Lochia
Vital Signs
Postpartum Hemorrhage Assessment
Postpartum Complications
Bubble-he
100

This is the first stage of lochia, characterized by bright red vaginal discharge and lasts for about 1-3 days postpartum

What is lochia rubra?

100

According to AWHONN guidelines, how often should vital signs be assessed in the first hour postpartum to detect complications such as hemorrhage or cardiovascular instability?

What is every 15 minutes?

100

Postpartum hemorrhage (PPH) is defined as blood loss greater than ______ mL after a vaginal delivery.

What is 500 mL?

100

This common postpartum complication involves the inflammation and infection of the breast tissue, often seen in breastfeeding mothers.

What is mastitis?

100

In the BUBBLE-HE assessment, which component involves checking for engorgement, pain, and nipple condition, especially in breastfeeding mothers?

What is breasts?

200

This stage of lochia is typically pinkish-brown in color, occurring around days 4 to 10 postpartum

What is lochia serosa

200

This vital sign typically falls initially after delivery but should return to pre-pregnancy levels by week 6. If it remains elevated, further assessment is required.

What is blood pressure?

200

The most common cause of postpartum hemorrhage is when the uterus fails to contract properly after delivery. What is this condition called?

What is uterine atony?

200

This complication, often occurring after a cesarean section, involves redness, swelling, and discharge at the surgical site and may require antibiotic treatment.

What is a wound infection?

200

During the BUBBLE-HE assessment, the nurse palpates this to ensure it is firm and midline to prevent postpartum hemorrhage.

What is the uterus?

300

This final stage of lochia consists mainly of white blood cells and mucus, and it usually appears white or yellowish in color.

What is lochia alba?

300

What is the expected heart rate range for a postpartum client during the first few days after delivery due to increased cardiac output and decreased need to perfuse the placenta?

What is 40-60 beats per minute (bradycardia)?

300

What are two common clinical signs that may indicate a postpartum hemorrhage in a client?

What are a boggy uterus and saturating a perineal pad in 15 minutes or less?

300

This postpartum complication is a mood disorder that affects some mothers within the first year after childbirth and is characterized by feelings of sadness, anxiety, and difficulty bonding with the baby.

What is postpartum depression?

300

This component of the BUBBLE-HE assessment involves monitoring the type, amount, color, and odor of vaginal discharge, which progresses through three stages.

What is Lochia?

400

During which stage of lochia should the nurse be concerned if the discharge suddenly returns to bright red after previously transitioning to a lighter color?

What is lochia serosa?

400

During the postpartum period, what temperature would be concerning for infection if it persists beyond the first 24 hours after delivery?

What is 100.4°F (38°C) or higher?

400

In addition to uterine atony, name two other potential causes of postpartum hemorrhage included in the '5 T’s' mnemonic.

What are tissue (retained placental fragments) and trauma (lacerations or uterine rupture)? (The '5 T’s' include Tone (uterine atony), Tissue (retained placenta), Trauma (lacerations), Thrombin (coagulopathies), and Traction (uterine inversion)

400

Name two risk factors for developing deep vein thrombosis (DVT) in the postpartum period.

What are immobility and cesarean section?

400

In the BUBBLE-HE assessment, which component involves checking the perineal area for healing, signs of infection, and the presence of hemorrhoids?

What is Episiotomy/Incision?

500

List the three stages of lochia in order, along with their typical duration and the primary components found in each stage.

What are:

  1. Lochia rubra - lasts for 1-3 days, consisting of blood, small clots, and decidual and trophoblastic debris.
  2. Lochia serosa - lasts for 4-10 days, consisting of serous fluid, red blood cells, leukocytes, and cervical mucus.
  3. Lochia alba - lasts for 10-14 days up to 6 weeks, consisting mainly of leukocytes, mucus, and reduced fluid content.
500

Despite significant blood loss during childbirth, this hematologic measure often remains stable due to the loss of primarily plasma, not whole blood. A marked decrease in this value, however, may indicate a postpartum hemorrhage.

What is hematocrit?

500

Identify two pharmacological interventions used to treat postpartum hemorrhage and briefly describe their mechanisms of action.

What are oxytocin and methylergonovine (Methergine)? Oxytocin: Stimulates uterine contractions to reduce bleeding. Methylergonovine (Methergine): Causes uterine smooth muscle contraction to decrease blood flow and reduce hemorrhage. 

500

Which life-threatening postpartum complication involves simultaneous clotting and bleeding, and can result from severe hemorrhage, sepsis, or preeclampsia?

What is disseminated intravascular coagulation (DIC)? (DIC is a condition in which the body's clotting mechanisms become overactive, leading to both clotting and bleeding complications, often triggered by severe postpartum hemorrhage, sepsis, or preeclampsia.)

500

Which BUBBLE-HE component requires the nurse to assess for signs of deep vein thrombosis, such as calf pain, swelling, and redness, and is crucial for preventing thromboembolic complications?

What is Homan’s Sign/Extremities?