Ch. 17 Postpartum physiological adaptations

During the second postpartum day, a woman asks the nurse, "Why are my afterpains so much worse this time than after the birth of my other child?" The best answer by the nurse would be:

"Afterpains are more severe for women who have already given birth." Rationale:Afterpains are more acute for multiparas because repeated stretching of muscle fibers leads to low muscle tone, which results in repeated contraction and relaxation of the uterus. Breastfeeding increases the severity of afterpains. The afterpains are self-limiting and will decrease rapidly after 48 hours.

Constipation is a common problem during the postpartum period. Select all the reasons for constipation during this period.

-Diminished bowel tone -Episiotomy that causes the fear of pain with elimination -Some pain medications

When assessing the perineum, episiotomy site, or surgical site, the nurse should assess for specific signs. Select all the signs that are appropriate when assessing a surgical site.

-Redness -Edema -Ecchymosis -Discharge

When reading the postpartum chart the nurse notices that the client's fundus is recorded as "u+1." The nurse understands that this means the fundus is:

1 cm above the umbilicus. Rationale:Descent of the fundus is documented in relation to the umbilicus and is measured in centimeters. Numbers with a plus sign mean that the fundus is above the umbilicus; numbers with a minus sign mean that the fundus is below the umbilicus.

While doing client teaching, the woman tells the nurse, "I don't have to worry about contraception because I am breastfeeding." The nurse should base her answer on the fact that:

Breastfeeding is not a reliable contraceptive method. Rationale:Menses in a breastfeeding mother may resume between 12 weeks and 18 months. Normally the first few cycles of menses are without ovulation; however, ovulation may occur before the first menses. Therefore, other contraceptive measures are important considerations for this mother.

A mother that is 3 days postpartum calls the clinic and complains of "night sweats." She is afraid that she is going into early menopause. The nurse should base her answer on the fact that:

Diaphoresis is normal during the postpartum period, and comfort measures can be suggested to the mother. Rationale:Diaphoresis and diuresis rid the body of excess fluids that accumulated during the pregnancy. Diaphoresis is not clinically significant, but can be unsettling for the mother who is not prepared for it. Explanations of the cause and provision of comfort measures, such as showers and dry clothing, are generally sufficient.

Ice causes vasoconstriction and is most effective if applied soon after the birth to the perineal area to prevent

Edema

One nursing measure that can help prevent postpartum hemorrhage and urinary tract infections is:

Encouraging voiding every 2 to 3 hours. Rationale:Urinary retention and overdistention of the bladder may cause urinary tract infection and postpartum hemorrhage. Encouraging the mother to empty her bladder frequently will help prevent retention and overdistention. Forcing fluids and perineal care may assist with preventing urinary tract infections. Stool softeners assist with return of normal bowel elimination.

The nurse is assessing the client's vaginal discharge. It is red and has about a 2-inch stain on the peripad. The nurse will record this finding as a:

Light amount of lochia rubra. Rationale:Lochia rubra is red in color and occurs the first 3 or 4 days after birth. A light amount of discharge is classified as a 1- to 4-inch stain on the peripad.

Immediately after birth, the nurse can anticipate the fundus to be located:

Midway between the symphysis pubis and umbilicus. Rationale:Immediately after birth the uterus is about the size of a large grapefruit and the fundus can be palpated midway between the symphysis pubis and umbilicus. Within 12 hours the fundus rises to the level of the umbilicus. By the second day, the fundus starts to descend by approximately 1 cm/day.

On the first postpartum day a client's white blood cell count is 25,000/mm3. The nurse's next action should be to:

Note the results in the chart. Rationale:Marked leukocytosis occurs during the postpartum period. The WBC count increases to as high as 30,000/mm3. The WBC count should fall to normal values by day 7. Neutrophils, which increase in response to inflammation, pain, and stress to protect against invading organisms, account for the major increase in WBCs. Because this is a normal reading, noting the results in the chart is the appropriate action.

When assessing a woman who gave birth 2 hours ago, the nurse notices a constant trickle of lochia. The uterus is well contracted. The next nursing action should be to:

Notify the physician Rationale:Excessive lochia in the presence of a contracted uterus suggests lacerations of the birth canal. The health care provider must be notified so that lacerations can be located and repaired. The uterus is well contracted, so further massage is not necessary.

The postpartum woman has a blood pressure of 150/90 mm Hg, pulse of 72 bpm, and respirations of 14 breaths/min. She continues to bleed heavily. The order states she may have methylergonovine (Methergine), 0.2 mg IM, or oxytocin (Pitocin), 10 units IM for heavy bleeding. The nurse should administer which medication?

Oxytocin Rationale:Methylergonovine (Methergine) is contraindicated if the woman has an elevated blood pressure.

During the early post-cesarean section phase, it is important for the woman to turn, cough, and deep-breathe. The rationale for this is to prevent:

Pooling of secretions in the airway. Rationale:The post-cesarean section woman is usually on bed rest for the first 8 to 12 hours. She is at risk for pooling of secretions in the airway. By assisting her to turn, cough, and expand her lungs by breathing deeply at least every 2 hours, the pooling of secretions will be decreased.

A woman was admitted to the ED with her newborn baby. The baby was born 4 days ago at home. The woman had no prenatal care. The nurse is assessing the lab work and sees that the mother has an O-negative blood type, the baby is O-positive, and the Coombs test shows that the mother is not sensitized to the positive blood. The nurse's next action should be:

Record the findings of the lab work and not plan on any further action at this time. Rationale:The mother is a candidate for Rho(D) immune globulin; however, it should be given within 72 hours after childbirth to prevent the development of maternal antibodies. Because she gave birth 4 days ago, that time period as passed and she is not sensitized to the positive blood.

The first time a woman ambulates after the birth of the newborn, she has a nursing diagnosis of Risk for injury because of the:

Risk for developing orthostatic hypotension. Rationale:After birth a rapid decrease in intraabdominal pressure results in dilation of the blood vessels supplying the viscera. The resulting engorgement of abdominal blood vessels contributes to a rapid fall in blood pressure when the woman moves from a recumbent to a sitting position. The mother feels dizzy or lightheaded and may faint when she stands. Bradycardia is a normal change during the postpartum period. The cardiac output increases during the postpartum period, but does not produce orthostatic hypotension.

As part of the postpartum assessment, the nurse examines the breasts of a primiparous breastfeeding woman who is 1 day postpartum. An expected finding would be:

Soft, contender; colostrum is present. Rationale:Breasts are essentially unchanged for the first 2 or 3 days after birth. Colostrum is present and may leak from the nipples. On day 3 or 4 lactation begins and engorgement can occur, resulting in the findings of B and C. Response D indicates problems with the breastfeeding techniques used.

The new mother is complaining of pain at the episiotomy site; however, because she is breastfeeding, she does not want any medication. What other alternatives can the nurse offer this mother to help relieve the pain?

Topical anesthetics