CH 22: Nursing Management of the Postpartum Women at Risk

The nurse is administering methylergonovine 0.2 mg to a postpartum client with uterine subinvolution. Which assessment will the nurse need to make prior to administering the medication? a.if the client can walk without experiencing dizziness b.if urine output is higher than 50 ml/h c.if hematocrit level is higher than 45% d.if blood pressure is lower than 140/90 mm Hg

if blood pressure is lower than 140/90 mm Hg Rationale: Methylergonovine elevates blood pressure. It is important to assess that it is not already elevated before administration.

The nurse assesses the client who is 1 hour postpartum and discovers a heavy, steady trickle of bright red blood from the vagina in the presence of a firm fundus. Which potential cause should the nurse question and report to the RN or primary care provider? a.Perineal hematoma b.Uterine atony c.Infection of the uterus d.Laceration

Laceration Rationale: A steady trickle of blood with a firm uterus is more likely to occur from a laceration rather than from the uterine atony. This type of bleeding is usually bright red in color rather than the dark red color of lochia. A perineal hematoma presents as a bulging, swollen mass on the perineum. Uterine infection typically presents with a foul smelling discharge.

A nurse is caring for a postpartum client with a platelet count of 15,000/ml and has been diagnosed with idiopathic thrombocytopenic purpura (ITP). Which intervention should the nurse perform first? a.administration of platelet transfusions as prescribed b.avoiding administration of oxytocics c.administration of prescribed nonsteroidal anti-inflammatory drugs (NSAIDs) d.continual firm massage of the uterus

administration of platelet transfusions as prescribed Rationale: This client is postpartum and has a platelet count lower than 20,000 to 30,000/ml. The client has been diagnosed with idiopathic thrombocytopenic purpura (ITP). Therefore, the nurse should administer platelet transfusions as prescribed to control bleeding. Glucocorticoids, intravenous immunoglobulins, and intravenous anti-Rho(D) are also administered to the client. The nurse should not administer an nonsteroidal anti-inflammatory drug (NSAID) when caring for a client with ITP, because NSAIDs cause platelet dysfunction.

A postpartum client with a history of deep vein thrombosis is being discharged on anticoagulant therapy. The nurse teaches the client about the therapy and measures to reduce her risk for bleeding. Which statement by the client indicates the need for additional teaching? a.If I get a cut, I need to apply direct pressure for about 5 minutes or more." b."I should brush my teeth vigorously to stimulate the gums." c."I need to avoid using any aspirin-containing products." d."If my lochia increases, I need to call my health care provider."

"I should brush my teeth vigorously to stimulate the gums." Rationale: The client is at risk for bleeding and as such should gently brush her teeth with a soft toothbrush to prevent injury. An increase in lochia warrants notification of the health care provider. Aspirin and aspirin-containing products should be avoided. If the client experiences a cut that bleeds, she should apply direct pressure to the site for 5 to 10 minutes.

The nurse is caring for several women in the postpartum clinic setting. Which statement(s), when made by one of the clients, would alert the nurse to further assess that client for postpartum psychosis? Select all that apply. a."I believe my newborn is losing weight because I will not feed him because my milk was poisoned by the health care provider." b."The newborn is not really mine emotionally, since I was never pregnant and do not have children." c."I am sad because I am not spending as much time with my toddler now that my newborn is here." d."When the newborn is sleeping, I can see his thoughts projected on my phone and I do not like the thoughts." e."Sometimes I get tired of being with only the newborn, so I call my mom and sister to come visit."

"The newborn is not really mine emotionally, since I was never pregnant and do not have children." "When the newborn is sleeping, I can see his thoughts projected on my phone and I do not like the thoughts." "I believe my newborn is losing weight because I will not feed him because my milk was poisoned by the health care provider." Rationale: Postpartum psychosis is a serious and emergent condition in which the new mother has lost touch with reality and needs immediate psychiatric intervention. Visual hallucinations such as seeing the newborn's thoughts projected on her phone is a sign of postpartum psychosis. Denying the pregnancy or that the newborn is hers is a sign of postpartum psychosis. The delusion that her milk is poisoned is a sign of postpartum psychosis. Being concerned about time with the toddler is a sign of postpartum blues or possibly depression. Reaching out for family to visit is a positive coping skill.

The nurse is providing education to a postpartum woman who has developed a uterine infection. Which statement by the woman indicates that further instruction is needed? a."I will take frequent walks around my home to promote drainage." b."When I am sleeping or lying in bed, I should lie flat on my back." c."I will change my perineal pad regularly to remove the infected drainage." d."If my abdomen becomes firm, or if I don't urinate as much, I need to call the doctor."

"When I am sleeping or lying in bed, I should lie flat on my back." Rationale: With a uterine infection, the client needs to be in a semi-Fowler position to facilitate drainage and prevent the infection from spreading. Changing the perineal pads regularly; walking to promote drainage; and contacting the doctor if her uterus becomes rigid (or if she notes a decrease in urinary output) are all correct actions.

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

.Semi-Fowler Rationale: A semi-Fowler 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.

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. a.decreased interest in life b.bizarre behavior c.manifestations of mania d.loss of confidence d.inability to concentrate

.inability to concentrate decreased interest in life loss of confidence Rationale: 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. Manifestations of mania and bizarre behavior are noted in clients with postpartum psychosis.

The nurse determines that a woman is experiencing postpartum hemorrhage after a vaginal birth when the blood loss is greater than which amount? a.300 ml b.1000 ml c.750 ml d.500 ml

1000 ml Rationale: Postpartum hemorrhage (PPH) is defined as a cumulative blood loss greater than 1,000 ml with signs and symptoms of hypovolemia within 24 hours of the birth process, regardless of the route of delivery. Morbidity from PPH can be severe, with sequelae including organ failure, shock, edema, thrombosis, acute respiratory distress, sepsis, anemia, intensive care admissions, and prolonged hospitalization. Hemorrhage is the most common reason postpartum women are admitted to intensive care units and it is the most preventable cause of maternal death.

A client has had a cesarean birth. Which amount of blood loss would the nurse document as a postpartum hemorrhage in this client? a.250 ml b.250 ml c.1000 ml d.750 ml

1000 ml Rationale: Postpartum hemorrhage is defined as blood loss of 500 ml or more after a vaginal birth and 1000 ml or more after a cesarean birth.

The nurse is caring for a client who has given birth to twins. During which time period would the nurse instruct on the possibility of a late postpartum hemorrhage? a.24 to 48 hours after birth b.6 weeks to 3 months after birth c.24 hours to 12 weeks after birth d.6 weeks to 6 months after birth

24 hours to 12 weeks after birth Rationale: Mothers who give birth to twins are instructed on postpartum hemorrhage at the same time as a mother with a single newborn. Delayed or late postpartum hemorrhages occur more than 24 hours but less than 12 weeks postpartum. Immediate, early, or primary postpartum hemorrhages occur within 24 hours of birth.

A nurse is assessing the perineum of several postpartum clients using the REEDA score. The nurse initiates interventions to minimize the risk for postpartum infection for the client with which score? a.3 b.9 c.5 d.7

9 Rationale: The nurse would implement measures to minimize the risk for postpartal infection for the woman with a REEDA score of 9. The acronym REEDA is frequently used for assessing a woman's perineum status. It is derived from five components that have been identified to be associated with the healing process of the perineum. These include: redness, edema, ecchymosis, discharge and approximation of skin edges. Each category is assessed and a number assigned (0 to 3 points, with 0 indicating none or intact and 3 indicating more significant problems). The total REEDA score ranges from 0 to 15. Higher scores indicate increased tissue trauma predisposing the woman to an increased risk for infection and a greater risk for postpartal hemorrhage. Therefore the woman with a total score of 9 is at greatest risk for problems.

The nurse is assisting with a birth, and the client has just delivered the placenta. Suddenly, bright red blood gushes from the vagina. The nurse recognizes that which occurrence is the most likely cause of this postpartum hemorrhage? a.Uterine Atony b.A cervical laceration

A cervical laceration Rationale: Lacerations of the cervix are usually found on the sides of the cervix, near the branches of the uterine artery. If the artery is torn, the blood loss may be so great that blood gushes from the vaginal opening. Because this is arterial bleeding, it is brighter red than the venous blood lost with uterine atony. Fortunately, this bleeding ordinarily occurs immediately after detachment of the placenta, when the primary care provider is still in attendance. Uterine atony, or relaxation of the uterus, is the most frequent cause of postpartum hemorrhage; it tends to occur most often in Asian or Hispanic woman. Conditions that contribute to uterine atony include having received deep anesthesia or analgesia and a prior history of postpartum hemorrhage. Disseminated intravascular coagulation is typically associated with premature separation of the placenta, a missed early miscarriage, or fetal death, none of which is evident in this scenario. A retained placental fragment is possible, but there is no evidence for this in the scenario.

The nurse is caring for a mother within the first four hours after a cesarean birth. Which nursing intervention would be most appropriate to prevent thrombophlebitis in the mother? a.Ambulate the client as soon as her vital signs are stable. b.Limit oral intake of fluids for the first 24 hours to prevent nausea. c.Roll a bath blanket or towel and place it firmly behind the knees. d.Assist client in performing leg exercises every 2 hours.

Ambulate the client as soon as her vital signs are stable. Rationale: The best prevention for thrombophlebitis is ambulation as soon as possible after recovery. Ambulation requires blood movement throughout the cardiovascular system, decreasing thrombophlebitis risks. Placing a bath blanket behind the knees interrupts circulation and could cause a thrombus. Fluids are encouraged not limited. Leg exercises may put strain on the abdominal incision.

A client who had an emergency cesarean birth for fetal distress 3 days ago is preparing for discharge. When reviewing the home care instructions with the nurse, the client reveals she is saddened about her cesarean and feels let down that she was not able to have a vaginal birth. When questioned further, the client states she feels "weepy about everything" and cannot stop crying. What nursing action is indicated first? a.Discuss the client's potential depression with her family members. b.Contact the primary care provider to report the client's deteriorating mental status. c.Document the conversation d.Ask the client to elaborate on her feelings.

Ask the client to elaborate on her feelings. Rationale: The client's affect is consistent with postpartum blues, a transient source of sadness experienced during the first week after birth. The nurse should offer support to the client and encourage her to discuss her concerns and feelings. The client's emotional state is normal and contacting the care provider is not indicated. Discussing the client's feelings with family members is a violation of confidentiality and is not an appropriate action. Documenting the interaction is indicated but should take place after the encounter is completed.

A postpartum woman is developing a thrombophlebitis in her right leg. Which assessments would the nurse make to detect this? a.Assess for pedal edema. b.Bend her knee, and palpate her calf for pain. c.Ask her to raise her foot and draw a circle. d.Blanch a toe, and count the seconds it takes to color again.

Assess for pedal edema. Rationale: Calf swelling, erythema, warmth, tenderness, and pedal edema may be noted and are caused by an inflammatory process and obstruction of venous return.

The nurse observes an ambulating postpartum woman limping and avoiding putting pressure on her right leg. Which assessments should the nurse prioritize in this client? a.Blanch a toe, and count the seconds it takes to color again. b.Assess for warmth, erythema, and pedal edema. c.Bend the knee and palpate the calf for pain. d.Ask the client to raise the foot and draw a circle.

Assess for warmth, erythema, and pedal edema. Rationale: This client is demonstrating potential symptoms of DVT, but is avoiding putting pressure on the leg and limping when ambulating. DVT manifestations are caused by inflammation and obstruction of venous return and can be assessed by the presence of calf swelling, warmth, erythema, tenderness, and pedal edema. The client would not need to bend the knee to assess for pain in the calf. Asking the client to raise her toe and draw a circle is assessing reflexes, and blanching a toe is assessing capillary refill (which may be affected by the DVT but is not indicative of a DVT).

The nurse is monitoring a client who is 5 hours postpartum and notes her perineal pad has become saturated in approximately 15 minutes. Which action should the nurse prioritize? a.Initiate Ringer's lactate infusion. b.Assess the woman's vital signs. c.Call the woman's health care provider. d.Assess the woman's fundus.

Assess the woman's fundus. Rationale: The nurse should prioritize assessing the uterine fundus to eliminate it as a source of the bleeding. Assessing the vital signs would be the next step, especially if the massage is ineffective, to determine if the client is becoming unstable. The nurse would then alert the RN or health care provider about the increased bleeding and/or unstable vital signs. The LPN would not initiate an IV infusion without an order from the health care provider but should be prepared to do so, if it is ordered.

A 29-year-old postpartum client is receiving anticoagulant therapy for deep venous thrombophlebitis. The nurse should include which instruction in her discharge teaching? A.Avoid iron replacement therapy. B.Wear knee-high stockings when possible. C.Shortness of breath is a common adverse effect of the medication. D.Avoid over-the-counter (OTC) salicylates.

Avoid over-the-counter (OTC) salicylates. Rationale: Discharge teaching should include informing the client to avoid OTC salicylates, which may potentiate the effects of anticoagulant therapy. Iron will not affect anticoagulation therapy. Restrictive clothing should be avoided to prevent the recurrence of thrombophlebitis. Shortness of breath should be reported immediately because it may be a symptom of pulmonary embolism.

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.

Check the lochia. Rationale: 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 (38° 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.

A woman who gave birth to an infant 3 days ago has developed a uterine infection. She will be on antibiotics for 2 weeks. What is the priority education for this client? a.Encourage an oral intake of 2 to 3 liters per day. b.Take analgesics for uterine pain. c.Keep the environment quiet to encourage rest. d.Change her perineal pads frequently.

Encourage an oral intake of 2 to 3 liters per day. Rationale: Many antibiotics are nephrotoxic, so the nurse would encourage liberal fluid intake each day to support a urinary output of at least 30 ml/hr. The other three actions are important but not the highest priority for this client.

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.Subinvolution b.Episiotomy infection c.Endometritis d.Mastitis

Endometritis Rationale: 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 collects a urine specimen for culture from a postpartum woman with a suspected urinary tract infection. Which organism would the nurse expect the culture to reveal? A.Klebsiella pneumoniae B.Staphylococcus aureus C.Escherichia coli D.Gardnerella vaginalis

Escherichia coli Rationale: E. coli is the most common causative organism for urinary tract infections. S. aureus is the most common causative organism for mastitis. G. vaginalis is a common cause of metritis. K. pneumoniae is a common cause of endometritis, but some species of Klebsiella may cause urinary tract infections.

A client is diagnosed with a postpartum infection. The nurse is most correct to provide which instruction? a.Change the perineal pad every 3 to 4 hours to decrease the uterine infection. b.Drink plenty of fluids to decrease a bladder infection. c.Apply ice to the perineum to decrease pain of a perineal infection. d.Finish all antibiotics to decrease a genital tract infection.

Finish all antibiotics to decrease a genital tract infection. Rationale: A postpartum infection is an infection of the genital tract after delivery through the first 6 weeks postpartum. It is most important to include finishing all antibiotics in nursing instructions. Endometritis is an infection of the mucous membrane or endometrium of the uterus. Cystitis is an infection of the bladder. Infection of the perineum or episiotomy is a localized infection and not inclusive of the entire genital tract.

In talking to a mother who is 6 hours post-delivery, the mother reports that she has changed her perineal pad twice in the last hour. What question by the nurse would best elicit information needed to determine the mother's status? a."Are you in any pain with your bleeding?" b."When did you last void?" c."What time did you last change your pad?" d."How much blood was on the two pads?"

How much blood was on the two pads?" Rationale: The nurse needs to determine the amount of bleeding the client is experiencing; therefore, the best question to ask the mother is the amount of blood noted on her perineal pads when she changes them. If she had an epidural, she may not feel any pain or discomfort with the bleeding. Although a full bladder can prevent the uterus from contracting, the nurse's main concern is the amount of lochia the mother is having.

The nurse is working with several clients who have recently delivered healthy newborns. Which statement by a mother would alert the nurse to further assess the mother for postpartum depression? a."The first few days I was home, I was overwhelmed." b."I seem to cry more each and every day that goes by." c."I am hearing voices and sometimes want to harm myself and my newborn." d."Life sure has changed since I had the newborn....I am so tired but it is worth it."

I seem to cry more each and every day that goes by." Rationale: The symptoms of postpartum depression are similar to the "baby blues" but worsen over time and do not lighten, so the nurse would further assess the mother who states she is crying more, not less. If the mother is in danger of harming herself or her newborn and hearing voices, she is likely experiencing postpartum psychosis, which is a psychiatric emergency.

A nurse is assessing a client with postpartum hemorrhage; the client is presently on IV oxytocin. Which interventions should the nurse perform to evaluate the efficacy of the drug treatment? Select all that apply. a.Assess deep tendon reflexes. b.Monitor the client's vital signs. c.Get a pad count. d.Assess the client's uterine tone. e.Assess the client's skin turgor.

Monitor the client's vital signs. Get a pad count. Assess the client's uterine tone. Rationale: A nurse should evaluate the efficacy of IV oxytocin therapy by assessing the uterine tone, monitoring vital signs, and getting a pad count. Assessing the skin turgor and assessing deep tendon reflexes are not interventions applicable to administration of oxytocin.

What medication would the nurse administer to a client experiencing uterine atony and bleeding leading to postpartum hemorrhage? a.Domperidone b.Oxytocin c.Calcium gluconate d.Magnesium sulfate

Oxytocin Rationale: Oxytocin causes the uterus to contract to improve uterine tone and reduce bleeding. Magnesium sulfate is administered to clients with preeclampsia or eclampsia or hypertension problems. Domperidone is used to increase lactation in women. Calcium gluconate is an antagonist used in clients experiencing side effects of magnesium sulfate.

The nurse is monitoring several postpartum women for potential complications related to the birthing process. Which assessment should a nurse prioritize on an hourly basis? a.Vital signs b.Pad count c.Complete blood count d.Urine volume excreted

Pad count Rationale: The way to monitor for bleeding every hour is to assess pads and percentage of the pad saturated by blood in the previous hour. It would not be necessary to do a complete blood count every hour, nor hourly urines. Vital signs are not typically taken every hour.

The nurse is assessing a client who is 14 hours postpartum and notes very heavy lochia flow with large clots. Which action should the nurse prioritize? a.Assess her blood pressure. b.Palpate her fundus. c.Have her turn to her left side. d.Assess her perineum.

Palpate her fundus. Rationale: The nurse should assess the status of the uterus by palpating the fundus and determining its condition. If it is boggy, the nurse would then initiate fundal massage to help it contract and encourage the passage of the lochia and any potential clots that may be in the uterus. Assessing the blood pressure and assessing her perineum would follow if indicated. It would be best if the woman is in the semi-Fowler position to allow gravity to help the lochia to drain from the uterus. The nurse would also ensure the bladder was not distended.

After the nurse teaches a local woman's group about postpartum affective disorders, which statement by the group indicates that the teaching was successful? a."Postpartum blues usually resolves by the 4th or 5th postpartum day." b."Postpartum depression develops gradually, appearing within the first 6 weeks." c."Postpartum psychosis usually involves psychotropic drugs but not hospitalization." d."Postpartum psychosis usually appears soon after the woman comes home."

Postpartum depression develops gradually, appearing within the first 6 weeks." Rationale: Postpartum depression usually has a more gradual onset, becoming evident within the first 6 weeks postpartum. Postpartum blues usually peaks on the 4th to 5th postpartum day and resolves by the 10th day. Postpartum psychosis generally surfaces within 3 weeks of giving birth. Treatment typically involves hospitalization for up to several months. Psychotropic drugs are almost always a part of treatment, along with individual psychotherapy and support group therapy.

The father of a 2-week-old infant presents to the clinic with his disheveled wife for a postpartum visit. He reports his wife is acting differently, is extremely talkative and energetic, sleeping only 1 or 2 hours at a time (if at all), not eating, and appears to be totally neglecting the infant. The nurse should suspect the client is exhibiting signs and symptoms of which disorder? a.Postpartum blues b.Maladjustment c.Postpartum psychosis d.Postpartum depression

Postpartum psychosis Rationale: Postpartum psychosis in a client can present with extreme mood changes and odd behavior. Her sudden change in behavior from normal, along with a lack of self-care and care for the infant, are signs of psychosis and need to be assessed by a provider as soon as possible. Postpartum depression affects the woman's ability to function; however, her perception of reality remains intact. Postpartum blues is a transitory phase of sadness and crying common among postpartum women.

A nurse is caring for a postpartum client whose most recent assessment reveals a large, purplish area of edema on the left side of the perineum. What action will the nurse take? a.Apply an ice pack and reassess in 30 minutes. b.Document the expected finding and reassess frequently. c.Provide a hot pack and administer analgesia as prescribed. d.Report the finding promptly to the primary health care provider.

Report the finding promptly to the primary health care provider. Rationale: This client's presentation is consistent with a hematoma, which indicates a hemorrhage and which must be treated promptly. Because this is a large hematoma, reporting this change in status is priority. If the hematoma had been small in size, hot and/or cold treatments will likely be used. This is not an expected finding; thus, the nurse needs to intervene.

A woman arrives at the office for her 4-week postpartum visit. Her uterus is still enlarged and soft, and lochial discharge is still present. Which nursing diagnosis is most likely for this client? a.Ineffective peripheral tissue perfusion related to interference with circulation secondary to development of thrombophlebitis b.Risk for fatigue related to chronic bleeding due to subinvolution c.Risk for impaired breastfeeding related to development of mastitis d.Risk for infection related to microorganism invasion of episiotomy

Risk for fatigue related to chronic bleeding due to subinvolution Rationale: Subinvolution is incomplete return of the uterus to its prepregnant size and shape. With subinvolution, at a 4- or 6-week postpartal visit, the uterus is still enlarged and soft. Lochial discharge usually is still present. The symptoms in the scenario are closest to those of subinvolution.

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

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

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

Symptoms include fever, chills, malaise, and localized breast tenderness. Rationale: Mastitis is an infection of the breast characterized by flu-like symptoms, along with redness and tenderness in the breast. The most common causative agent is Staphylococcus aureus. Breast abscess is rarely a complication of mastitis if the client continues to empty the affected breast. Mastitis usually occurs in one breast, not bilaterally.

A nurse is caring for a postpartum client who has been treated for deep vein thrombosis (DVT). Which prescription would the nurse question? a.Plan long rest periods throughout the day. b.Wear compression stockings. c.Take aspirin as needed. d.Take an oral contraceptive pill daily.

Take an oral contraceptive pill daily. Rationale: When caring for a client with DVT, the nurse should instruct the client to avoid using oral contraceptives. Cigarette smoking, use of oral contraceptive pills, sedentary lifestyle, and obesity increase the risk for developing DVT. The nurse should encourage the client with DVT to wear compression stockings. The nurse should instruct the client to avoid using products containing aspirin when caring for clients with bleeding, but not for clients with DVT. Prolonged rest periods should be avoided. Prolonged rest involves staying motionless; this could lead to venous stasis, which needs to be avoided in cases of DVT.

The nurse palpates a postpartum woman's fundus 2 hours after birth and finds it located to the right of midline and somewhat soft. What is the correct interpretation of this finding? a.The uterine placement is normal. b.The bladder is distended. c.The uterus is filling up with blood. d.There is an infection inside the uterus.

The bladder is distended. Rationale: If a postpartum client's bladder becomes full, the client's uterus is displaced to the side. The client should be taught to void on demand to prevent the uterus from becoming soft and increasing the flow of lochia.

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

The client feels empty since she gave birth to the neonate. Rationale: 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. The other options are considered normal and would not be cause for concern. Many first-time mothers are nervous about caring for their neonates by themselves after discharge. New mothers may want a demonstration before doing a task themselves. A client may want to get some uninterrupted sleep, so she may ask that the neonate be taken to the nursery.

A fundal massage is sometimes performed on a postpartum woman. The nurse would perform this procedure to address which condition? a.uterine atony b.uterine contraction c.uterine prolapse d.uterine subinvolution

Uterine atony Rationale:

A postpartum client is recovering from the birth and emergent repair of a cervical laceration. Which sign on assessment should the nurse prioritize and report to the health care provider? a.Decreased respiratory rate b.Weak and rapid pulse c.Elevated blood pressure d.Warm and flushed skin

Weak and rapid pulse Rationale: Excessive hemorrhage puts the client at risk for hypovolemic shock. Signs of impending shock include a weak and rapid pulse, decreased blood pressure, tachypnea, and cool and clammy skin. These findings should be reported immediately to the health care provider so that proper intervention for the client may be instituted.

What postpartum client should the nurse monitor most closely for signs of a postpartum infection? a.a primiparous client who had a vaginal birth b.a client who had an 8-hour labor c.a client who conceived following fertility treatments d.a client who had a nonelective cesarean birth

a client who had a nonelective cesarean birth Rationale: 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.

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.talking to the client and reassuring her that she will feel better soon b.scheduling electroconvulsive therapy c.telling the client that she has no need to be depressed d.administrating a selective serotonin reuptake inhibitor

administrating a selective serotonin reuptake inhibitor Rationale: 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.

Which intervention would be helpful to a client who is bottle feeding her infant and experiencing hard, engorged breasts? a. administering bromocriptine b. applying warm compresses c.restricting fluids d.applying ice

applying ice Rationale: Women who do not breastfeed often experience moderate to severe engorgement and breast pain when no treatment is applied. Ice promotes comfort by decreasing blood flow (vasoconstriction), numbing the area, and discouraging further letdown of milk. Restricting fluids does not reduce engorgement and should not be encouraged. Warm compresses will promote blood flow and hence, milk production, worsening the problem of engorgement. Bromocriptine has been removed from the market for lactation suppression.

Which measurement best describes postpartum hemorrhage? a.blood loss of 1,000 ml, occurring at least 24 hours after birth b.blood loss of 800 ml, occurring at least 24 hours after birth c.blood loss of 400 ml, occurring at least 24 hours after birth d.blood loss of 600 ml, occurring at least 24 hours after birth

blood loss of 1,000 ml, occurring at least 24 hours after birth Rationale: Postpartum hemorrhage involves blood loss in excess of 1,000 mL within the first 24 hours of delivery.

A nurse is caring for a client who has just given birth. What is the best method for the nurse to assess this client for postpartum hemorrhage? a.by monitoring hCG titers b.by assessing skin turgor c.by assessing blood pressure d.by frequently assessing uterine involution

by frequently assessing uterine involution Rationale: The nurse should closely assess the woman for hemorrhage after giving birth by frequently assessing uterine involution. Assessing skin turgor and blood pressure and monitoring hCG titers will not help to determine hemorrhage.

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? a.medications used during labor and birth b.drop in estrogen and progesterone levels after birth c.lack of social support from family or friends d.preexisting conditions in the client

drop in estrogen and progesterone levels after birth Rationale: 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. Lack of support, medications, and preexisting conditions may contribute but are not the main etiology.

A nurse is developing a plan of care for a postpartum woman with superficial venous thrombosis of the left leg. Which intervention would the nurse most likely include? a.administering opioids for pain relief b.encouraging elevation of the left leg c.administering intravenous anticoagulant therapy d.applying cool compresses to the left leg

encouraging elevation of the left leg Rationale: For the woman with superficial venous thrombosis, administer nonsteroidal anti-inflammatory drugs (NSAIDs) for analgesia, provide for rest and elevation of the affected leg, apply warm compresses to the affected area to promote healing, and use antiembolism stockings to promote circulation to the extremities. Intravenous anticoagulant therapy would be used for a woman with deep vein thrombosis.

The nurse is caring for a woman who experienced a vaginal birth 6 hours prior. The health care provider is concerned the woman may have retained placental tissue. What assessment finding would alert the nurse to further assess the client for complications of retained placental tissue? a.he client's pulse is 130 beats/min at rest and base line was 98 beat/min. b.The client's blood pressure is 160/78 mm Hg with a base line of 102/62 mm Hg. c.The client states being slightly nauseated and having no appetite since giving birth. d.The client reports perineal discomfort and burning pain.

he client's pulse is 130 beats/min at rest and base line was 98 beat/min. Rationale: Retained placental fragments (or tissue) is a cause of postpartum hemorrhage. The nurse would assess the client for signs of hemorrhage, including a high pulse rate. The blood pressure would be lower if hemorrhaging. The client's appetite and perineal pain are not indicative of a hemorrhage as stand-alone data.

The nurse is conducting a review class for a group of perinatal nurses about factors that place a pregnant woman at risk for infection in the postpartum period. The nurse determines that additional teaching is needed when the group identifies which factor? a.prolonged labor with multiple vaginal examinations to evaluate progress b.retained placental fragments c.loss of protection with premature rupture of membranes d.increased vaginal acidity leading to growth of bacteria

increased vaginal acidity leading to growth of bacteria rationale: Vaginal acidity is decreased due to the presence of amniotic fluid, blood, and lochia, all of which are alkaline. An alkaline environment encourages the growth of bacteria. With rupture of membranes, the barrier is removed, allowing bacteria to ascend through the internal genital structures. A prolonged labor with multiple vaginal examinations provides opportunities for exposure to organisms, with time for the bacteria to multiply. Retained placental fragments provide an excellent medium for bacterial growth.

A client presents to her postpartum appointment with vague reports. The nurse suspects postpartum depression based on which assessment finding? a.lack of pleasure b.She feels like eating all the time. c.She is over her interest in her baby. d.extreme periods of elation

lack of pleasure Rationale: Some signs and symptoms of postpartum depression include feeling restless, worthless, guilty, hopeless, moody, sad, overwhelmed; crying a lot; exhibiting a lack of energy and motivation; experiencing a lack of pleasure; changes in appetite, sleep, or weight; withdrawing from friends and family; feeling negatively toward her baby; or showing lack of interest in her baby.

An Rh-positive client gives birth vaginally 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.method of birth B.length of labor C.size of the neonate D.maternal Rh status

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

The nurse is assessing the breast of a woman who is 1 month postpartum. The woman reports a painful area on one breast with a red area. The nurse notes a local area on one breast to be red and warm to touch. What should the nurse consider as the potential diagnosis? a.breast yeast b. mastitis c.plugged milk duct d.engorgement

mastitis Rationale: Mastitis usually occurs 2 to 3 weeks after birth and is noted to be unilateral. Mastitis needs to be assessed and treated with antibiotic therapy.

A nurse is conducting a class for nurses working in the postpartum unit about ways to reduce the risk of postpartum infections. The nurse determines that the teaching was effective when the group identifies which preventive measure as essential? a.meticulous handwashing b.fluid intake limitations c.unlimited visitation from family and friends d.use of clean gloves for invasive procedures

meticulous handwashing Rationale: Meticulous handwashing is essential for preventing postpartum infections, including before and after each client care activity. Aseptic technique, not clean gloves, are needed when performing invasive procedures. All visitors should be screened for any signs of active infection to reduce the risk for exposure. Adequate hydration, not fluid limitations, would be appropriate.

A woman is experiencing a postpartum hemorrhage due to uterine atony. Which risk factor would the nurse recognize as contributory to this specific problem? A.preeclampsia B.placenta accreta C.multiparity D.fetal demise

multiparity Rationale: Risk factors for postpartum hemorrhage due to uterine atony include many factors, including multiparity. Placenta accreta is associated with placental issues, preeclampsia is seen in disruption of maternal clotting factors, and fetal demise can cause a disruption in maternal clotting factors, but not uterine atony.

A nurse is caring for a client in the clinic. The client reports burning during urination for the past few days. Assessment reveals cloudy urine, with the presence of white blood cells (WBCs). Vital signs: temperature, 101.4°F (38.5°C); heart rate, 101 beats/min; blood pressure, 100/64 mm Hg. The priority actions of the nurse should be to first -administer antibiotics -obtain a culture -Recheck the clients temperature Followed by -encourage intake of fluids -Initiate antibiotics -administer nonsteroidal anti- -inflammatory drug

obtain a culture Initiate antibiotics Rationale: The nurse should first obtain a culture for sensitivity before administering antibiotics. Once the culture has been obtained, the nurse should administer a broad-spectrum antibiotic per provider prescription. Rechecking the client's temperature is not necessary. An antibiotic should not be administered until a culture has been obtained. The priorities for this client would be to first obtain a culture, then administer a broad-spectrum antibiotic. The nurse will encourage fluid intake, but this is not the priority. A nonsteroidal anti-inflammatory drugs (NSAID) can be administered for fever, but the priority is to obtain a culture and start the client on a broad-spectrum antibiotic to start treating the infection.

Manual manipulation is used to reposition the uterus of a client experiencing uterine inversion. After the repositioning, which type of medication would the nurse administer as prescribed to the client? a.indomethacin b.nifedipine c.oxytocin agent d.magnesium sulfate

oxytocin agent Rationale: The nurse should administer a prescribed oxytocin agent to the client after repositioning the uterine fundus because it causes uterine contractions preventing reinversion and decreasing blood loss. The nurse should administer prescribed medications such as magnesium sulfate, indomethacin, and nifedipine, which are uterine relaxants that help in the repositioning of the uterus. These drugs are administered during the repositioning of the uterus and not after in case of uterine inversion.

Two weeks after giving birth, a woman is feeling sad, hopeless, and guilty because she cannot take care of the infant and partner. The woman is tired but cannot sleep and has isolated herself from family and friends. The nurse recognizes that this client is exhibiting signs of: a.lack of partner support. b.postpartum depression. c. maladjustment to parenting. d.postpartum blues.

postpartum depression. Rationale: Feeling sad; coping poorly; being overwhelmed; being fatigued, but unable to sleep; and withdrawing for social interactions are signs of postpartum depression. Signs of postpartum blues are similar, but less severe and seen within the first week after birth. It is normal for new mothers to feel overwhelmed and unable to care for her partner, as she did prior to the pregnancy. There is no evidence of lack of partner support in this situation.

Methylergonovine is prescribed for a woman experiencing postpartum hemorrhage. The nurse monitors the woman closely for which adverse effects? a.uterine hyperstimulation b.seizures c.headache d.flushing

seizures Rationale: Seizures, hypertension, uterine cramping, nausea, vomiting, and palpitations are adverse effects of methylergonovine. Uterine hyperstimulation is an adverse effect of oxytocin. Flushing and headache are adverse effects of carboprost.

Quickly determining the cause of postpartum hemorrhaging enables effective treatment. A nurse using the 5 Ts tool will recognize which of the following as potential causes of postpartum hemorrhage? Select all that apply. a.tissue b.time c.technique of birth d.thrombin e.tone

tissue time thrombin Rationale: A helpful way to remember the causes of postpartum hemorrhage is by using the 5 Ts: tone, tissue, trauma, thrombin, and traction.

Which factor puts a multiparous client on her first postpartum day at risk for developing hemorrhage? a.uterine atony b.moderate amount of lochia rubra c.thrombophlebitis d.hemoglobin level of 12 g/dl (120 g/L)

uterine atony Rationale: Multiparous women typically experience a loss of uterine tone due to frequent distentions of the uterus from previous pregnancies. As a result, this client is also at higher risk for hemorrhage. Thrombophlebitis does not increase the risk of hemorrhage during the postpartum period. The hemoglobin level and lochia flow are within acceptable limits.

A client who gave birth several hours ago is experiencing postpartum hemorrhage. She had a cesarean birth and received deep, general anesthesia. She has a history of postpartum hemorrhage with her previous births. The blood is a dark red. Which cause of the hemorrhage is most likely in this client? a.uterine atony b.disseminated intravascular coagulation c.retained placental fragment d.cervical laceration

uterine atony Rationale: Uterine atony, or relaxation of the uterus, is the most frequent cause of postpartum hemorrhage; it tends to occur most often in Asian or Hispanic woman. Conditions that contribute to uterine atony include having received deep anesthesia or analgesia and a prior history of postpartum hemorrhage. A cervical laceration is less likely because the blood is dark, not bright red, and bleeding from such a laceration usually occurs immediately after detachment of the placenta. Disseminated intravascular coagulation is typically associated with premature separation of the placenta, a missed early miscarriage, or fetal death, none of which is evident in this scenario. A retained placental fragment is possible, and could contribute to the atony, but there is no evidence for this in the scenario.

Which complication is most likely responsible for a late postpartum hemorrhage? a.cervical laceration b.perineal laceration c.clotting deficiency d.uterine subinvolution

uterine subinvolution Rationale: Late postpartum bleeding is usually the result of subinvolution of the uterus. Retained products of conception or infection commonly cause subinvolution. Cervical or perineal lacerations can cause an immediate postpartum hemorrhage. A client with a clotting deficiency may have an immediate postpartum hemorrhage if the deficiency is not corrected at the time of birth.

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? a.Dehydration b.Shock c.Normal vital signs d.Infection

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

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? a.Use of breast pumps b.Complete emptying of the breast c.Pierced nipple d.Frequent feeding

Pierced nipple Rationale: 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.

When monitoring a postpartum client 2 hours after birth, the nurse notices heavy bleeding with large clots. Which response is most appropriate initially? a.administering ergonovine b.performing bimanual compressions c.notifying the primary care provider d.massaging the fundus firmly

massaging the fundus firmly Rationale: Initial management of excessive postpartum bleeding is firm massage of the fundus and administration of oxytocin. Bimanual compression is performed by a primary health care provider. Ergonovine maleate should be used only if the bleeding does not respond to massage and oxytocin. The primary health care provider should be notified if the client does not respond to fundal massage, but other measures can be taken in the meantime.

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? a.Height, level of orientation, support systems bAttachment, lochia color, complete blood cell count c.Degree of responsiveness, respiratory rate, fundus location d.Blood pressure, pulse, reports of dizziness

Blood pressure, pulse, reports of dizziness Rationale: 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.

It is discovered that a new mother has developed a postpartum infection. What is the most likely expected outcome that the nurse will identify for this client related to this condition? a.Client's temperature remains below 100.4°F (38.8°C) orally. b.Lochia discharge amount is 6 inches or less on a perineal pad in 1 hour. c.Fundus remains firm and midline with progressive descent. d.Client maintains a urinary output greater than 30 ml per hour.

Client's temperature remains below 100.4°F (38.8°C) orally. Rationale: As fever would accompany a postpartum infection, a likely expected outcome would be to reduce the client's temperature and keep it in a normal range. The other expected outcomes do not pertain as directly to postpartum infection as does the reduced temperature.

Various medications are available to help control hemorrhage in the postpartum client. When reviewing the client's history, the nurse notes the client's history of asthma. Which medication if prescribed would the nurse question? a.carboprost b.methylergonovine c.dinoprostone d.oxytocin

carboprost Rationale: Carboprost is contraindicated with asthma due to the risk of bronchial spasms. Oxytocin should be given undiluted as a bolus injection, and methylergonovine should not be given to a woman who is hypertensive. Dinoprostone and methylergonovine can be used in pregnant clients with asthma, although should be used cautiously. Dinoprostone may cause hypotension, nausea/vomiting, diarrhea and temperature elevation.

The nurse reviews the history of a postpartum woman G3P3 and notes it is positive for obesity and smoking. The nurse would be especially alert for the development of signs and symptoms of which complication in this client? a.postpartum hemorrhage b.uterine atony c.metritis d.deep venous thrombosis

deep venous thrombosis Rationale: Factors that can increase a woman's risk for DVT include prolonged bed rest, diabetes, obesity, cesarean birth, progesterone-induced distensibility of the veins of the lower legs during pregnancy, severe anemia, varicose veins, advanced maternal age (older than 34), and multiparity. Reference:

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? a.Escherichia coli b.Staphylococcus aureus c.Streptococcus pyogenes (group A strep) d.group B streptococcus (GBS)

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

Effective nursing management involves many aspects and being aware of subtle changes in the client. Which finding should alert the nurse to a potential infection in the client? a.temperature of 38°C (100.4°F) or higher after the first 24 hours after birth b.temperature of 38.5°C (101.3°F) or higher after the first 36 hours after birth c.temperature of 39°C (102.2°F) or higher after the first 48 hours after birth d.temperature of 37.5°C (99.5°F) or higher after the first 12 hours after birth

temperature of 38°C (100.4°F) or higher after the first 24 hours after birth

Which assessment on the third postpartum day would indicate to the nurse that a woman is experiencing uterine subinvolution? a.She experiences "pulling" pain while breastfeeding. b.Her uterus is three finger widths under the umbilicus. c.Her uterus is 2 cm above the symphysis pubis. d.Her uterus is at the level of the umbilicus.

Her uterus is at the level of the umbilicus. Rationale A uterus involutes at a rate of one finger width daily. On the third postpartum day, it is normally three finger widths below the umbilicus.

The nurse notes uterine atony in the postpartum client. Which assessment is completed next? a.Assessment of bowel function b.Assessment of the perineal pad c.Assessment of laboratory data d.Assessment of the lung fields

.Assessment of the perineal pad Rationale: Uterine atony is a cause of postpartum hemorrhage due to the inability of the uterus to contract effectively. Assessment of the perineal pad for the characteristics and amount of bleeding is essential. It is important to monitor all postpartum women for excessive bleeding because two-thirds of the women who experience postpartum hemorrhage have no risk factors. Assessment of bowel and bladder function is routine in a postpartum assessment but not included in concerns for hemorrhage. Assessment of the lungs and any laboratory work is common but not as high of a concern.

One of the primary assessments a nurse makes every day is for postpartum hemorrhage. What does the nurse assess the fundus for? a.Content, lochia, place b.Consistency, shape, and location c.Consistency, location, and place d.Location, shape, and content

Consistency, shape, and location Rationale: Assess the fundus for consistency, shape, and location. Remember that the uterus should be firm, in the midline, and decrease 1 cm each postpartum day.

The nurse is assisting a new mother who is several hours postpartum. Which reaction by the new mother should be of concern to the nurse? a.Returns baby to the nursery because of fatigue b.Ignores the newborn crying c.Cuddles her baby close to her while feeding d.Is hesitant to change the diaper

Ignores the newborn crying Rationale: After birth, the woman would be excited and interested in the birth and the infant. Ignoring the newborn's crying may be an indication of malattachment and should be further evaluated and brought to the attention of the RN and/or health care provider. If this is a new mother, she may be hesitant to change the diaper because she is unsure of how to do it or fears she might hurt her newborn; she would need encouragement and instruction on how to do this.

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? a.laceration b.uterine inversion c.hematoma d.uterine atony

laceration Rationale: Lacerations typically present with a firm contracted uterus and a steady stream of unclotted bright red blood. 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. Uterine inversion would present with the uterine fundus at or through the cervix. Uterine atony would be manifested by a noncontracted uterus.

The nurse notes that a client's uterus, which was firm after the fundal massage, has become boggy again. Which intervention would the nurse do next? a.Use semi-Fowler position to encourage uterine drainage. b.Offer analgesics prescribed by health care provider. c.Check for bladder distention, while encouraging the client to void. d.Perform vigorous fundal massage for the client.

Check for bladder distention, while encouraging the client to void. Rationale: If the nurse finds a previously firm fundus to be relaxed, displaced, and boggy, the nurse should assess for bladder distention and encourage the woman to void or initiate catheterization as indicated. Emptying a full bladder facilitates uterine contraction and decreased bleeding. The nurse should not perform vigorous fundal massage. Excessive massage leads to overstimulation of uterine muscle, resulting in excessive bleeding. The nurse should place the client in a semi-Fowler position to encourage uterine drainage in the client with postpartum endometritis. The nurse should offer analgesics as prescribed by the health care provider to minimize perineal discomfort in clients experiencing postpartum lacerations.