CH 23: Conditions Occurring After Delivery

An Rh positive client vaginally gives birth to a 6 lb, 10 oz (3,005 g) neonate after 17 hours of labor. Which condition puts this client at risk for infection? A) length of labor B) maternal Rh status C) method of birth D) size of the neonate

A) length of labor A prolonged length of labor places the mother at increased risk for developing an infection. The average size of the neonate, vaginal birth, and Rh status of the client do not place the mother at increased risk.

After teaching a postpartum client about postpartum blues, the nurse determines that the teaching was effective when the client makes which statement? A) "If the symptoms last more than a few days, I need to call my doctor." B) "I might feel like laughing one minute and crying the next." C) "I'll need to take medication to treat the anxiety and sadness." D) "I should call this support line only if I hear voices."

B) "I might feel like laughing one minute and crying the next." Emotional lability is typical of postpartum blues. Further evaluation is necessary if symptoms persist for more than 2 weeks. Postpartum blues are usually self-limiting and require no medication. Support lines can be used whenever the woman feels down. Nurses can ease a mother's distress by encouraging her to vent her feelings and by demonstrating patience and understanding with her and her family. Suggest that getting outside help with housework and infant care might help her to feel less overwhelmed until the blues ease. Provide telephone numbers she can call when she feels down during the day. Making women aware of this disorder while they are pregnant will increase their knowledge about this mood disturbance, which may lessen their embarrassment and increase their willingness to ask for and accept help if it does occur.

Blood loss for c-section

1000 mL

Blood loss for vaginal birth

500 mL

von Willebrand disease (VWD)

A genetic or acquired clotting disorder

A nurse is assigned to care for a client with a uterine prolapse. Which of the following would be most important for the nurse to assess when determining the severity of the prolapse? A) Uterine protrusion into the vagina B) Uterine bleeding present C) Foul smelling lochia D) Pain in the lower abdomen

A) Uterine protrusion into the vagina To determine if the uterine prolapse in the client is mild or severe, the nurse should assess for uterine protrusion of the cervix and uterus into the vagina. As more of the uterus descends, the vagina becomes inverted. Uterine bleeding, foul-smelling lochia, and pain or tenderness in the lower abdomen are all characteristic manifestations of late postpartum hemorrhage.

A postpartum woman who developed deep vein thrombosis is being discharged on anticoagulant therapy. After teaching the woman about this treatment, the nurse determines that additional teaching is needed when the woman makes which statement? A) "I will use a soft toothbrush to brush my teeth." B) "I can take ibuprofen if I have any pain." C) "I need to avoid drinking any alcohol." D) "I will call my health care provider if my stools are black and tarry."

B) "I can take ibuprofen if I have any pain." Individuals receiving anticoagulant therapy need to avoid use of any over-the-counter products containing aspirin or aspirin-like derivatives such as NSAIDs (ibuprofen) to reduce the risk for bleeding. Using a soft toothbrush and avoiding alcohol are appropriate measures to reduce the risk for bleeding. Black, tarry stools should be reported to the health care provider.

A woman is 2 weeks postpartum when she calls the clinic and tells the nurse that she has a fever of 101°F (38.3°C). She reports abdominal pain and a "bad smell" to her lochia. The nurse recognizes that these symptoms are associated with which condition? A) Mastitis B) Endometritis C) Subinvolution D) Episiotomy infection

B) Endometritis The woman with endometritis typically looks ill and commonly develops a fever of 100.4°F (38°C) or higher (more commonly 101°F [38.3°C], possibly as high as 104°F [40° C]) on the third to fourth postpartum day. The rise in temperature at this specific time is the most significant finding. The woman exhibits tachycardia, typically a rise in pulse rate of 10 beats per minute for each rise in temperature of one degree. In addition, the woman may report chills, anorexia, and general malaise. She also may report abdominal cramping and pain, including strong afterpains. Fundal assessment reveals uterine subinvolution and tenderness. Lochia typically increases in amount and is dark, purulent, and foul-smelling. However, with certain microorganisms, her lochia may be scant or absent.

The nurse is assessing vital signs on the client and notes a normal blood pressure along with an elevated pulse when the patient moves from a lying to a standing or sitting position. What would this indicate? A) Delayed labor B) Overhydration C) Arrested labor D) Low fluid volume

D) Low fluid volume A normal blood pressure in conjunction with a rising pulse upon moving from a recumbent to a sitting or standing position is associated with low fluid volume. Hypotension is associated with severe dehydration.

1st degree uterine inversion (incomplete)

Prolapse of the fundus into the uterine cavity

3rd degree uterine inversion (Uterine prolapse)

Prolapse of the fundus through the uterus to the introitus

2nd degree uterine inversion (Complete)

Protrusion of the fundus through the cervical os

puerperal infection

genital tract infection following childbirth

Metritis/Endometritis

inflammation of uterine lining

Which leg is the most common to get a clot in pregnant women?

left leg

6 drugs used to treat VWD

replacement therapy with VWF-containing concentrates, antifibrinolytic drugs such as tranexamic acid (particularly for bleeding from mucus membranes), topical therapy with thrombin or fibrin sealant at the site of a wound (usually used for nasal or oral bleeding), recombinant human factor VIIa, estrogen for some women, and, most commonly, desmopressin.

4th degree uterine inversion

Complete prolapse of both the uterus and vagina (total uterine and vaginal)

A nurse is providing education to a woman who is experiencing postpartum hemorrhage and is to receive a uterotonic agent. The nurse determines that additional teaching is needed when the woman identifies which drug as treating postpartum hemorrhage? A) oxytocin B) methylergonovine C) carboprost D) terbutaline

D) terbutaline Terbutaline is a tocolytic agent that may be used to halt preterm labor. It would not be used to treat postpartum hemorrhage. Oxytocin, methylergonovine, and carboprost are drugs used to manage postpartum hemorrhage.

A multipara client develops thrombophlebitis after birth. Which assessment findings would lead the nurse to intervene immediately? A) dyspnea, diaphoresis, hypotension, and chest pain B) dyspnea, bradycardia, hypertension, and confusion C) weakness, anorexia, change in level of consciousness, and coma D) pallor, tachycardia, seizures, and jaundice

A) dyspnea, diaphoresis, hypotension, and chest pain Sudden unexplained shortness of breath and reports of chest pain along with diaphoresis and hypotension suggest pulmonary embolism, which requires immediate action. Other signs and symptoms include tachycardia, apprehension, hemoptysis, syncope, and sudden change in the woman's mental status secondary to hypoxemia. Anorexia, seizures, and jaundice are unrelated to a pulmonary embolism.

What postpartum client should the nurse monitor most closely for signs of a postpartum infection? A) A client who had a nonelective cesarean birth B) A primaparous client who had a vaginal birth C) A client who had an 8-hour labor D) A client who conceived following fertility treatments

A) A client who had a nonelective cesarean birth The major risk factor for postpartum infection is a nonelective cesarean birth. Antepartum risk factors include history of infection; history of chronic conditions, such as diabetes, anemia, or poor nutrition; infections of the genital tract; smoking; and obesity. The other listed factors are not noted risk factors for infection.

A nurse is caring for a postpartum client diagnosed with von Willebrand disease. What should be the nurse's priority for this client? A) Check the lochia. B) Assess the temperature. C) Monitor the pain level. D) Assess the fundal height.

A) Check the lochia The nurse should assess the client for prolonged bleeding time. von Willebrand disease is a congenital bleeding disorder, inherited as an autosomal dominant trait, that is characterized by a prolonged bleeding time, a deficiency of von Willebrand factor, and impairment of platelet adhesion. A fever of 100.4° F (30.0° C) after the first 24 hours following birth and pain indicate infection. A client with a postpartum fundal height that is higher than expected may have subinvolution of the uterus.

The nurse is concerned that a postpartum patient with a cervical laceration is developing hypovolemic shock. What did the nurse assess in this patient? A) Weak and rapid pulse B) Warm and flushed skin C) Elevated blood pressure D) Decreased respiratory rate

A) Weak and rapid pulse If the loss of blood is extremely copious, a woman will quickly begin to exhibit symptoms of hypovolemic shock such as a weak and rapid pulse. The skin will be pale and clammy, and the blood pressure will fall. Respiratory rate will be increased and shallow.

Assessment of a postpartum client reveals a firm uterus with bright-red bleeding and a localized bluish bulging area just under the skin at the perineum. The woman also reports significant pelvic pain and is experiencing problems with voiding. The nurse suspects which condition? A) hematoma B) laceration C) bladder distention D) uterine atony

A) hematoma The woman most likely has a hematoma based on the findings: firm uterus with bright-red bleeding; localized bluish bulging area just under the skin surface in the perineal area; severe perineal or pelvic pain; and difficulty voiding. A laceration would involve a firm uterus with a steady stream or trickle of unclotted bright-red blood in the perineum. Bladder distention would be palpable along with a soft, boggy uterus that deviates from the midline. Uterine atony would be noted by a uncontracted uterus.

Which findings would lead the nurse to suspect that a postpartum woman has developed metritis? Select all that apply. A) pain on both sides of the abdomen B) foul-smelling lochia C) hematuria D) flank pain E) leukocytosis

A) pain on both sides of the abdomen B) foul-smelling lochia E) leukocytosis

A nurse is assessing a client who gave birth vaginally about 4 hours ago. The client tells the nurse that she changed her perineal pad about an hour ago. On inspection, the nurse notes that the pad is now saturated. The uterus is firm and approximately at the level of the umbilicus. Further inspection of the perineum reveals an area, bluish in color and bulging just under the skin surface. Which action would the nurse do next? A) Apply warm soaks to the area. B) Notify the health care provider. C) Massage the uterine fundus. D) Encourage the client to void.

B) Notify the health care provider The client is experiencing postpartum hemorrhage secondary to a perineal hematoma. The nurse needs to notify the health care provider about these findings to prevent further hemorrhage. Applying warm soaks to the area would do nothing to control the bleeding. With a perineal hematoma, the uterus is firm, so massaging the uterus or encouraging the client to void would not be appropriate.

The nurse suspects that a mother who delivered her infant 2 weeks ago is experiencing postpartum depression. What is the first line of treatment for this client? A) scheduling electroconvulsive therapy B) administrating a selective serotonin reuptake inhibitor C) talking to the client and reassuring her that she will feel better soon D) telling the client that she has no need to be depressed

B) administrating a selective serotonin reuptake inhibitor Selective serotonin reuptake inhibitors are the first-line drugs for postpartum depression and will help the new mother cope with the stresses of motherhood. They are also safe for breastfeeding mothers. Electroconvulsive therapy is used on women who are not responsive to medications. Minimizing the importance of the depression is counterproductive and not supportive of the mother.

The nurse is assigned to care for a postpartum client with a deep vein thrombosis (DVT) who is prescribed anticoagulation therapy. Which statement will the nurse include when providing education to this client? A) "It is appropriate for you to sit with your legs crossed over each other." B) "It is expected for you to have minimal blood in your urine during therapy." C) "You need to avoid medications which contain acetylsalicylic acid." D) "You can breastfeed your newborn while taking any anticoagulation medication."

C) "You need to avoid medications which contain acetylsalicylic acid." The nurse should caution the client to avoid products containing acetylsalicylic acid, or aspirin, and other nonsteroidal anti-inflammatory medications while on anticoagulation therapy. These medications inhibit the synthesis of clotting factors and can further prolong clotting time and precipitate bleeding. The nurse should instruct the client to avoid crossing the legs as a preventive measure. Hematuria is not expected and indicates internal bleeding. The client would be instructed to notify the primary health care provider for any prolonged bleeding. The client may not be able to breastfeed while taking anticoagulation medications. Warfarin is not thought to be excreted in breastmilk; however, most medications are excreted in breast milk. Therefore, breastfeeding is generally not recommended for the client on anticoagulation therapy.

The nurse is monitoring a postpartum client who says she's concerned because she feels mildly depressed. The nurse recognizes that she is most likely experiencing "postpartum blues," and reassures the client that this symptom is experienced by approximately what percentage of women? A) 25% B) 40% C) 85% D) 100%

C) 85% Postpartum blues, or mild depression during the first 10 days after giving birth, affects up to 85% of women who give birth. More intense depression during this period is referred to as postpartum depression, which affects approximately 10% to 15% of postpartum clients. Postpartum depression can be severe with negative implications for maternal and neonatal well-being.

A nurse is a caring for a postpartum client. What instruction should the nurse provide to the client as a precautionary measure to prevent thromboembolic complications? A) Avoid performing any deep-breathing exercises. B) Try to relax with pillows under knees. C) Avoid sitting in one position for long periods of time. D) Refrain from elevating legs above heart level.

C) Avoid sitting in one position for long periods of time.

Which instruction should the nurse offer a client as primary preventive measures to prevent mastitis? A) Avoid massaging the breast area. B) Avoid frequent breast-feeding. C) Perform handwashing before breast-feeding. D) Apply cold compresses to the breast.

C) Perform handwashing before breast-feeding. As a primary preventive measure to prevent mastitis, the nurse should instruct the client to perform good handwashing before breast-feeding. The nurse should instruct the client to frequently breastfeed to prevent engorgement and milk stasis. If the breast is distended before feeding, the nurse should instruct the client to apply cold, not warm, moist heat to the breast. Gently massaging the affected area of the breast also helps.

Which factor in a client's history would alert the nurse to an increased risk for postpartum hemorrhage? A multiparity, age of mother, operative birth B) size of placenta, small baby, operative birth C) uterine atony, placenta previa, operative procedures D) prematurity, infection, length of labor

C) uterine atony, placenta previa, operative procedures Risk factors for postpartum hemorrhage include a precipitous labor less than three hours, uterine atony, placenta previa or abruption, labor induction or augmentation, operative procedures such as vacuum extraction, forceps, or cesarean birth, retained placental fragments, prolonged third stage of labor greater than 30 minutes, multiparity, and uterine overdistention such as from a large infant, twins, or hydramnios.

The nurse is caring for a postpartum woman who is diagnosed with endometritis. Which position should the nurse encourage the client to maintain? A) Flat in bed B) On her left side C) Trendelenburg D) Semi-Fowler

D) Semi-Fowler A semi-Fowler's position encourages lochia to drain so it will not become stagnant and cause further infection. Placing the woman flat in bed, on her left side, or in the Trendelenburg position would not accomplish this goal and could result in the infection spreading to other parts of the body.

Which recommendation should be given to a client with mastitis who is concerned about breast-feeding her neonate? A) She should stop breast-feeding until completing the antibiotic. B) She should supplement feeding with formula until the infection resolves. C) She should not use analgesics because they are not compatible with breast-feeding. D) She should continue to breast-feed; mastitis will not infect the neonate.

D) She should continue to breast-feed; mastitis will not infect the neonate. The client with mastitis should be encouraged to continue breast-feeding while taking antibiotics for the infection. No supplemental feedings are necessary because breast-feeding does not need to be altered and actually encourages resolution of the infection. Analgesics are safe and should be administered as needed.