Post-partum Assessment: BUBBLES questions with complete solutions

Breast - ANS Position patient, provide for privacy, cover with bath blanket or sheet, expose one breast at a time Inspect breast for symmetry, making size is relatively equal and engorgement is not present. Inspect color and condition- look for redness and warmth, are any lesions present, is vein dissection present Check nipples-does patient complain of sore nipples? Are they chapped, bleeding or crack? Wha kind of discharge is present:blood, colostrum or milk Palpate breast for tenderness, masses, nodules Explain process of milk production Uterus - ANS Explain procedure and rationale to mother and let her know is might be a little uncomfortable. Offer pain medication if needed 30 minutes before procedure. Place in supine position Put gloves on and expose abdominal area Palpate uterus putting one hand below uterus check for firmness- If firm, uterus is contracting to stop bleeding (involuting), if boggy, massage uterus Explain process if involution- uterus going back to normal: goes back to normal in about 3 weeks, but remind mother it took 9 months to get like that Measure fundal height in finger breadths, from umbilicus Position mother on left side Check buttocks for pooling -blood from vagina Inspect perineum, especially episiotomy site Bladder - ANS Inspect and Palpate Explain about proper perineal care:wiping form front to back Check for bladder distention while checking fundus Explain that the first 2-3 voids need to be measured, should be approx 150 mls : frequent small voidings with or without pain and burning may indicate infection or retention Bowel Function - ANS Ask about bowel movements Ask about flatus/gas passing Explain need to not become constipated Offer mild laxatives as necessary Listen to bowel sounds Lochia - ANS Vaginal bleeding/discharge Explain expected changes in amount and color types of Lochia: Rubra:1-3 days dark red Cerosa: pink/brown days 4-8 Alba: yellow/.white days 9-3 weeks Clots golfball sized and under ok Heavy period is normal amount, less with c-section Episiotomy - ANS Perineum cut or tear-Inspect with legs in from position Inspect for REEDA: Redness, Ecchymosis, Edema, Drainage, Approximation Check rectal area for hemorrhoids-discuss use of sitz bath, witch hazel pads, pain relief, cleanliness and coitus 1st degree: small tear that only extends through the lining of the vagine, no underlying tissue 2nd Degree: Most common, through vaginal lining as well as vaginal tissue 3rd Degree: vaginal lining, vaginal tissues and part of anal sphincter, into the muscle 4th Degree: vaginal lining, vaginal tissue, anal sphincter, rectal lining Homan's sign - ANS Press down gently on patient's knee with legs extended flat on the bed, ask her to flex her foot Pain or tenderness in the calf is a positive sign and possible indication of thrombophlebitis. Physician should be notified immediately Edema - ANS Palate for pedal edema-most have some Check pretrial edema over tibia-some pitting normal in pregnant women Emotional Status - ANS Throughout the physical assessment, notice and evaluate the mother's emotional state. Explain to the mother and family she may cry easily for awhile and her emotions may shift from high to low. The changes are normal and are probably caused by the tremendous hormonal changes occurring in her body and by her realization of new responsibilities that accompany each new child's birth. Does the patient appear dependent or independent? Is she elated or despondent? What does she say about family? Are there other nonverbal responses?