Saunders | Postpartum Complications

338. The nurse is monitoring a postpartum client who received epidural anesthesia for delivery for the presence of a vulvar hematoma. Which assessment finding would best indicate the presence of a hematoma? 1. Changes in vital signs 2. Signs of heavy bruising 3. Complaints of intense pain 4. Complaints of a tearing sensation

1. Changes in vital signs - Because the client has had epidural anesthesia and is anesthetized, she cannot feel pain, pressure, or a tearing sensation. - Changes in vital signs indicate hypovolemia in an anesthetized postpartum client with vulvar hematoma.

331. The nurse is preparing a list of self-care instructions for a postpartum client who was diagnosed with mastitis. Which instructions should be included on the list? Select all that apply. 1. Wear a supportive bra. 2. Rest during the acute phase. 3. Maintain a fluid intake of at least 3000 mL. 4. Continue to breast-feed if the breasts are not too sore. 5. Take the prescribed antibiotics until the soreness subsides. 6. Avoid decompression of the breasts by breast-feeding or breast pump.

1. Wear a supportive bra. 2. Rest during the acute phase. 3. Maintain a fluid intake of at least 3000 mL. 4. Continue to breast-feed if the breasts are not too sore. - Take analgesics to relieve discomfort. - Antibiotics may be prescribed and are taken until the complete prescribed course is finished. They are not stopped when the soreness subsides. - Moist heat or ice packs - Wear a supportive bra. - Continued decompression of the breast by breast-feeding or breast pump is important to empty the breast and prevent the formation of an abscess.

330. The nurse is monitoring a client in the immediate postpartum period for signs of hemorrhage. Which sign, if noted, would be an *early sign* of excessive blood loss? 1. A temperature of 100.4 ° F 2. An increase in the pulse rate from 88 to 102 beats/minute 3. A blood pressure change from 130/88 to 124/80 mm Hg 4. An increase in the respiratory rate from 18 to 22 breaths/minute

2. An increase in the pulse rate from 88 to 102 beats/minute - An *increasing pulse* is an early sign of excessive blood loss because the heart pumps faster to compensate for reduced blood volume. - A *decrease in blood pressure* as the blood volume diminishes BUT would not be the earliest sign of hemorrhage. - A slight *increase in temperature* is normal. - A *slight increase respiratory rate* is normal. - During the *4th stage of labor, check vitals every 15 minutes during the first hour*.

337. A postpartum client is diagnosed with cystitis. The nurse should plan for which priority nursing action in the care of the client? 1. Providing sitz baths 2. Encouraging fluid intake 3. Placing ice on the perineum 4. Monitoring hemoglobin and hematocrit levels

2. Encouraging fluid intake - Cystitis: infection of the bladder - Consume 3000 mL of fluids per day - Sitz baths and ice would be for perineal discomfort - H&H levels would be monitored with hemorrhage

339. The nurse is developing a plan of care for a postpartum client with a small vulvar hematoma. The nurse should include which specific action during the first 12 hours after delivery? 1. Assess vital signs every 4 hours. 2. Measure fundal height every 4 hours. 3. Prepare an ice pack for application to the area. 4. Inform the health care provider of assessment findings.

3. Prepare an ice pack for application to the area. - A hematoma is a localized collection of blood into the tissues of the reproductive sac after delivery. - Application of ice reduces swelling caused by hematoma formation in the vulvar area.

332. The nurse is providing instructions about measures to prevent postpartum mastitis to a client who is breast-feeding her newborn. Which client statement would indicate *a need for further instruction?* 1. "I should breast-feed every 2 to 3 hours." 2. "I should change the breast pads frequently." 3. "I should wash my hands well before breast- feeding." 4. "I should wash my nipples daily with soap and water."

4. "I should wash my nipples daily with soap and water." - Soap is drying and could lead to cracking of the nipples - Breast-feed every 2 to 3 hours - Change nursing pads when they are wet - Avoid continuous pressure on the breasts.

336. The nurse is preparing to care for four assigned clients. Which client is at highest risk for hemorrhage? 1. A primiparous client who delivered 4 hours ago 2. A multiparous client who delivered 6 hours ago 3. A primiparous client who delivered 6 hours ago and had epidural anesthesia 4. A multiparous client who delivered a large baby after oxytocin (Pitocin) induction

4. A multiparous client who delivered a large baby after oxytocin (Pitocin) induction Causes of postpartum hemorrhage: - uterine atony - laceration of the vagina - hematoma development - retained placental fragments. Predisposing factors for hemorrhage: - previous history of postpartum hemorrhage - placenta previa - abruptio placentae - overdistention of the uterus from polyhydramnios, multiple gestation, a large neonate, infection, multiparity - dystocia (obstructed labour where after the delivery of the head, the anterior shoulder of the infant cannot pass below, or requires significant manipulation to pass below, the pubic symphysis -prolonged labor - operative delivery such as a cesarean or forceps delivery - intrauterine manipulation