MCH 2480: MATERNAL EXAM 2
CONCEPT 100% RATED A+
Fundus after birth
• Midline between the umbilicus and symphysis pubis
• Fundus descends 1 fingerbreadth per day
Causes of Postpartum Hemorrhage (PPH)
• Rapid second stage labor
• Rapid/precipitous labor (less than 3 hours from onset to delivery)
• Operative vaginal deliveries (forceps- or vacuum-assisted)
• Fetal manipulation (extrauterine or intrauterine version, corkscrew maneuver for
shoulder dystocia [corkscrew maneuver: a progressive 180-degree manual rotation of the
baby's posterior shoulder to release the impacted anterior shoulder])
• Large episiotomies, Fetal macrosomia, Cesarean birth
• Uterine rupture (increased incidence with previous uterine surgery, tetanic
contractions, labor stimulation, versions, and placental attachment abnormalities—placenta
accreta, placenta increta, and placenta percreta)
• Retained placental fragment most common cause of PPH, subinvolution, uterine
infection
Postpartum Hemorrhage: how to assess
• Before RN recognizes it these usual signs of shock—restlessness; anxiety; pallor;
cool, clammy skin; increased pulse; tachypnea; shaking; and decreased blood
pressure—until 30% to 40% of the patient's total circulating blood volume has
been lost.
BUBBLEHEEN: Post-Partum Assessment
• B – Breast Breast vs. Bottle feeding: assess for latching on. If formula
feeding, teach about engorgement of breast, mother binds breast 24/7 and no
nipple stimulation
• U – Uterus Firm & Midline, 12 hours after delivery uterus is 1 fingerbreadth
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, MCH 2480: MATERNAL EXAM 2
CONCEPT 100% RATED A+
above naval, decreases approximately 1 fingerbreadth each day. If uterus is
not midline, have patient void.
• B – Bladder Patients have decreased sensation to void, especially with spinal,
patients need to void every 3 hours. Number one cause of hemorrhage is a full
bladder.
• B – Bowel Flatus? Bowel sounds x 4 quadrants? Use stool softener, as
needed. Should take stool softener if second degree tear or higher and all C-
sections. If C-section, patient should walk at least three times per day (breakfast,
lunch, and dinner)
• L – Lochia Assess flow and ask how many hours since last changed pad, if
using one pad per hour, suspect hemorrhage. Lochia flow should progress in
color: red, pink,
brownish, white, none.
• E – Episiotomy Check incision for REEDA (redness, edema, ecchymosis,
drainage, and approximation) Look for signs and symptoms of infection (give
stool softeners & abt)
• H – Homan’s Sign, Must assess Homan’s Sign (support leg with
dorsiflexion) Teach patient about ambulation and hydration to prevent
DVT
• E – Edema Swelling in lower legs? Pitting?
• E – Emotions Is the mother bonding with newborn? Changing diapers?
• N – Nutrition Mothers need 500 calories more when breastfeeding. C-sections
cannot have a straw due to the intake of air. Also, no cabbage or broccoli due to
causing gas.
This study source was downloaded by 100000843924616 from CourseHero.com on 04-18-2022 14:36:29 GMT -05:00
https://www.coursehero.com/file/66859535/Maternal-exam-2-conceptdocx/
CONCEPT 100% RATED A+
Fundus after birth
• Midline between the umbilicus and symphysis pubis
• Fundus descends 1 fingerbreadth per day
Causes of Postpartum Hemorrhage (PPH)
• Rapid second stage labor
• Rapid/precipitous labor (less than 3 hours from onset to delivery)
• Operative vaginal deliveries (forceps- or vacuum-assisted)
• Fetal manipulation (extrauterine or intrauterine version, corkscrew maneuver for
shoulder dystocia [corkscrew maneuver: a progressive 180-degree manual rotation of the
baby's posterior shoulder to release the impacted anterior shoulder])
• Large episiotomies, Fetal macrosomia, Cesarean birth
• Uterine rupture (increased incidence with previous uterine surgery, tetanic
contractions, labor stimulation, versions, and placental attachment abnormalities—placenta
accreta, placenta increta, and placenta percreta)
• Retained placental fragment most common cause of PPH, subinvolution, uterine
infection
Postpartum Hemorrhage: how to assess
• Before RN recognizes it these usual signs of shock—restlessness; anxiety; pallor;
cool, clammy skin; increased pulse; tachypnea; shaking; and decreased blood
pressure—until 30% to 40% of the patient's total circulating blood volume has
been lost.
BUBBLEHEEN: Post-Partum Assessment
• B – Breast Breast vs. Bottle feeding: assess for latching on. If formula
feeding, teach about engorgement of breast, mother binds breast 24/7 and no
nipple stimulation
• U – Uterus Firm & Midline, 12 hours after delivery uterus is 1 fingerbreadth
This study source was downloaded by 100000843924616 from CourseHero.com on 04-18-2022 14:36:29 GMT -05:00
https://www.coursehero.com/file/66859535/Maternal-exam-2-conceptdocx/
, MCH 2480: MATERNAL EXAM 2
CONCEPT 100% RATED A+
above naval, decreases approximately 1 fingerbreadth each day. If uterus is
not midline, have patient void.
• B – Bladder Patients have decreased sensation to void, especially with spinal,
patients need to void every 3 hours. Number one cause of hemorrhage is a full
bladder.
• B – Bowel Flatus? Bowel sounds x 4 quadrants? Use stool softener, as
needed. Should take stool softener if second degree tear or higher and all C-
sections. If C-section, patient should walk at least three times per day (breakfast,
lunch, and dinner)
• L – Lochia Assess flow and ask how many hours since last changed pad, if
using one pad per hour, suspect hemorrhage. Lochia flow should progress in
color: red, pink,
brownish, white, none.
• E – Episiotomy Check incision for REEDA (redness, edema, ecchymosis,
drainage, and approximation) Look for signs and symptoms of infection (give
stool softeners & abt)
• H – Homan’s Sign, Must assess Homan’s Sign (support leg with
dorsiflexion) Teach patient about ambulation and hydration to prevent
DVT
• E – Edema Swelling in lower legs? Pitting?
• E – Emotions Is the mother bonding with newborn? Changing diapers?
• N – Nutrition Mothers need 500 calories more when breastfeeding. C-sections
cannot have a straw due to the intake of air. Also, no cabbage or broccoli due to
causing gas.
This study source was downloaded by 100000843924616 from CourseHero.com on 04-18-2022 14:36:29 GMT -05:00
https://www.coursehero.com/file/66859535/Maternal-exam-2-conceptdocx/
