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BUBBLE LE Acronym for Postpartum Assessment
BUBBLE LE Acronym
BUBBLE LE Acronym is one of the most popular and useful mnemonics in nursing to remember the order in Postpartum Assessment. It can be a little difficult to remember the Postpartum Assessment. So this article will help you greatly.
What does BUBBLE LE stand for?
B – Breasts
U – Uterus
B – Bladder
B – Bowels
L – Lochia
E – Episiotomy (Laceration)
L – Lower Extremities
E – Emotions
BREASTS
Colostrum, which is the first type of breast milk produced, has high concentrations of beneficial substances such immunoglobulins and growth factors. The breasts may get heavier and fuller as the milk matures, which typically takes 72–96 hours, and they may feel nodular and firm. Check the breasts for symptoms of infection (mastitis), including discomfort, redness, and warmth.
The breasts are assessed for:
- • Symptoms of engorgement, such as fullness, on the third and fourth postpartum days
- • Areas that are hot, red, aching, and swollen could be signs of mastitis.
- • Nipple condition and latch-on technique of breastfeeding mothers
UTERUS
In order to prevent postpartum hemorrhage, the uterus must remain firm and contract. The uterus should be massaged if the uterus feels boggy. If the uterus deviates to one side, it may indicate bladder distention.
The fundus is assessed for:
- • By approximately one-hour following delivery, the fundus is firm and at the level of the umbilicus.
- • The fundus continues to descend into the pelvis at the rate of approximately 1 cm or finger-breadth per day and should be nonpalpable by 14 days postpartum.
Patients are also evaluated for uterine cramps and given pain medication if necessary.
In the event of a boggy uterus or severe bleeding, patients or family members might be trained to assess the firmness of the fundus and to massage the area. Before the uterine fundus is palpated, patients are advised to urinate since a full bladder can cause the uterus to displace and cause excessive bleeding.
BLADDER
After delivering a baby, the mother might have trouble voiding, which would cause her bladder to expand. Because the distended bladder puts pressure on the uterus, the woman is more likely to have a hemorrhage if the bladder gets distended.
Assessment of urination and bladder function includes:
- • Urination returns after delivery, which should happen between six and eight hours after giving birth.
- • For approximately 8 hours after delivery, the amount of urine at each urination. Patients should urinate a minimum of 150 mL per void; less than 150 mL per void could indicate urinary retention due to reduced bladder tone post-delivery (in the absence of preeclampsia or other significant health problems).
- • Signs and symptoms of a urinary tract infection (UTI), include dysuria, increased frequency of urination, bladder spasm, cloudy urine, and persistent urge to urinate.
The bladder should be nonpalpable above the symphysis pubis.
Patients are advised to drink an adequate amount of fluid each day and to report signs and symptoms of a urinary tract infection, including frequency, urgency, painful urination, and hematuria.
BOWEL
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 or Laxatives may be given to the woman in order to support the easier passage of the bowel movement.
Assessment of the bowel is important in all postpartum patients. It is especially vital for patients following C-sections. The bowel is assessed for:
- • Bowel sounds
- • Return of bowel function
- • Flatus
- • Color and consistency of stool
Prescribed stool softeners or laxatives are administered as needed to treat constipation and ease perineal discomfort during defecation.
LOCHIA
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.
Lochia is assessed during the postpartum period:
- • Saturating one pad in less than an hour, a constant trickle of lochia, or the presence of large (i.e., golf-ball sized) blood clots is indicative of more serious complications and should be investigated immediately. A significant amount of lochia despite a firm fundus may indicate a laceration in the birth canal, which should be addressed immediately.
- • Foul-smelling lochia typically indicates an infection and needs to be addressed as soon as possible.
- • Lochia should progress from rubra to serosa to alba. Any changes in this progression could be considered abnormal and should be reported. Lochia rubra is present on days 1–3, lochia serosa on days 4–10, and lochia alba on days 11–21.
It is important to note that patients who had a C-section will typically have less lochia than patients who delivered vaginally; however, some lochia should be present.
After discharge, patients should report any abnormal progressions of lochia, excessive bleeding, foul-smelling lochia, or large blood clots to their physician immediately. Patients are instructed to avoid sexual activity until the lochial flow has ceased.
EPISIOTOMY (LACERATION)
The acronym REEDA is commonly used to assess an episiotomy or laceration of the perineum. REEDA stands for:
- R – Redness
- E – Edema
- E – Ecchymosis
- D – Discharge
- A – Approximation
Redness is considered normal with episiotomies and lacerations. However, if there is significant pain present, further assessment should be done. The use of ice packs during the immediate postpartum period is generally indicated.
There should be an absence of discharge from the episiotomy or laceration, and the wound edges should be well approximated. Perineal pain must be assessed and treated.
Performing Kegel exercises are an important component of strengthening the perineal muscles after delivery and may be begun as soon as it is comfortable to do so.
LOWER EXTREMITIES
The lower extremities must be assessed for deep vein thrombosis. This can be done easily by looking for redness, warmth, and edema. of the calf muscles. DVT could lead to pulmonary embolism, a serious complication, which presents with shortness of breath and tachycardia. There is controversy on the usefulness and accuracy of checking for Homan’s sign (dorsiflexion of the foot while the knee is flexed – positive sign is a 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.
EMOTIONS
Emotions are an essential part of the postpartum assessment. The postpartum blues are caused by a multitude of factors, including hormonal fluctuations, physical exhaustion, and maternal role adjustment. These changes can cause the mother to experience many strong and new emotions. Postpartum women typically exhibit symptoms of the “baby blues” or “postpartum blues,” demonstrated by tearfulness, irritability, and sometimes insomnia. The nurse should assess how the mother is feeling to determine whether the mom may be experiencing postpartum blues.
This is a normal part of the postpartum experience. If symptoms last longer than a few weeks or if the postpartum patient becomes nonfunctional or expresses a desire to harm herself or her infant, she should be instructed to report this to her certified nurse-midwife or physician immediately.
E can also include providing “Education” to the mother dependent on her needs.
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