests infection.

;Normal postpartum changes that do '''not''' need reporting
:Heavy sweating and large urine output in the first days, chills and shaking right after birth in a client with no fever, afterpains that are stronger during breastfeeding and in clients who have had more than one baby, and fatigue.

;Perineal care after a vaginal birth
:'''Ice packs for the first 24 hours''' to reduce swelling, then sitz baths and warmth afterward. Use a peri-bottle with warm water, pat rather than rub, and always cleanse and wipe '''front to back'''. Change the pad at each voiding and wash hands before and after.

;REEDA
:'''R'''edness, '''E'''dema, '''E'''cchymosis (bruising), '''D'''ischarge, '''A'''pproximation of the wound edges. Used to check an episiotomy or laceration repair.

;A postpartum client with severe, unrelieved perineal or rectal pain
:Suspect a '''hematoma''', which is a collection of blood in the tissue that can hide a large blood loss. Report it to the registered nurse right away; do not simply give more pain medication and move on.

;Signs of mastitis and what happens to feeding
:Usually one breast with a red, warm, tender, wedge-shaped area, plus fever and flu-like aching. It is treated with antibiotics, rest, and fluids, and '''the mother keeps breastfeeding or pumping''' on that side, because emptying the breast is part of the treatment.

;Postpartum blues versus something that needs urgent help
:'''Blues''' are common tearfulness and mood swings that start within days and go away by about 2 weeks. '''Report''' sadness or hopelessness lasting longer than 2 weeks, inability to care for herself or the baby, or any statement about harming herself or the baby. '''Hallucinations or strange beliefs about the baby are an emergency''', and the infant must not be left alone with her.

;Postpartum warning signs to teach before discharge
:Fever, foul-smelling discharge, soaking a pad in an hour, severe headache or vision changes, chest pain or trouble breathing, pain, swelling, warmth, or redness in one calf, and thoughts of harming self or baby. Remind her that '''high blood pressure problems can start after going home'''.