Bubble HE Assessment Notes for OB

BUBBLE-HER The BUBBLE-HE Acronym B: Breast U: Uterus B: Bladder B: Bowels L: Lochia H: Homan's E: Episiotomy and perineum/Education R: Respiration B: Breast Breast Assessment Assessment include evaluating the breast in the postpartum period The first step is to determine if the new mamma is breastfeeding or bottle-feeding: This will guide the assessment along with patient education Breast Evaluation Size Shape Firmness Redness Symmetry Bottle-Feeding Mom: Lactation Suppression Teach the mom about breast engorgement. This usually occurs about 72 hours after birth The breasts will be very tender with a feeling of heaviness A firm, snug-fitting bra is ideal for the woman whose not breastfeeding. Also this will help, engorgement may still occur Ice and cabbage leaves can provide relief. There is an enzyme in the cabbage leaves that helps Do not express milk as it will encourage additional production Any warmth over the breasts and stimulation of the nipples will create a faucet-like effect Breastfeeding Mom Focus on the nipple and areola. The nipple should be erect, but some are flat or inverted. Hopefully, this was identified during the pregnancy in order for shield to be placed upon them Assess the nipples for signs of bruising, crackling, chapping. A deep crack or blister may indicate incorrect placement or another issue Avoid placing want cold packs on the breasts Mastitis Infection: Nursing Considerations Mastitis is an infection of the breast surrounding the ducts that's characterized by fullness, pain, warmth, and hardness of the breast. It's crucial to differentiae infection from engorgement. Mastitis may involve fever, while localized symptoms are limited to specified area that usually appears red and feels warm and possibly hardened Mastitis needs to be treated with antibiotics and the patient is usually encouraged to continue breastfeeding. The cause of infection is associated with stagnant milk in the ducts. In most cases, the milk is not infected; only the ducts The best way to feed is to start on the uninfected breast first. The mother should then switch to the affected breast within a few minutes so this breast can be fully emptied and drained. The infant is the best drainer- no breast pump can ever compare. The only time a breastfeeding mom is asked to stop is when boils and/or cysts are present Breast and Bottle Feeding The decision to breast or bottle feed is highly personal. While the benefits of breast milk nutritionally and physiologically outweigh those of formula, it may not always be possible or in the best interest of the mom and baby to breastfeed. The nurse's role is to educate the mom and support the family in whatever choice is made, not pass judgment. Benefits of Bottle Feeding Not solely a "Mom-only" responsibility Breastfeeding does not always "come naturally" to all moms- it may be difficult for some May be considered more socially acceptable to whip out a bottle in the middle of a restaurant versus a breast May be easier for moms who work outside of the home Bonding dad and baby or other relatives who feed Disadvantages of Bottle Feeding No passive immunity Harder for baby to digest Expensive, especially if a specialized formula is needed More allergies Overfeeding is easier Stool is more odorous Benefits of Breast Feeding . Passive immunity Less incidents of ear infections (formula pools into the Eustachian tube) Easy digestibility Bonding between mom and baby No cost and always available and at the right temperature For the foodies: Some moms may enjoy being able to eat an extra 5flfl calories/day Benefits to Mom: Release of oxytocin (the "let-down") causes the uterus to contract, which promotes quicker return to pre-pregnancy weight. It also decreases risks of ovarian and breast cancer Breastfeeding Teaching Positioning: holds- chest to chest or tummy to tummy in some way, grab under the breasts and push down and out (taking the milk ducts and pushing it forward, make a C-Hold around the areola (pull back, down, and forward while bringing forward) get a nice big drop of colostrum on the nipple tickle the lip with nipple, shove as much breast as possible into the mouth once it's open