Conditions Occurring after Delivery

After teaching a woman with a postpartum infection about care after discharge, which client statement indicates the need for additional teaching? A "I need to call my doctor if my temperature goes above 100.4° F (38° C)." B "When I put on a new pad, I'll start at the back and go forward." C "If I have chills or my discharge has a strange odor, I'll call my doctor." D "I'll point the spray of the peri-bottle so the water flows front to back."

B. The woman needs additional teaching when she states that she should apply the perineal pad starting at the back and going forward. The pad should be applied using a front-to-back motion. NOT A.C.D. Notifying the health care provider of a temperature above 100.4° F (38° C), aiming the peri-bottle spray so that the flow goes from front to back, and reporting danger signs such as chills or lochia with a strange odor indicate effective teaching

If a nurse suspects that a patient is experiencing hypovolemic shock, the initial step taken should be to call for help T/F

False

The risk for venous thromboembolism is higher during pregnancy than in the postpartum period. T/F

False Increased during PP period

A postpartum client who had a cesarean birth reports right calf pain to the nurse. The nurse observes that the client has nonpitting edema from her right knee to her foot. The nurse knows to prepare the client for which test first? 1 venous duplex ultrasound of the right leg 2 transthoracic echocardiogram 3 venogram of the right leg 4 noninvasive arterial studies of the right leg

1 Right calf pain and nonpitting edema may indicate DVT. PP clients and clients who have had abdominal surgery are at increased risk for DVT. Venous duplex ultrasound is a noninvasive test that visualizes the veins and assesses blood flow patterns. NOT 3 A venogram is an invasive test that utilizes dye and radiation to create images of the veins and would not be the first choice. 2 Transthoracic echocardiography looks at cardiac structures and is not indicated at this time. 4 Right calf pain and edema are symptoms of venous outflow obstruction, not arterial insufficiency

A multipara client develops thrombophlebitis after birth. Which assessment findings would lead the nurse to intervene immediately? 1 dyspnea, diaphoresis, hypotension, and chest pain 2 dyspnea, bradycardia, hypertension, and confusion 3 weakness, anorexia, change in level of consciousness, and coma 4 pallor, tachycardia, seizures, and jaundice

1 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. NOT 3.4. Anorexia, seizures, and jaundice are unrelated to a pulmonary embolism

The nurse is assessing vital signs on the client and notes a normal blood pressure along with an elevated pulse when the client moves from a lying to a standing or sitting position. What would this indicate? 1 delayed labor 2 overhydration 3 arrested labor 4 low fluid volume

4 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

Methylergonovine is one medication that can safely be administered to a hypertensive patient affected by postpartum hemorrhage. T/F

False

Signs of shock

Decreased blood pressure; rapid, weak pulse; mottled to gray skin color; changes in mental status

Postpartum depression is an expected condition that begins approximately 2 to 3 days after delivery and resolves within 2 weeks. T/F

False Postpartum depression is defined as major depression with an onset during pregnancy or in the first 4 weeks after the birth

Fundal massage overview

Fundal massage is performed for uterine atony, which is failure of the uterus to contract and retract after birth. The nurse would place the gloved dominant hand on the fundus and the gloved nondominant hand on the area just above the symphysis pubis. Using a circular motion, the nurse massages the fundus with the dominant hand. Then the nurse checks for firmness and, if firm, applies gentle downward pressure to express clots that may have accumulated. Finally, the nurse assists the woman with perineal care and applying a new perineal pad

Uncontrolled postpartum hemorrhage can lead to ________________ shock.

hypovolemic

A first-degree uterine ________________ occurs when the uterine fundus prolapses into the uterine cavity.

inversion

A client in her sixth week postpartum reports general weakness. The client has stopped taking iron supplements that were prescribed to her during pregnancy. The nurse would assess the client for which condition? 1 hyperglycemia 2 hypertension 3 hypovolemia 4 hypothyroidism

3 The nurse should assess the client for hypovolemia as the client must have had hemorrhage during birth and puerperium. Additionally, the client also has discontinued iron supplements. NOT 1 Hyperglycemia can be considered if the client has a history of diabetes. 2.4. Hypertension and hyperthyroidism are not related to discontinuation of iron supplements

The nurse recognizes that the postpartum period is a time of rapid changes for each client. What is believed to be the cause of postpartum affective disorders? 1 drop in estrogen and progesterone levels after birth 2 lack of social support from family or friends 3 medications used during labor and birth 4 preexisting conditions in the client

1 Plummeting levels of estrogen and progesterone immediately after birth can contribute to postpartum mood disorders. It is believed that the greater the change in these hormone levels between pregnancy and postpartum, the greater the change for developing a mood disorder. NOT 2.3.4. Lack of support, medications, and preexisting conditions may contribute but are not the main etiology

A nurse is making a home visit to a postpartum client. Which finding would lead the nurse to suspect that a woman is experiencing postpartum psychosis? 1 delirium 2 feelings of guilt 3 sadness 4 insomnia

1 Postpartum psychosis is at the severe end of the continuum of postpartum emotional disorders. It is manifested by depression that escalates to delirium, hallucinations, anger toward self and infant, bizarre behavior, mania, and thoughts of hurting herself and the infant. NOT 2.3.4. Feelings of guilt, sadness, and insomnia are associated with postpartum depression

A postpartum client calls the nurse to her room and states that she knows something awful is going to happen to her. What should the nurse do? 1 Report this immediately to the health care provider. 2 Tell her she is being silly; nothing is going to happen to her. 3 Ask if she would like to see the social worker. 4 Call a code.

1 The postpartum woman who develops a pulmonary embolism typically exhibits a sudden onset of dyspnea, pleuritic chest pain and an impending sense of severe apprehension or doom. NOT 2.3.4. If the woman experiences any of these signs/symptoms, the nurse will report them immediately to the health care provider

A postpartum woman is prescribed oxytocin to stimulate the uterus to contract. Which action would be most important for the nurse to do? 1 Administer the drug as an IV bolus injection. 2 Give as a vaginal or rectal suppository. 3 Piggyback the IV infusion into a primary line. 4 Withhold the drug if the woman is hypertensive.

3 When giving oxytocin, it should be diluted in a liter of IV solution and the infusion set up to be piggy-backed into a primary line to ensure that the medication can be discontinued readily if hyperstimulation or adverse effects occur. NOT 1 It should never be given as an IV bolus injection. 4 Oxytocin may be given if the woman is hypertensive. 2 Oxytocin is not available as a vaginal or rectal suppository

The nurse is teaching a client about mastitis. Which statement should the nurse include in her teaching? 1 The most common pathogen is group A streptococcus (GAS). 2 A breast abscess is a common complication of mastitis. 3 Mastitis usually develops in both breasts of a breastfeeding client. 4 Symptoms include fever, chills, malaise, and localized breast tenderness.

4 Mastitis is an infection of the breast characterized by flu-like symptoms, along with redness and tenderness in the breast. NOT 1 The most common causative agent is Staphylococcus aureus. 2 Breast abscess is rarely a complication of mastitis if the client continues to empty the affected breast. 3 Mastitis usually occurs in one breast, not bilaterally

Factors that contribute to the baby blues

A combination of factors likely contributes to the baby blues. Psychological adjustment along with a physiologic decrease in estrogen and progesterone appear to be the greatest contributors. Additional contributing factors include too much activity, fatigue, disturbed sleep patterns, and discomfort.

Methylergonovine (Methergine)

Acts directly on the uterine muscle to stimulate forceful contractions. Used for PP hemorrhage. Precautions/interactions: use with extreme caution in clients with HTN, preeclampsia, heart disease, venoatrial shunts, mitral valve stenosis, sepsis, or hepatic or renal impairment. Side effects: potential vasoconstriction, HTN, headache. Interventions: continuously monitor BP, assess uterine bleeding and uterine tone.

Why assess placenta after birth?

After the placenta is expelled, a thorough inspection is necessary to confirm its intactness because tears or fragments left inside may indicate an accessory lobe or placenta accreta. These can lead to profuse hemorrhage because the uterus is unable to contract fully.

______________ is the preferred initial medication for treatment of a pulmonary embolism.

Heparin

A woman recovering from cesarean birth in the hospital and who was catheterized complains of a feeling of burning on urination and a feeling of frequency. Which of the following should be the next nursing action? 1 Obtain a clean-catch urine specimen. 2 Administer amoxicillin, as prescribed. 3 Encourage her to drink large amounts of fluid. 4 Suggest that she take an oral analgesic.

1 The client in this scenario shows classic signs of a urinary tract infection. The priority nursing action at this point is to obtain a clean-catch urine specimen to confirm the infection. NOT 2.3.4. The other answers are therapeutic management interventions that would take place after confirmation of the infection via the clean-catch urine specimen

What postpartum client should the nurse monitor most closely for signs of a postpartum infection? 1 a client who had a nonelective cesarean birth 2 a primiparous client who had a vaginal birth 3 a client who had an 8-hour labor 4 a client who conceived following fertility treatments

1 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. NOT 2.3.4. 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? 1 Check the lochia. 2 Assess the temperature. 3 Monitor the pain level. 4 Assess the fundal height

1 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. NOT 2.3. A fever of 100.4° F (38° C) after the first 24 hours following birth and pain indicate infection. 4 A client with a postpartum fundal height that is higher than expected may have subinvolution of the uterus.

A nurse is preparing a class for a group of new parents on the psychological adaptations that occur after the birth. The nurse should include which signs and symptoms that might suggest postpartum depression? Select all that apply. 1 restlessness 2 feelings of worthlessness 3 feeling overwhelmed 4 sleeping well 5 hunger

1.2.3. The symptoms of postpartum depression will last longer and are different than the baby blues. Some signs and symptoms of depression include feeling the following: restless, worthless, guilty, hopeless, moody, sad, and overwhelmed.

A client in her seventh week of the postpartum period is experiencing bouts of sadness and insomnia. The nurse suspects that the client may have developed postpartum depression. What signs or symptoms are indicative of postpartum depression? Select all that apply. 1 inability to concentrate 2 loss of confidence 3 manifestations of mania 4 decreased interest in life 5 bizarre behavior

1.2.4.The nurse should monitor the client for symptoms such as inability to concentrate, loss of confidence, and decreased interest in life to verify the presence of postpartum depression. NOT 3.5. Manifestations of mania and bizarre behavior are noted in clients with postpartum psychosis

Which situation should concern the nurse treating a postpartum client within a few days of birth? 1 The client is nervous about taking the baby home. 2 The client feels empty since she gave birth to the neonate. 3 The client would like to watch the nurse give the baby her first bath. 4 The client would like the nurse to take her baby to the nursery so she can sleep.

2 A client experiencing postpartum blues may say she feels empty now that the infant is no longer in her uterus. She may also verbalize that she feels unprotected now. NOT The other options are considered normal and would not be cause for concern. 1 Many first-time mothers are nervous about caring for their neonates by themselves after discharge. 3 New mothers may want a demonstration before doing a task themselves. 4 A client may want to get some uninterrupted sleep, so she may ask that the neonate be taken to the nursery

A client who gave birth vaginally 16 hours ago states she does not need to void at this time. The nurse reviews the documentation and finds that the client has not voided for 7 hours. Which response by the nurse is indicated? 1 "If you don't attempt to void, I'll need to catheterize you." 2 "It's not uncommon after birth for you to have a full bladder even though you can't sense the fullness." 3 "I'll contact your health care provider." 4 "I'll check on you in a few hours."

2 After a vaginal birth, the client should be encouraged to void every 4 to 6 hours. As a result of anesthesia and trauma, the client may be unable to sense the filling bladder. NOT 1 It is premature to catheterize the client without allowing her to attempt to void first. 3 There is no need to contact the care provider at this time as the client is demonstrating common adaptations in the early postpartum period. 4 Allowing the client's bladder to fill for another 2 to 3 hours might cause overdistention

The nurse is giving an educational presentation to the local Le Leche league chapter. One woman asks about risk factors for mastitis. Which condition would the nurse most likely include in the response? 1 Use of breast pumps 2 Pierced nipple 3 Complete emptying of the breast 4 Frequent feeding

2 Certain risk factors contribute to the development of mastitis. These include inadequate or incomplete breast emptying during feeding or lack of frequent feeding leading to milk stasis; engorgement; clogged milk ducts; cracked or bleeding nipples; nipple piercing; and use of plastic-backed breast pads

The nurse is caring for a postpartum woman who exhibits a large amount of bleeding. Which areas would the nurse need to assess before the woman ambulates? 1 Attachment, lochia color, complete blood cell count 2 Blood pressure, pulse, reports of dizziness 3 Degree of responsiveness, respiratory rate, fundus location 4 Height, level of orientation, support systems

2 Continue to monitor the woman's vital signs for changes. If she reports dizziness or light-headedness when getting up, obtain her blood pressure while lying, sitting, and standing, noting any change of 10 mm Hg or more

A postpartum client tells the nurse that she feels like crying for no apparent reason and is unable to sleep well. What should the nurse point out to the client that this may be related to? 1 increased thyroid hormone levels 2 increased estrogen levels 3 decreased hemoglobin levels 4 decreased progesterone levels

2 Decreased progesterone and estrogen levels are believed to cause postpartum blues in which the client might cry without reason and have some difficulty sleeping. NOT 1 Decreased thyroid hormone levels have been noted to be related with postpartum depression. 3 Decreased hemoglobin levels are related to anemia

While assessing a postpartum woman, the nurse palpates a contracted uterus. Perineal inspection reveals a steady stream of bright red blood trickling out of the vagina. The woman reports mild perineal pain. She just voided 200 mL of clear yellow urine. Which condition would the nurse suspect? 1 hematoma 2 laceration 3 uterine inversion 4 uterine atony

2 Lacerations typically present with a firm contracted uterus and a steady stream of unclotted bright red blood. NOT 1 Hematoma would present as a localized bluish bulging area just under the skin surface in the perineal area, accompanied by perineal or pelvic pain and difficulty voiding. 3 Uterine inversion would present with the uterine fundus at or through the cervix. 4 Uterine atony would be manifested by a noncontracted uterus

A nurse is conducting a class for pregnant women who are in their third trimester. The nurse is reviewing information about the emotional changes that occur in the postpartum period, including postpartum blues and postpartum depression. After reviewing information about postpartum blues, the group demonstrates understanding when they make which statement about this condition? 1 "Postpartum blues is a long-term emotional disturbance." 2 "Getting some outside help for housework can lessen feelings of being overwhelmed." 3 "The mother loses contact with reality." 4 "Extended psychotherapy is needed for treatment."

2 Postpartum blues require no formal treatment other than support and reassurance because they do not usually interfere with the woman's ability to function and care for her infant. 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

The nurse determines that a woman is experiencing postpartum hemorrhage after a vaginal birth when the blood loss is greater than which amount? 1 300 ml 2 500 ml 3 750 ml 4 1000 ml

2 Postpartum hemorrhage is defined as a cumulative blood loss greater than 500 m after a vaginal birth and greater than 1,000 ml after a cesarean birth, with signs and symptoms of hypovolemia within 24 hours of the birth process

The nurse is administering a postpartum woman an antibiotic for mastitis. Which statement by the mother indicates that she understood the nurse's explanation of care? 1 "I will stop breastfeeding until I finish my antibiotics." 2 "I am able to pump my breast milk for my baby and throw away the milk." 3 "I can continue breastfeeding my infant, but it may be somewhat uncomfortable." 4 "When breastfeeding, it is recommended to begin nursing on the infected breast first."

3 Breastfeeding on antibiotics for mastitis is fine, and the mother is encouraged to empty the infected breast to prevent milk stasis. However, the nurse should prepare the mother for the process being somewhat painful because the breast is tender. NOT 4 It is recommended to start the infant nursing on the uninvolved breast first as vigorous sucking may increase the mother's pain. 1.2. Unless contraindicated by the antibiotic, the breast milk will be stored for later if the mother needs to pump her breasts; she does not need to throw the milk away

The postpartum nurse is assessing clients, and all have given birth within the past 24 hours. Which client assessment leads the nurse to suspect the woman is experiencing postpartum blues? 1 an 18-year-old mother who is currently holding her baby and looking face-to-face at the baby without saying a word 2 a 29-year-old mother who has lots of family visiting, offering to help her with meals and cleaning for the next few months 3 a 30-year-old woman who is teary-eyed when asked how she and the baby are doing with breastfeeding 4 a 38-year-old G1P1 who is constantly holding the baby and touching the baby's hands and fingers

3 During the postpartum period, many women experience some feelings of overwhelming sadness or "baby blues." They may burst into tears easily or feel let down and irritable. This phenomenon may be caused by hormonal changes, particularly the decrease in estrogen and progesterone that occurred with delivery of the placenta. NOT 1 The teenage mom is holding the baby in en face position, which is normal. 2 The 29-year-old woman has a supportive, close family and there is no indication she is experiencing postpartum blues. 4 The 38-year-old mother is in a normal phase after birth and is exploring the infant's body, a part of the taking-in phase that occurs 1 to 3 days after birth

A postpartum client is prescribed methylergonovine 0.2 mg for uterine subinvolution. Which action should the nurse take before administering the medication to the client? 1 Assess ambulation. 2 Measure urine output. 3 Measure blood pressure. 4 Evaluate current hematocrit level.

3 Methylergonovine can increase blood pressure and must be used with caution in clients with hypertension. The nurse should assess the blood pressure prior to administrating and about 15 minutes afterward to detect this side effect. NOT 1.2.4. Methylergonovine does not affect ambulation, urine output, or hematocrit level

The nurse is assessing a client 48 hours postpartum and notes on assessment: temperature 101.2oF (38.4oC), HR 82, RR 18, BP 125/78 mm Hg. The nurse should suspect the vital signs indicate which potential situation? 1 Dehydration 2 Normal vital signs 3 Infection 4 Shock

3 Temperatures elevated above 100.4° F (38° C) 24 hours after birth are indicative of possible infection. NOT 2.1.4. All but the temperature for this client are within normal limits, so they are not indicative of shock or dehydration

The nurse receives a report on a client with type 1 diabetes whose delivery was complicated by polyhydramnios and macrosomia. The nurse is aware of these complications and knows to monitor the client closely for which of the following? 1 postpartum mastitis 2 increased insulin needs 3 postpartum hemorrhage 4 gestational hypertension

3 The client is at risk for a postpartum hemorrhage from the overdistention of the uterus because of the extra amniotic fluid and the large neonate. The uterus may not be able to contract as well as it would normally. NOT 2 The client with diabetes usually has decreased insulin needs for the first few days postpartum. 4.1. Neither polyhydramnios nor macrosomia would increase the client's risk of gestational hypertension or mastitis

The nurse is teaching a client with newly diagnosed mastitis about her condition. The nurse would inform the client that she most likely contracted the disorder from which organism? 1 Escherichia coli 2 group B streptococcus (GBS) 3 Staphylococcus aureus 4 Streptococcus pyogenes (group A strep)

3 The most common cause of mastitis is S. aureus, transmitted from the neonate's mouth. Mastitis is not harmful to the neonate. NOT 1.2.4. E. coli, GBS, and S. pyogenes are not associated with mastitis. GBS infection is associated with neonatal sepsis and death.

The nurse is explaining the discharge instructions to a client who has developed postpartum cystitis. The client indicates she is not drinking a glass of fluid every hour because it hurts too much when she urinates. What is the best response from the nurse? 1 Advise her to take acetaminophen to ease symptoms. 2 Ask primary care provider to prescribe an analgesic. 3 Instruct to use a sitz bath while voiding. 4 Teach that adequate hydration helps clear the infection quicker.

4 Adequate hydration is necessary to dilute the bacterial concentration in the urine and aid in clearing the organisms from the urinary tract. Encourage the woman to drink at least 3000 ml of fluid a day, suggesting she drink one glass per hour. Drinking fluid will make the urine acidic, deterring organism growth. NOT 1.2.3. The other choices are also options but address the symptoms and not the root cause. The goal should be to rid the body of the infection, not concentrate on counteracting the results of the infection

Which recommendation should be given to a client with mastitis who is concerned about breastfeeding her neonate? 1 She should stop breastfeeding until completing the antibiotic. 2 She should supplement feeding with formula until the infection resolves. 3 She should not use analgesics because they are not compatible with breastfeeding. 4 She should continue to breastfeed; mastitis will not infect the neonate.

4 The client with mastitis should be encouraged to continue breastfeeding while taking antibiotics for the infection. NOT 2. No supplemental feedings are necessary because breastfeeding does not need to be altered and actually encourages resolution of the infection. 3 Analgesics are safe and should be administered as needed

The nurse is monitoring the woman who is 1 hour postpartum and notes on assessment the uterine fundus is boggy, to the right, and approximately 2 cm above the umbilicus. The nurse would conclude this is most likely related to which potential complication? 1 Urinary infection 2 Excessive bleeding 3 A ruptured bladder 4 Bladder distention

4 The displacement of the uterus to one side is suggestive of bladder distention. The bladder should be emptied and then fundal massage instituted to encourage the uterus to contract and stop the excessive bleeding. It's important to ensure the bladder is empty before starting the fundal massage to ensure the uterus will stay contracted. NOT 2 If the uterus was in the midline, then this would be related solely to uterine bleeding. 1 A urinary infection would be noted to cause burning on urination. 3 A ruptured bladder would be indicative of hematuria as well as pelvic pain