• blood with small amounts of mucus, shreds of decidua, epithelial cells, leukocytes; may contain fetal meconium, lanugo, or vernix caseosa 
• dark red, boody; fleshy, musty, stale odor that is nonoffensive; may have clots smaller than a nickle
• occurrence 1-3 days postpartum 

• composed of serum, erythrocytes, shreds of degenerating decidua, leukocytes, cervical mucus, numerous bacteria
• pink or brownish; watery; odorless
• occurs 4-10 days postpartum

• Composed of leukocytes, decidual cels, epithelial cells, fat, cervical mucus, cholesterol, bacteria
• yellow to white; may have slightly stale odor
• occurs 11-21 days postpartum; may persist to 6 weeks in lactating women 

caused by intermittent uterine contractions following delivery

* more painful in multiparous and breast-feeding women

• soft, irregular, and edematous; may appear bruised with multiple small lacerations
• closes to 2-3cm after several days, admits a fingertip after 1 wk
• shape permanently changes to lateral slit-like os of multiparous woman

• smooth walls, edematous with multiple small lacerations
• client should be free from perineal pain within 2 wks
• Low estrogen levels postpartum lead to decreased vaginal lubrication and vasocongestion for 6-10 wks, resulting in painful intercourse

• soft and flabby with decreased muscle tone
• striae (silver in white woman, dark in dark women)
• Diastasis recti

• returns to pre-pregnant state within 2 wks
• 40% blood volume increase is eliminated by diuresis
• First 48 hrs pose greatest risk of complications for clients with heart disease
• BP should remain consistent with pregnancy baseline
• Bradycardia of 50-70bpm common during first 6-10 days
• Increased WBC count up to 30,000/mm3 (increase > 30% in 6hrs indicates pathology)
• Decreased Hgb r/t amount of blood loss during delivery; returns to prelabor value in 2-6 wks
• Hct increases by 3-5 days r/t diuresis; drop indicates abnormal blood loss 

• increased bladder capacity and decreased bladder tone lead to decreased sensation and increased r/f urinary retention & infection
• diuresis of 2-3,000mL increases output in first 12-24hrs after delivery and accounts for 5-Ib weight loss
• Increased glomerular filtration rate assists in diuresis
• full bladder displaces uterus, increasing risk of uterine atony and hemorrhage 
• Fluids lost through diaphoresis (night)

• hunger and thirst
• risk for constipation r/t decreased peristalsis, use of narcotic analgesics, dehydration and decreased mobility during labor, and fear of pain from having BM
• Risk for hemorrhoids increases because of pressure from pushing during second stage of labor

• estrogen and progesterone levels drop rapidly after placental delivery
• menstruation resumes 7-9wks for nonlactating women with 90% experiencing menstrual period by 12 wks; 1st cycle usually anovulatory
• Ovulation & menstruation return time prolonged in lactating women (may very from 2-18 months
• lactation

1. taking-in phase
2. taking-hold phase
3. letting-go phase

• first 3 days postpartum; needs to discuss L&D
• preoccupied with own needs; passive and dependent
• touches and explores infant

• 3rd-10th day postpartum
• obsessed with body functions
• rapid mood swings
• anticipatory guidance most effective now

• 10 days-6 wks postpartum
• mothering functions established
• sees infant as a unique person

• process by which parents form emotional relationship with their infant over time
• mother explores infant first with fingertips, then palms, and finally enfolding NB with whole hands and arms
• Holds infant in en face position
• uses a soft, high-pitched tone of voice
• engrossment

• maternal adjustment reaction
• transient depression usually occurs btw 2nd & 3rd day and/or within first 2 wks
• r/t changes in hormone levels, fatigue, and psychological stress r/t infant dependency
• mood swings, anger, tearfulness, feeling let down, anorexia, and insomnia
• usually resolves spontaneously, but may lead to postpartum depression

• temp > 100.4 may indicate infection; may be elevated initially after delivery r/t dehydration
• Pulse: 50-80 bpm; report if >100
• Resp: 16-24 bpm
• BP: assess for orthostatic hypotension

1. B: breasts
2. U: uterus
3. B: bladder
4. B: bowel
5. L: lochia
6. E: episiotomy or perineal lacerations
7. H: homan's sign
8. E: emotional status
9. B: bonding

• determine method of feeding
• palpate for engorgement or tenderness
• inspect nipples for redness, cracks, erectility

• palpate top of fundus with dominate hand
• determine firmness, height, & position in relation to midline of abdomen
• correlate fundal location with expected descent of 1 cm per day
• Inspect abdominal incisions, episiotomy, and lacerations for REEDA

• R: redness
• E: edema
• E: ecchymosis
• D: discharge
• A: approximation of skin edges

• void within 6-8 hrs post-delivery
• assess frequency, burning, or urgency (UTI)
• evaluate ability to completely empty bladder
• Palpate for bladder distention if assessment is questionable 

• assess for passage of flatus
• inspect for signs of distention
• auscultate bowel sounds x4 for postoperative clients

• inspect type, quantity, amount, and odor
• correlate findings with expected bleeding
• cesarean-delivered women may have less lochia

• inspect perineum for REEDA
• inspect for hemorrhoids 

• pain in calf upon dorsiflexion of foot is recorded as + sign and may indicate thrombophlebitis
• inspect for pedal edema, redness, or warmth; if abnormal changes are present, assess pedal pulse

• assess risk factors
• keep bladder empty
• gently massage uterus if boggy
• administer oxytocic meds as ordered 
• monitor for side effects of meds (hypotension with rapid IV bolus of Pitocin; hypertension with Methergine and Ergotrate)

• Dermaplast
• Americaine Spray
• witch hazel compresses (Tucks)

• acetaminophen (Tylenol)
• NSAIDs (ibuprofen) 
• narcotics (codeine, hydrocodone, oxycodone)
• PCA pump (morphine epidural) for c-section

• late-onset respiratory depression (8-12 hrs)
• N&V (4-7 hrs)
• itching (w/in 3 and up to 10 hrs)
• urinary retention
• somnolence 

• early and frequent ambulation
• increased fluids and fiber
• stool softeners as ordered
• avoid straining; normal bowel pattern returns in 2-3 wks

• voiding q2-3 hrs even if no urge is felt
• catheterize as ordered for urinary retention
• Foley catheter for 12-24 hrs after c-section

• utilize snug bra or breast binder continuously for 5-7 days to prevent engorgement
• avoid heat and stimulation of breasts
• apply ice packs for 20 min qid if engorgement occurs
• encourage demand feedings q3-4hr, awakening during day and allowing to sleep at night

• add 500 kcal/day
• fluid intake of 2,000 mL/day
• continue prenatal vits and iron

• after episiotomy has healed and lochia has stopped (about 3 weeks post-delivery)
• use water-soluble lubricant PRN
• inform that breast milk may be released with orgasm 

• bright red bleeding saturating more than 1 pad per hour or passing large clots
• temp > 100.4F
• chills
• excessive pain
• reddened or warm areas of breast
• reddened or gaping episiotomy, foul-smelling lochia
• inability to urinate; burning, frequency, or urgency with urination
• calf pain, tenderness, redness, or swelling

• titer of < 1:8 (not immune)
• KNDA to neomycin
• admin 0.5 mL subQ prior to discharge
• delay vaccine at least 6 wks, and preferably 3 months, to avoid drug interaction and reduced rubella immunity if RhoGAM is indicated 
• Avoid pregnancy for at least 3 months because vaccine contains live virus and can adversely effect fetus