Complete Shadow Health Focused Exam: Postpartum Care for Gloria Hernandez. Comprehensive postpartum assessment using BUBBLE-HE framework — Breasts, Uterus, Bowel, Bladder, Lochia, Episiotomy/incision, Homans sign, Emotional wellbeing. SBAR handoff to Preceptor Diana and Care Plan included. Used in maternity and obstetric nursing programs.
Gloria Hernandez is a 29-year-old on day two postpartum following an uncomplicated vaginal delivery. She is breastfeeding and reports breast engorgement, perineal discomfort, latch difficulty and mild postpartum blues. The Shadow Health Postpartum Assessment covers a full BUBBLE-HE examination (Breasts, Uterus, Bladder, Bowel, Lochia, Episiotomy, Homans sign, Emotional status), breastfeeding latch assessment and positioning guidance, Edinburgh Postnatal Depression Scale (EPDS) administration, postpartum haemorrhage risk assessment and newborn care teaching. Discharge education covers activity restrictions, warning signs, contraception options and the six-week follow-up appointment.
Gloria delivered via uncomplicated vaginal delivery and developed postpartum hemorrhage with blood loss estimated at 650 mL. Her fundus was midline but boggy — fundal massage was performed for 2 minutes until the fundus firmed. Pitocin was increased to 125 mL/hr and oxygen administered at 8L.
Students must complete the full BUBBLE-HE framework — Breasts, Uterus, Bladder, Bowel, Lochia, Episiotomy/perineum, Homan's sign (DVT screening), and Emotional/Edinburgh Postnatal Depression Scale. Each component is scored individually.
The care plan is scored at 7.5/7.5 (100%). Nursing diagnosis: Impaired Fluid Volume. Signs and symptoms: dizziness and uncontrolled bleeding. Short-term goal: patient reports resolution of dizziness and agrees to postpartum care instructions by end of shift.
Gloria reports difficulty getting her baby, Beatriz, to latch. Breastfeeding education and support documentation is a scored component. Students must document feeding method, latch assessment, and patient education provided regarding breastfeeding technique.
Fundus found midline but boggy on palpation. Fundal massage performed for 2 minutes until the uterus firmed and contracted. This is a graded intervention requiring correct documentation of technique, duration, and patient response.
Lochia pad saturation with abnormal clotting observed. Blood loss estimated at 650 mL — exceeding the 500g threshold that defines postpartum hemorrhage. Students must document lochia colour, consistency, odour, and amount using standard terminology.
Oxygen administered at 8L to maintain adequate saturation. Heart rate and blood pressure monitoring required every 4 hours. Urine output monitoring set at greater than 30 mL/hour as a fluid status indicator.
EPDS administered as part of BUBBLE-HE emotional assessment. Question 10 (self-harm) requires specific documentation and clinical follow-up per protocol. Any positive response triggers a full psychiatric assessment referral.
ICNP nursing diagnosis: Impaired Fluid Volume. Scored 1.5/1.5. Rationale: postpartum hemorrhage caused dizziness, fatigue, and uncontrolled bleeding — a combination that compromised fluid volume. Addressing this ensures Gloria can distinguish complications from her hemorrhage if they arise at home.
Instruct patient to inspect lochial color, consistency, and odour for abnormalities such as clotting, until cleared by provider. Have patient count and record postpartum pads used per day, notifying provider if saturation becomes frequent. Monitor urine output to ensure output is greater than 30 mL per hour.
Students must explain the rationale behind the nursing diagnosis and goals to Gloria in patient-friendly language. Model answer: "Despite recovering from your postpartum hemorrhage, Gloria, you still lost a significant amount of blood. Your self-reported dizziness and fatigue indicate a need for an extra cautious approach to your postpartum care."
Record vital signs and maintain accurate intake and output record. Ask patient to state back and agree to postpartum care instructions — teach-back method is required. Patient must consent to the care plan before education begins.
Every document on NursingProxy is written by a board-certified PMHNP-BC — not AI, not tutors. When you access the Gloria Hernandez documents you receive the full postpartum interview transcript, BUBBLE-HE assessment, fundal massage documentation, lochia assessment, REEDA wound evaluation, Edinburgh Postnatal Depression Scale, SBAR handoff, and completed care plan. Each file is verified to meet the grading criteria of programs that assign this case.