Chapter 12: Postpartum Physiological Assessments and Nursing Care

The nurse is completing postpartum discharge teaching to a client who had no immunity to rubella and was given the rubella immunization. Which of the following statements by the client indicates understanding of the teaching?

"I should avoid pregnancy for 4 weeks after being immunized."

The nurse is assessing a multiparous woman who is 8 hours' postpartum. Her fundus is located 2 cm above the umbilicus and shifted slightly to the right. What education would the nurse provide to the patient related to this assessment finding?

Emptying the bladder frequently will help to reduce displacement of the uterus.

The nurse is palpating a patient's uterus 12 hours after a vaginal delivery. For which reason does the nurse place one hand just above the symphysis pubis?

To prevent uterine inversion

The nurse is providing discharge teaching for the patient related to prevention of future pregnancy. The following statement by the patient indicates additional education is required.

"I will start using a barrier method once my menstrual cycle begins."

The nurse is providing teaching to a patient who is breastfeeding a newborn. The patient expresses interest in maintaining a healthy nutritional status for both her and her baby. Which information does the nurse present to meet the patient's need? Select all that apply.

- . Increase caloric intake by 500 to 1,000 per day - Drink 2 to 3 liters of fluid each day

The nurse is performing a uterus assessment on a patient who is 20 hours' postpartum. The nurse finds the fundus of the uterus to be soft and boggy. In addition, the uterus is displaced to the left and moderate bleeding is noted. If the uterus does not respond to uterine massage, which actions does the nurse implement? Select all that apply.

- Assist the patient to the bathroom to void. - Administer oxytocin as prescribed - Make the patient nothing by mouth (NPO) for surgery

The nurse is preparing to perform a visual assessment of the perineum of a postpartum patient. The nurse will use the REEDA acronym. Which specific assessments are covered by REEDA? Select all that apply.

- Perineal coloration - Suture line appearance - Amount of swelling - Soft-tissue trauma

The nurse is reviewing the medical record for a patient who is postpartum. The nurse notices the patient is rubella-nonimmune. Which information does the nurse present to the patient? Select all that apply

- The patient should be immunized before discharge. - There are risks to the fetuses of any future pregnancies. - If given rubella vaccination, pregnancy should be avoided for 4 weeks

The nurse is assessing patients who are postpartum. Which patients does the nurse identify as being at increased risk for respiratory complications? Select all that apply.

- The patient with leg pain and swelling - The patient who received large amounts of IV fluid due to blood loss - The patient with preeclampsia treated with magnesium sulfate

In an attempt to improve the effectiveness of postpartum teaching, the nurse uses the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) acronym POST BIRTH. Which teaching points require the patient to call for 911 assistance? Select all that apply

- Thoughts of hurting self or baby - Pain in the chest

A postpartum patient states, "I am really in pain." For which sources of pain will the nurse specifically assess the patient? Select all that apply

1. Uterine contractions 2. Perineal trauma 3. Breast engorgement 4. Hemorrhoids 5. General soreness

A postpartum patient calls the obstetric (OB) office 8 days following a vaginal delivery. The patient reports concern regarding vaginal bleeding. Which patient-reported symptom causes the nurse concern?

A description of the lochia as being red in color

A patient who is 12 hours' postpartum after a vaginal delivery continues to have difficulty in initiating urination. The nurse is aware that an integrative method used when a woman is unable to void is peppermint oil. In which manner will the peppermint oil be used?

A saturated cotton ball is placed in a "hat" on the toilet.

A multiparous patient reports severe uterine cramps the first day after a vaginal delivery. The nurse is aware the patient is breastfeeding and associates the patient's pain primarily with which occurrence?

An increase in oxytocin release related to the newborn suckling

The nurse is providing postpartum care to a patient 24 hours after a vaginal delivery. Which action does the nurse perform before assessing the patient's uterus?

Ask the patient to void.

The nurse is discussing contraception with a breastfeeding woman and her husband before discharge following the birth of a first child. The couple are uncertain about the method but are certain about avoiding pregnancy for at least 2 years. Which method does the nurse recommend?

Depo-Provera

The nurse in a postpartum unit frequently teaches patients regarding breast care. Which teaching is most helpful to the breastfeeding patient?

Express milk by a breast pump or manually if the infant is unable to nurse.

The nurse is preparing a postpartum patient for discharge. Which patient teaching is most important for the nurse to provide?

The signs and symptoms of secondary hemorrhage

The nurse is collecting the urine of a postpartum patient who is passing large clots. For which reason does the nurse examine the large collected clots?

To determine the presence of tissue

Before discharge from the birthing center, the nurse informs the patient that she will receive vaccines for rubella, hepatitis B, pertussis, and influenza. For which reason does the nurse explain the need for the vaccinations?

Vaccinating the mother will protect the neonate from serious illnesses.

The nurse is providing care to a patient who is postpartum. Using anatomy and physiology knowledge, which expectation does the nurse relate to the cardiovascular system?

White blood cell (WBC) laboratory level of 30,000/mm a few hours after delivery

After pregnancy and birth, a mother may notice a condition called diastasis recti abdominis, which is a(n)_ of the rectus muscle

separation