Postpartum Nursing Priorities – BUBBLE-HE Assessment Explained

Caring for a mother after childbirth is one of the most important roles of a registered nurse (RN nurse). The postpartum period requires careful monitoring to detect complications early and promote recovery. To make this process easier, nurses use the BUBBLE-HE assessment—a structured tool that helps guide postpartum checks step by step.

For any nurse preparing for the NCLEX, mastering BUBBLE-HE is crucial. This framework not only simplifies postpartum care but also ensures no key area is missed. If you are studying with a nursing bundle or preparing for exams, this assessment is a must-know skill.

What Does BUBBLE-HE Stand For?

Each letter in BUBBLE-HE represents a specific area to assess in the postpartum patient:

1. B – Breasts
   • Assess for engorgement, cracked nipples, or mastitis.
   • Check if breastfeeding is effective and offer teaching for positioning and latch.
2. U – Uterus
   • Palpate the fundus to ensure it is firm, midline, and descending daily.
   • A boggy uterus may indicate uterine atony and risk for hemorrhage.
3. B – Bladder
   • Assess for urinary retention, distention, or incomplete emptying.
   • Encourage frequent voiding to prevent displacement of the uterus.
4. B – Bowels
   • Monitor bowel sounds, gas passage, and return of normal bowel movements.
   • Encourage hydration, ambulation, and stool softeners if needed.
5. L – Lochia
   • Assess vaginal discharge for amount, color, and odor.
   • Scant to moderate lochia rubra is normal initially, but heavy clots or foul odor may indicate hemorrhage or infection.
6. E – Episiotomy/Perineum
   • Inspect for redness, swelling, hematoma, or signs of infection.
   • Teach perineal care, including sitz baths and proper hygiene.
7. H – Homan’s Sign/Extremities
   • Assess for calf pain, warmth, or swelling (possible DVT).
   • Encourage ambulation and monitor circulation.
8. E – Emotional Status
   • Evaluate maternal bonding, mood, and signs of postpartum blues or depression.
   • Support emotional well-being and provide resources if needed.

Why BUBBLE-HE Matters for Nurses

• Provides a structured approach to postpartum care.
• Helps RN nurses quickly identify red flags such as hemorrhage, infection, or emotional distress.
• A high-yield NCLEX topic that nursing students should review regularly.
• Included in most nursing bundles because it connects directly to real-world patient care.

NCLEX Tip:

Expect questions where you need to prioritize postpartum assessments. For example:

• A boggy uterus → massage immediately.
• Heavy bleeding with clots → notify provider.
• Signs of depression → provide support and referral.

Final Thoughts

The BUBBLE-HE assessment is more than just a mnemonic; it’s a lifesaving tool. Every nurse, whether a student preparing for the NCLEX or a practicing registered nurse, should master this framework. Adding this to your study routine or nursing bundle ensures you’re confident in postpartum care and ready to keep moms safe.