Editing Maternal and Newborn Nursing – RN Flashcards (section)

== Postpartum ==

;BUBBLE-HE
:'''B'''reasts, '''U'''terus, '''B'''ladder, '''B'''owel, '''L'''ochia, '''E'''pisiotomy or perineum, '''H'''oman sign or lower extremity and VTE assessment, '''E'''motional status. Homan sign is unreliable and is no longer recommended diagnostically, though it persists in older material.

;Expected fundal involution
:Firm, midline, at or near the umbilicus within a few hours of birth, then descending about 1 cm (1 fingerbreadth) per day, becoming nonpalpable by roughly 10 to 14 days. Cesarean clients still require fundal assessment.

;Boggy fundus versus firm fundus with heavy bleeding
:'''Boggy''' means atony: massage first, then have the client void or catheterize, then give uterotonics. '''Firm and midline with heavy bright red bleeding''' points to a genital tract laceration or hematoma and requires inspection and provider notification, not massage.

;Lochia stages and the abnormal findings
:'''Rubra''' dark red days 1 to 3, '''serosa''' pinkish-brown days 4 to 10, '''alba''' creamy white or yellow from day 11 to about 4 to 6 weeks. Abnormal: saturating a pad in 1 hour or less, foul odor, large clots, or a return to bright red after progression. Always check underneath the client, because blood pools under the buttocks.

;The four T's of postpartum hemorrhage
:'''T'''one (uterine atony, roughly 70 to 80 percent of cases), '''T'''rauma (lacerations, hematoma, inversion, rupture), '''T'''issue (retained placental fragments), '''T'''hrombin (coagulopathy including DIC). Late secondary hemorrhage after 24 hours is most often retained tissue or subinvolution.

;Uterotonic contraindications
:'''Methylergonovine''' is contraindicated in hypertension and preeclampsia (check blood pressure before each dose). '''Carboprost''' is contraindicated in asthma (causes bronchospasm; expect diarrhea, nausea, and fever). Oxytocin is first line; misoprostol causes fever and shivering; tranexamic acid is an adjunct given within 3 hours of birth.

;Why postpartum vital signs are read differently
:Bradycardia of 50 to 70 beats per minute is '''normal''' in the first days from increased stroke volume and mobilized blood volume. '''Tachycardia is the warning sign''' for hemorrhage, infection, pain, or anxiety. Falling blood pressure is a '''late''' sign of hypovolemia; narrowing pulse pressure, restlessness, and cool clammy skin come first.

;Postpartum fever thresholds
:Up to 100.4 degrees F (38 degrees C) in the first 24 hours may reflect dehydration and exertion. '''100.4 degrees F or higher on two occasions after the first 24 hours''' suggests puerperal infection: endometritis, urinary tract infection, wound infection, or mastitis.

;Mastitis management
:Usually unilateral localized redness, warmth, tenderness, fever, and flu-like symptoms. Treat with antibiotics, analgesia, rest, fluids, and '''continued emptying of the breast''' by feeding or pumping. Stopping breastfeeding worsens stasis and can lead to abscess.

;Postpartum blues, depression, and psychosis
:'''Blues''': tearfulness and lability affecting most patients, beginning within days and resolving by about 2 weeks; supportive care. '''Depression''': persists beyond 2 weeks or begins later in the first year with impaired function; screen with a validated tool such as the Edinburgh Postnatal Depression Scale and refer for treatment. '''Psychosis''': hallucinations and delusions often centered on the infant, a '''psychiatric emergency''' with high risk of suicide and infanticide; the infant is never left alone with the parent.

;Two immunization-related discharge items
:'''Rubella-nonimmune''' clients receive MMR before discharge with teaching to avoid pregnancy for 28 days. '''Rh-negative''' clients with an Rh-positive newborn receive Rho(D) immune globulin within 72 hours.