The fundus should be firm, midline, and at the umbilicus right after birth, descending about one fingerbreadth (1 cm) per day.
Before you read
Test yourself first: 5 questions
Question 1 of 5
A nurse is assessing a client 5 days postpartum who reports a sudden onset of dyspnea, sharp chest pain, tachycardia, and anxiety. What is the nurse's priority action?
Answer: A. Sudden dyspnea, pleuritic chest pain, tachycardia, and anxiety in a postpartum client suggest a pulmonary embolism, a life-threatening complication of the hypercoagulable postpartum state. The priority is to apply oxygen, raise the head of the bed, and rapidly summon emergency help/notify the provider while maintaining the airway and oxygenation. Encouraging ambulation, applying heat to the legs, or simply documenting would delay critical care.
Question 2 of 5
A nurse is reviewing involution with a postpartum client. The nurse explains that subinvolution is suspected when which finding is present at the 6-week postpartum visit?
Answer: A. Subinvolution is the failure of the uterus to return to its nonpregnant size and condition. Signs include a uterus that remains enlarged and high, prolonged lochial discharge, irregular or excessive bleeding, and sometimes a boggy uterus. A uterus that is no longer palpable and scant white lochia indicate normal involution. Persistent lochia rubra and an enlarged, soft uterus point to subinvolution.
Question 3 of 5
A nurse is assessing a client who is 3 days postpartum. The client's temperature is 38.4 C (101.1 F), and she reports chills and lower abdominal pain with foul-smelling lochia. Which complication does the nurse suspect?
Answer: A. Puerperal (postpartum) endometritis presents after the first 24 hours with fever of 38 C or higher, chills, lower abdominal/uterine tenderness, and foul-smelling lochia. Mastitis usually presents later with a tender, reddened breast area. A UTI typically causes dysuria and frequency. Wound infection is localized to an incision site.
Question 4 of 5
A nurse is caring for a postpartum client 6 days after a cesarean birth who reports a sudden onset of sharp chest pain, shortness of breath, and anxiety. What is the priority action?
Answer: A. Sudden dyspnea, pleuritic chest pain, and anxiety in a postpartum cesarean client suggest pulmonary embolism, a life-threatening emergency. The priority is to apply oxygen, elevate the head of the bed, and immediately notify the rapid response team or provider while staying with the client.
Question 5 of 5
A nurse is performing a neurologic assessment using the Glasgow Coma Scale (GCS) on a client after a stroke. Which response would receive the LOWEST (most impaired) score in the eye-opening category?
Answer: A. On the Glasgow Coma Scale, eye-opening is scored from 4 (spontaneous) down to 1 (no eye opening). No eye opening to any stimulus is the lowest score of 1. Opening spontaneously scores 4, opening to voice scores 3, and opening to pain scores 2. A lower total GCS indicates more severe impairment.
Keep the streak going with more questions like these, each with a full rationale.
What is postpartum assessment (bubble-he)?
The letters stand for Breasts, Uterus, Bladder, Bowel, Lochia, Episiotomy/perineum, Homans/lower extremities, and Emotional status. Hemorrhage is the leading early postpartum threat.
Key points to remember
- The fundus should be firm, midline, and at the umbilicus right after birth, descending about one fingerbreadth (1 cm) per day.
- A boggy or displaced (off-midline) fundus suggests uterine atony or a full bladder, the most common causes of early hemorrhage.
- Lochia progresses rubra (red, days 1 to 3) to serosa (pink-brown, days 4 to 10) to alba (white-yellow, up to 6 weeks); it should never have a foul odor.
- Saturating one perineal pad within an hour or passing large clots indicates excessive blood loss.
- Engorgement, redness, or a localized hot tender area on the breast may indicate mastitis.
Nursing priorities
- Palpate the fundus for tone and position; massage it if boggy and reassess after the bladder is emptied.
- Assess lochia amount, color, and odor and weigh pads if bleeding is heavy (1 g = 1 mL).
- Inspect the perineum/episiotomy using REEDA (Redness, Edema, Ecchymosis, Discharge, Approximation).
- Encourage early ambulation and assess legs for warmth, redness, and swelling to detect DVT.
- Screen emotional status and bonding, distinguishing normal baby blues from postpartum depression.
Labs & values
Patient teaching
- Change perineal pads frequently and wipe front to back; report a pad soaked within an hour.
- Report foul-smelling discharge, fever, or worsening pain as signs of infection.
- Feeling sad or weepy for a few days is common, but persistent hopelessness or thoughts of harming yourself or the baby must be reported.
Red flags: report now
- A boggy fundus that does not firm with massage plus heavy bleeding is a postpartum hemorrhage emergency.
- Foul-smelling lochia with fever and uterine tenderness signals endometritis and must be reported.
- Calf pain, unilateral swelling, or chest pain with dyspnea suggests DVT or pulmonary embolism.
- Lochia that returns to bright red after lightening can indicate retained placental fragments or overexertion.
References
Clinical references for this topic
