Chapter 14 High-Risk Postpartum Nursing Care
The nurse is assisting the primary care provider with the third stage of a vaginal delivery. The patient is multiparous, experienced a precipitous birth, and has a history of hypertension. Which medical prescription does the nurse anticipate for this patient?
Carboprost-tromethamine
The nurse in a labor and delivery department carefully assesses postpartum patients for signs of complications related to hemorrhage. Which factor makes it most difficult to identify the risk of hemorrhage through vital sign evaluation?
Changes in blood pressure may not be an immediate sign.
The nurse is providing care for a patient who is 8 hours postpartum after a vaginal delivery. The patient reports severe perineal pain unaffected by pain medication. The nurse notices a 4 cm area of discolo
Contact the primary care provider for further evaluation.
The nurse is aware the greatest source of bleeding during childbirth occurs following detachment of the placenta. Which physiological change takes place immediately after the expulsion of the placenta to decrease the amount of blood loss?
Contractions of the uterine myometrium
The nurse is providing care for a patient who is 1 day postpartum and exhibiting symptoms of postpartum psychosis. Which medical management does the nurse expect for this patient?
Immediate hospitalization in a psychiatric unit
The nurse is assessing a patient who is 36 hours postpartum following a cesarean delivery. Which findings cause the nurse to conclude that a wound infection is developing? Select all that apply.
Increased margins of incisional redness Notably warm skin around the incision
The nurse is aware of concern about the increasing numbers of severe maternal morbidity (SMM). It is believed to be related to changes in the overall health of the population of women giving birth. Which reasons does the nurse identify as causes of SMM? Select all that apply.
Increases in maternal age Prepregnancy obesity Cesarean deliveries Preexisting chronic medical conditions
A patient who is 8 months postpartum arrives for an OB appointment. The nurse notices that both the patient and the infant appear unkempt. The nurse anticipates a diagnosis of _________________________.
Postpartum depression
The lactation nurse takes a phone call from a mother who is breastfeeding her 2-month-old infant. The mother reports an area of redness and warmth on the breast and a painful burning sensation when breastfeeding. Which statement by the nurse is correct if mastitis is suspected?
"Continuing to breastfeed will help clear up the condition."
The nurse works in a labor and delivery facility with new protocols for estimating postpartum blood loss. Which method for estimating blood loss is implemented in the delivery room?
Collect blood in calibrated, under-buttocks drapes for vaginal birth.
The nurse continues to monitor a patient after a vaginal delivery with an estimated blood loss of 1,000 mL. Which assessment finding does the nurse recognize as requiring Stage 3 hemorrhage protocol?
Development of abnormal vital signs.
The nurse is providing postpartum care for a patient after a vaginal delivery. Which assessment finding causes the nurse to suspect endometritis from beta-hemolytic streptococcus?
Scant amount of odorless lochia
The nurse is preparing a postpartum patient for discharge. For which reasons does the nurse instruct the patient to call the primary care provider? Select all that apply.
Foul-smelling lochia Hot, red, painful breasts Frequent, painful urination
The nurse is preparing discharge teaching for a postpartum patient who exhibits signs and symptoms of an episiotomy infection and is on oral antibiotic therapy. Which discharge teaching will the nurse provide regarding pain management?
Information applicable to medication therapy
A postpartum patient informs the nurse of a frequent urge and burning when attempting to urinate. The nurse reviews the patient's medical record and associates which risk factors related to a possible urinary tract infection (UTI)? Select all that apply.
Neonatal macrosomia Use of a vacuum extractor Poor oral fluid intake Urinary catheter during labor
The nurse is closely monitoring a patient who is postpartum and at risk for PPH. Which assessment finding will cause the nurse to contact the primary care provider immediately?
Peripad weighs 100 g within 15 minutes.
The nurse on a postpartum unit observes a patient who delivered 2 days ago. The nurse notices extreme agitation and depressed mood. The patient states, "I think that my baby is deformed inside and we have to fix him." Which risk factor is most strongly related to possible postpartum psychosis (PPP)?
Prolonged labor resulting in cesarean
The labor and delivery unit nurses are adopting methods to reduce the number of women who develop postpartum depression. Research from Dennis and Dowswell (2013) provides evidence-based suggestions regarding beneficial interventions. Which suggestions do the nurses consider? Select all that apply.
Telephone-based peer support Interpersonal psychotherapy Professionally based postpartum home visits
The nurse is collecting information during a follow-up OB appointment with a patient who delivered 3 months ago. The patient reports her partner has become cynical, irritable, and verbally abusive. The nurse will screen for which risks related to paternal postnatal depression (PPND)? Select all that apply.
The father exhibited depression during the pregnancy. The birth of this fourth child was unexpected and unplanned. The father is recently estranged from his parents and siblings.
