BUBBLE-LE is an acronym to remember the key points for postpartum nursing assessment.
After 24 hours, clear yellow colostrum may develop and express from the breast. As the milk matures, usually within 72-96 hours, the breasts may become heavier and fuller and feel nodular and firm. The breasts should be assessed for signs of infection (mastitis) such as pain, redness, and warmth.
The uterus must remain firm and contracting in order to prevent postpartum hemorrhage. If the uterus feels boggy, it should be massaged. If the uterus becomes deviated to one side, it may indicate bladder distention.
Postpartum, the woman may experience difficulty voiding resulting in a distended bladder. If the bladder becomes distended, the woman is at a higher risk for hemorrhage because the distended bladder applies pressure on the uterus.
It may take 2 or 3 days for the woman to have a bowel movement due to pain, lack of food, dehydration, and soreness from lacerations or hemorrhoids. A stool softener may be given to the woman in order to aid in easier passage of the bowel movement.
The lochia should be assessed for color, amount, and odor. Too much lochia may indicate hemorrhage so it is important to know how the lochia is expected to look. In addition, foul smelling lochia may indicate infection. Lochia is usually bright red and contains small clots after birth. Normal shedding of blood and decidua is referred to as lochia rubra (red/red-brown) and lasts for the first few days following delivery. Between day 3-4 the lochia becomes more pink/brown color and contains serum, leukocytes, tissue debris and old blood and is called lochia serosa. Around 10 days post birth, the lochia becomes yellow/white and contains mainly leukocytes. This is referred to as Lochia Alba. Lochia will last 4-8 weeks postpartum.
If the woman had an episiotomy, the nurse should assess for redness, edema, ecchymosis, discharge, and approximation.
The lower extremities must be assessed for deep vein thrombosis. This can be done easily by looking for redness, warmth and edema as well as observing for tachycardia and shortness of breath. There is controversy on the usefulness and accuracy of checking for Homan’s sign (dorsiflexion of the foot while knee is flexed - positive sign is pain in the calf muscle indicating a thrombus). The mother is at risk for developing a DVT due to increased clotting factors from birth and lying in bed.
Hormone fluctuations, as well as, the birth experience can cause the mother to experience many new and strong emotions. The nurse should assess how the mother is feeling to determine whether the mom may be experiencing the postpartum blues. E can also include providing “education” to the mother dependent on her needs.
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