NUR 254 EXAM 2 STUDY GUIDE| COMPLETE GUIDE |
LATEST 2026
● Normal postpartum Vitals
○ HR: slightly altered, should return to non pregnant values within a few days
○ BP: slightly altered
○ RR: should return to normal within 6-8 weeks Postpartum
○ Temp: 100.4 for the 1st 24 hours, should return to normal after if not this can
indicate INFECTION
○ Rapid changes in pulse can indicate hypovolemia
○ Shivering initially after is not concerning
● Lochia Characteristics
○ Rubra: bright red discharge 1-3 days after birth
○ Serosa: pinkish brown discharge, 4-10 days after birth
○ Alba: whitish yellow discharge, 10-14 days after birth can last 3-6 weeks.
■ Lochia usually trickles from the vagina, if bloody discharge spurts from the
vagina and the uterus is firm there could be vaginal or cervical tearing. If
the amount of bleeding continues and is bright red a tear could be the
source.
● Uterine involution
○ The return of the uterus to pre-pregnant state
○ Should occur at a rate of 1-2 cm per day
○ Within 24 hours should be at the umbilicus (20 weeks gestation)
○ When checking, always place the hand above the symphysis pubis to stabilize
the uterus.
● BUBBLE HE
○ Breasts: s/s of infection, nipple assessment, temp, color
■ Assess for engorgement
■ Wear tight fitting bra both breastfeeding and not
■ If breast feeding ensure to start asap, try different positions
■ If not breastfeeding, turn back in showers to decrease stimulation, cold
packs
○ Uterus:location, normal involution, afterpains
○ Bladder: Color, odor, last void and amount (KEGELS to strengthen pelvic floor)
○ Bowel: color, odor, consistency, last BM and amount, assess bowel sounds
○ Lochia:color, amount, presence of clots
■ Scant amount: blood only on tissue when wiped or 1 inch stain
■ light amount: less than 4 inch stain
■ Moderate amount: less than 6 inch stain
■ Heavy amount: peri pad saturated within 1 hour
○ Episiotomy
■ REEDA ( Redness, edema, ecchymosis, discharge, approximation)
○ Hemorrhoids
○ Emotional status
● Postpartum hemorrhage
https://www.stuvia.com/user/lucidwise
, ○ Can be early or late
○ We always want to make sure the bladder, if they cannot void cath may be
required. A full bladder displaces the uterus, making it unable to contract
○ S/S: elevated HR, Resp, increased temp, decreased BP.
○ FIRST INTERVENTION IS FUNDAL MASSAGE
○ ALWAYS REMEMBER TO TURN PATIENT OVER TO ASSESS FOR BLOOD
○ Early PP hemorrhage:
■ Usually occurs within the first 24 hours
■ Risk factors: macrosomia, multiple gestation, polyhydramnios,
chorioamnionitis, prolonged labor, use of mag sulfate, use of oxytocin
■ Lacerations: if there is a steady flow of bright red blood, trickling but the
fundus is firm a laceration may be the cause
○ Late PP hemorrhage
■ Occurs more than 24 hours after birth, most of the time when the patient
has gone home
■ Common cause is a retained placenta or fragments of one
■ If lochia fails to progress appropriately, retained placental fragments is the
cause commonly. Another clue is subinvolution which is the failure of the
uterus to return to pre pregnant size.
■ Assess for signs of shock, remain with the pt. If uterus is boggy massage
gently but firmly.
● hematomas
○ S/S: discoloration of perineum, perineal pain, edema, rectal pressure, bleeding
○ Management: NOTIFY MD, could be surgical vs non surgical
● Perineal self care
○ Sitz bath and peri bottle
○ Ice 1st 24 hours
● DVT and thromb
○ Increased amounts of clotting factors present in pregnancy increase possibility of
thromboembolic disorders in the PP period
○ Superficial thrombophlebitis:
■ Most common, symptoms usually appear PP 3-4 days and consist of
heat, redness, tenderness, swelling and possible low grade fever
○ Pulmonary embolism is rare, but is a major complication
■ s/s: chest pain and dyspnea
○ DVT:
■ Seen most often if there is a hx of thrombosis or in women w/ OB
complications PIH and operative birth. Characterized by edema, chills,
fever, pain in calf w/pressure, possible decreased peripheral pulses.
Pulmonary embolism may be a complication
○ Thromboembolic disease:
■ Follows the same course as in non pregnant women, treated w/anticoags,
warm moist soaks, bedrest, elevated extremities
● Post partum infections
https://www.stuvia.com/user/lucidwise
LATEST 2026
● Normal postpartum Vitals
○ HR: slightly altered, should return to non pregnant values within a few days
○ BP: slightly altered
○ RR: should return to normal within 6-8 weeks Postpartum
○ Temp: 100.4 for the 1st 24 hours, should return to normal after if not this can
indicate INFECTION
○ Rapid changes in pulse can indicate hypovolemia
○ Shivering initially after is not concerning
● Lochia Characteristics
○ Rubra: bright red discharge 1-3 days after birth
○ Serosa: pinkish brown discharge, 4-10 days after birth
○ Alba: whitish yellow discharge, 10-14 days after birth can last 3-6 weeks.
■ Lochia usually trickles from the vagina, if bloody discharge spurts from the
vagina and the uterus is firm there could be vaginal or cervical tearing. If
the amount of bleeding continues and is bright red a tear could be the
source.
● Uterine involution
○ The return of the uterus to pre-pregnant state
○ Should occur at a rate of 1-2 cm per day
○ Within 24 hours should be at the umbilicus (20 weeks gestation)
○ When checking, always place the hand above the symphysis pubis to stabilize
the uterus.
● BUBBLE HE
○ Breasts: s/s of infection, nipple assessment, temp, color
■ Assess for engorgement
■ Wear tight fitting bra both breastfeeding and not
■ If breast feeding ensure to start asap, try different positions
■ If not breastfeeding, turn back in showers to decrease stimulation, cold
packs
○ Uterus:location, normal involution, afterpains
○ Bladder: Color, odor, last void and amount (KEGELS to strengthen pelvic floor)
○ Bowel: color, odor, consistency, last BM and amount, assess bowel sounds
○ Lochia:color, amount, presence of clots
■ Scant amount: blood only on tissue when wiped or 1 inch stain
■ light amount: less than 4 inch stain
■ Moderate amount: less than 6 inch stain
■ Heavy amount: peri pad saturated within 1 hour
○ Episiotomy
■ REEDA ( Redness, edema, ecchymosis, discharge, approximation)
○ Hemorrhoids
○ Emotional status
● Postpartum hemorrhage
https://www.stuvia.com/user/lucidwise
, ○ Can be early or late
○ We always want to make sure the bladder, if they cannot void cath may be
required. A full bladder displaces the uterus, making it unable to contract
○ S/S: elevated HR, Resp, increased temp, decreased BP.
○ FIRST INTERVENTION IS FUNDAL MASSAGE
○ ALWAYS REMEMBER TO TURN PATIENT OVER TO ASSESS FOR BLOOD
○ Early PP hemorrhage:
■ Usually occurs within the first 24 hours
■ Risk factors: macrosomia, multiple gestation, polyhydramnios,
chorioamnionitis, prolonged labor, use of mag sulfate, use of oxytocin
■ Lacerations: if there is a steady flow of bright red blood, trickling but the
fundus is firm a laceration may be the cause
○ Late PP hemorrhage
■ Occurs more than 24 hours after birth, most of the time when the patient
has gone home
■ Common cause is a retained placenta or fragments of one
■ If lochia fails to progress appropriately, retained placental fragments is the
cause commonly. Another clue is subinvolution which is the failure of the
uterus to return to pre pregnant size.
■ Assess for signs of shock, remain with the pt. If uterus is boggy massage
gently but firmly.
● hematomas
○ S/S: discoloration of perineum, perineal pain, edema, rectal pressure, bleeding
○ Management: NOTIFY MD, could be surgical vs non surgical
● Perineal self care
○ Sitz bath and peri bottle
○ Ice 1st 24 hours
● DVT and thromb
○ Increased amounts of clotting factors present in pregnancy increase possibility of
thromboembolic disorders in the PP period
○ Superficial thrombophlebitis:
■ Most common, symptoms usually appear PP 3-4 days and consist of
heat, redness, tenderness, swelling and possible low grade fever
○ Pulmonary embolism is rare, but is a major complication
■ s/s: chest pain and dyspnea
○ DVT:
■ Seen most often if there is a hx of thrombosis or in women w/ OB
complications PIH and operative birth. Characterized by edema, chills,
fever, pain in calf w/pressure, possible decreased peripheral pulses.
Pulmonary embolism may be a complication
○ Thromboembolic disease:
■ Follows the same course as in non pregnant women, treated w/anticoags,
warm moist soaks, bedrest, elevated extremities
● Post partum infections
https://www.stuvia.com/user/lucidwise
