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:
- B – Breasts
- Assess for engorgement, cracked nipples, or mastitis.
- Check if breastfeeding is effective and offer teaching for positioning and latch.
- 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.
- B – Bladder
- Assess for urinary retention, distention, or incomplete emptying.
- Encourage frequent voiding to prevent displacement of the uterus.
- B – Bowels
- Monitor bowel sounds, gas passage, and return of normal bowel movements.
- Encourage hydration, ambulation, and stool softeners if needed.
- 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.
- E – Episiotomy/Perineum
- Inspect for redness, swelling, hematoma, or signs of infection.
- Teach perineal care, including sitz baths and proper hygiene.
- H – Homan’s Sign/Extremities
- Assess for calf pain, warmth, or swelling (possible DVT).
- Encourage ambulation and monitor circulation.
- 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.