Ch 21 Postpartum Complications EAQ
A patient with venous thromboembolism is given I.V. heparin as prescribed by the primary health care provider (PHP). After 3 days the patient is prescribed oral anticoagulants. What duration of oral anticoagulant therapy does the nurse expect the PHP to prescribe? 1 2 months 2 3 months 3 4 months 4 5 months
3 months The PHP will prescribe oral anticoagulation therapy to the patient for 3 months. Two months of therapy would not be sufficient to achieve the desired effects in the patient. Four to five months of anticoagulant therapy may increase the risk of osteoporosis, because anticoagulants antagonize the action of vitamin K. Vitamin K is a primary vitamin required for the growth of bones and maintenance of bone density.
The nurse is assessing a patient with postpartum hemorrhage (PPH). During the physical assessment, the nurse finds that there are deep lacerations in the cervix. Which observation allows the nurse to conclude that the PPH is caused by cervical lacerations? Dark red blood Bright red blood Clots in the blood Foul-smelling blood
Bright red blood Bright red blood indicates that hemorrhage was caused by deep lacerations of the cervix. Foul-smelling blood during the postpartum period indicates infection. Bleeding caused by varices or superficial lacerations of the birth canal is dark red. Clots in the blood indicate disseminated intravascular coagulation (DIC).
A 28-year-old multipara delivered a 9 pound, 3 ounce baby girl an hour ago after a 22-hour labor with a forceps-assisted birth. As the patient is holding her daughter, she keeps shifting position and is becoming increasingly irritable and annoyed with everyone in the room. What action should the nurse initially take? 1 Massage the fundus. 2 Check her perineum. 3 Assess her vital signs. 4 Check the tone of her fundus
Check her perineum The patient is exhibiting increasing anxiety, which can signal the presence of postpartum hemorrhage. Risk factors for postpartum hemorrhage include a large fetus, prolonged labor, and a forceps-assisted birth. Because vital signs change late, the fastest way to see the amount of current hemorrhage is to check the perineum. The fundus would be massaged and additional nursing and medical interventions would be instituted.
After removal of the retained placental fragment, the patient is recovering on the mother-baby (postpartum) unit. What should the nurse identify as the priority of care? 1 Monitoring the infant's ability to nurse. 2 Checking the perineum frequently. 3 Assessing vital signs frequently. 4 Encouraging the patient to ambulate.
Checking the perineum frequently. Even though the retained placental fragment has been removed, the patient is still at risk for postpartum hemorrhage. Because vital signs change late, checking the perineum is the best way to assess for postpartum hemorrhage and is the priority.
During the assessment of a postpartum patient, the nurse finds the patient has endometritis. Which medication should be administered in the treatment plan for this patient? Clindamycin (Cleocin) Misoprostol (Cytotec) Ergonovine (Ergotrate) Methylergonovine (Methergine)
Clindamycin (Cleocin) Endometritis is a common postpartum infection. It usually begins as a localized infection at the placental site and spreads to the entire endometrium. Endometritis is usually managed by giving the patient a broad-spectrum antibiotic drug, like Clindamycin (Cleocin). Therefore clindamycin (Cleocin) should be involved in the treatment plan for management of endometritis. Misoprostol (Cytotec), ergonovine (Ergotrate), and methylergonovine (Methergine) are uterotonic drugs used to manage postpartum hemorrhage (PPH) caused by uterine atony.
After physical assessment of a patient during labor, the nurse finds that the fetal head is exerting pressure on the patient's vaginal mucosa. Which postpartum complication does the nurse expect in the patient? 1 Distention of the uterus 2 Loss of pelvic muscle strength 3 Deep vaginal lacerations and hematomas 4 Adherence of the placenta to the vagina
Deep vaginal lacerations and hematomas When the fetal head exerts prolonged pressure on the vaginal mucosa during labor, it reduces the flow of blood to the vaginal tissue and causes ischemia. Because of the reduced oxygen supply and tissue damage, the patient may have necrosis of the vaginal mucosa. This leads to deep vaginal lacerations and vaginal hematomas. After labor the patient typically has uterine distention caused by the change in the position of the uterus and the loss of pelvic muscle strength. However, exertion of pressure by the fetal head does not cause uterus distention or the loss of pelvic muscle strength. During pregnancy, the placenta attaches to the uterus if the patient has defective endometrium. The placenta does not attach to the vaginal mucosa during labor.
Which intervention does the nurse expect to be the most effective and least expensive for reducing the risk of urinary tract infections in the patient after the labor? 1 Providing good nutrition after labor 2 Teaching comfort measures after labor 3 Providing antibiotic therapy before labor 4 Maintaining aseptic conditions during labor
Maintaining aseptic conditions during labor The most effective and least expensive intervention that helps reduce the risk of infection in the patient is to maintain aseptic conditions during labor. This helps reduce the invasion of microorganisms that may cause urinary tract infections (UTIs). Providing good nutrition helps prevent lethargy and anemia in the patient. Antibiotic therapy can be started if the patient already has a UTI, but they are not safe to be given as a prophylactic treatment during pregnancy, because they have teratogenic effects. Teaching comfort measures does not help in preventing infection.
The nurse is caring for a postpartum patient who has deep vein thrombosis and is receiving warfarin (Coumadin) therapy. What instruction should the nurse give to the patient? 1 "Perform exercises regularly." 2 "Rub the affected area frequently." 3 "Keep the knees in a flexed position." 4 "Keep changing positions in the bed."
"Keep changing positions in the bed." The nurse instructs the patient to change the positions frequently, because this may decrease discomfort. A patient with deep vein thrombosis should rest and avoid exercise, because exercise can cause the embolus to rupture, leading to severe complications. The patient should avoid keeping her knees in a sharply flexed position, because this can cause pooling of the blood in lower extremities. Rubbing the affected area frequently may cause the clot to dislodge and thus should be avoided.
A patient who had a postpartum hemorrhage is being discharged. What discharge instructions should the nurse give the patient? Select all that apply. 1 "Limit your physical activity." 2 "Alternate activity and rest periods." 3 "Increase the fat content in your diet." 4 "Increase dietary iron and protein." 5 "Increase caffeine content in your diet."
"Limit your physical activity." "Alternate activity and rest periods." "Increase dietary iron and protein." The patient needs to limit the amount of physical activity to conserve energy. The patient may feel fatigued and exhausted because of the excessive blood loss during the delivery. To reduce fatigue, the patient should avoid working continuously and alternate activities with sufficient rest periods in between. The patient must increase the amount of dietary iron and protein intake to increase recovery from the blood loss. Increased fat content is not advised, because it may cause cardiovascular problems and weight gain. Moderate caffeine intake is allowed. However, increased caffeine intake is associated with cardiovascular problems.
The nurse is caring for a patient with a mild rectocele. The patient reports no improvement in her condition even after using vaginal pessaries. What instruction does the nurse give to the patient? "Maintain a low-protein diet." "Decrease the intake of fluids." "Take antidiarrheal drugs regularly." "Maintain a diet that is rich in fiber."
"Maintain a diet that is rich in fiber." The nurse asks the patient to maintain a diet high in fiber, because fiber helps ease defecation in patients with rectocele. Increased intake of fluids should be encouraged to help in softening the stools. A diet that is high in protein does not ease defecation. Antidiarrheals cause retention of stools and should not be administered to patients with rectocele.
The nurse is caring for a postpartum patient with venous thrombosis. What instructions related to precautions to take with anticoagulant therapy should the nurse give to the patient at the time of discharge? 1 "Use contraceptives on a regular basis to prevent pregnancy." 2 "Use only aspirin (Acuprin) when you have significant pain." 3 "Practice site rotation for administration through the intramuscular (IM) route." 4 "Practice site rotation for administration through the subcutaneous (SC) route."
"Practice site rotation for administration through the subcutaneous (SC) route." When anticoagulants are prescribed to administer subcutaneously (SC), the patient must be educated not to inject the drug at the same site repeatedly, because this may cause tissue necrosis. Oral contraceptives are contraindicated with oral anticoagulants because of the possible risk of thrombosis and teratogenicity. Aspirin (Acuprin) is contraindicated for a patient on oral anticoagulants because of drug interactions and because aspirin increases the clotting time. Intramuscular (IM) injections of anticoagulants are typically not used, and no site rotation is needed if they are administered through the IM route.
The nurse is caring for a patient whose placenta was removed manually. The nurse finds that the patient has developed an infection. Which category of medication does the nurse expect to be prescribed for the patient? Diuretics Electrolytes Antipyretics Anticoagulants
Antipyretics When the placenta is removed manually, the patient may develop and infection, which may cause a fever. Therefore antipyretics are prescribed for the patient to reduce the body temperature. Electrolytes and anticoagulants are given when the patient has excessive bleeding. They help prevent hypovolemia and excessive loss of blood. Diuretics are given when the patient has edema caused by fluid retention.
A pregnant patient with preeclampsia reports having spontaneous bleeding from the gums and nose and excessive bleeding from slight trauma. Upon assessment the nurse finds that the patient has tachycardia and diaphoresis. The laboratory reports show decreased levels of fibrinogen and proaccelerin. What would the nurse infer about the patient's clinical condition? 1 Rectocele 2 Endometritis 3 Retroperitoneal hematoma 4 Disseminated intravascular coagulation
Disseminated intravascular coagulation Disseminated intravascular coagulation (DIC) is a pathologic clotting process that consumes large amounts of clotting factors, including platelets, fibrinogen, and prothrombin. Preeclampsia is a common cause of DIC. Spontaneous bleeding from the gums and nose and excessive bleeding from slight trauma are symptoms of DIC. Because the patient has decreased levels of fibrinogen and proaccelerin, the nurse may infer that the patient has DIC. Rectocele is the herniation of the anterior rectal wall through the relaxed or ruptured vaginal fascia and rectovaginal septum. Endometritis is a common postpartum infection, presenting with symptoms of fever, chills, loss of appetite, nausea, fatigue, dullness, pelvic pain, and foul-smelling lochia. Persistent perineal pain, a feeling of pressure in the vagina, and shock are symptoms of retroperitoneal hematoma.
postpartum patient who had a cesarean section reports to the nurse a fever, loss of appetite, pelvic pain, and foul-smelling lochia. Upon assessment, the nurse finds that the patient has an increased pulse rate and uterine tenderness. The laboratory reports indicate significant leukocytosis. What clinical condition should the nurse suspect based on these findings? Cystocele 2 Rectocele 3 Hematoma 4 Endometritis
Endometritis Endometritis is a common postpartum infection. It usually begins as a localized infection at the placental site and spreads to the entire endometrium. Fever, loss of appetite, pelvic pain, and foul-smelling lochia are symptoms of endometritis. An increased pulse rate and uterine tenderness are also common in this condition. Therefore the nurse can infer that the patient has endometritis. Cystocele is the protrusion of the bladder downward into the vagina. Rectocele is the herniation of the anterior rectal wall through the relaxed or ruptured vaginal fascia and rectovaginal septum. The symptoms reported by the patient are not indicative of these conditions. Because the nurse does not find any collection of blood in the patient, the patient does not have hematoma.
A postpartum patient experiencing depression has been prescribed monoamine oxidase inhibitors (MAOIs). What is important to teach the patient about this medication? To avoid: Excessive fluids during the course of therapy Foods high in fiber during the course of therapy Foods high in tyramine during the course of therapy Foods high in potassium during the course of therapy
Foods high in tyramine during the course of therapy The nurse should instruct the patient to avoid foods high in tyramine, such as cheese, because these foods interact with monoamine oxidase inhibitors (MAOIs) and cause hypertensive crisis. Patients who take MAOIs can have fluids and foods high in fiber, because they do not interact with the medications. Increasing fluid intake helps prevent dehydration, and fibrous foods help prevent constipation. MAOIs do not increase potassium levels in the body. Therefore the patient can have foods high in potassium.
The nurse is caring for a patient during labor. While examining the patient, the nurse palpates a smooth mass through the dilated cervix. The patient also shows signs of hypovolemic shock. What must be the immediate nursing intervention? 1 Administering tocolytics 2 Giving intravenous (I.V.) fluids 3 Administering oxytocin (Pitocin) 4 Pushing the uterus into the pelvic cavity
Giving intravenous (I.V.) fluids The presence of a smooth mass in the dilated cervix indicates an incomplete inversion of the uterus. The most lethal complications associated with this are hemorrhage and cardiovascular collapse. Because the patient shows signs of hypovolemic shock, fluid resuscitation must be performed immediately to prevent complications of shock. The uterus must be relaxed before attempting the uterine replacement. Tocolytics are administered to relax the uterus. Complete relaxation of the uterus can be obtained with halogenated anesthetics. Oxytocin (Pitocin) is administered after the uterus has been replaced in the pelvic cavity. It produces contractions in the uterus, which prevent reinvolution of the uterus. Once the uterus is relaxed from the tocolytic agents and halogenated anesthetics, the uterus is replaced manually within the pelvic cavity.
Upon reviewing the ultrasound reports for a patient, the nurse finds that the patient has a retroverted uterus. What is the best nursing intervention for this patient? Increase fluids orally. 2 Have the patient perform Kegel exercises. 3 Maintain hygienic conditions. 4 Have the patient assume a knee-chest position
Have the patient assume a knee-chest position A prone position, in which the individual rests on the knees and upper part of the chest, is referred to as the knee-chest position. A knee-chest position for a few minutes several times a day helps in correcting a mildly retroverted uterus, a condition in which the uterus is tilted back. Kegel exercises are performed to improve the tone of the pelvic floor muscles. The intake of more fluids does not treat a retroverted uterus. Maintaining good hygiene is important when a pessary is inserted in the vagina to support the uterus, but does not treat a retroverted uterus.
The nurse is caring for a patient during labor. Despite a firm and contracted uterine fundus, the patient has frank vaginal bleeding. Which action should the nurse take first? Give stool softeners to the patient. Wash the vagina with cold water. Identify whether there are lacerations in the birth canal. Administer analgesia to alleviate the pain.
Identify whether there are lacerations in the birth canal Lacerations of the birth canal may occur during the delivery of the baby. Continuous bleeding, despite a firm and contracted uterine fundus, indicates that the bleeding is caused by lacerations in the birth canal. Lacerations must be identified and sutured immediately after the birth of the baby to prevent heavy blood loss, which otherwise may result in hypovolemic shock. Once the bleeding is controlled, analgesics must be administered to alleviate the pain. A cold wash is given to alleviate the pain, hasten clot formation, and decrease the inflammation. The patient may have problems with defecation, because it can put stress on the sutured lacerations. Stool softeners are given to assist the patient in reestablishing bowel habits and to reduce the stress that might rupture the sutures.
During an examination, the nurse finds that a patient has a cystocele. What other associated complication does the nurse expect the patient to have? 1 Rectocele 2 Incontinence 3 Genital fistulas 4 Prolapsed uterus
Incontinence Urinary incontinence is a symptom associated with cystocele. A cystocele can damage the bladder neck and urethra, thereby causing incontinence. A patient with a rectocele has problems during defecation. Genital fistulas are abnormal passageways between the vagina and other genital organs. A prolapsed uterus is a condition in which the uterus comes out of the vagina.
A pregnant patient reports urine leakage while sneezing or coughing. What does the nurse expect to be the cause of this problem? 1 Increased abdominal pressure 2 Disorders of the bladder and urethra 3 Acquired urinary tract abnormalities 4 Pathologic conditions of the spinal cord
Increased abdominal pressure Because the patient is pregnant, she has increased intraabdominal pressure. In this condition, the angle between the urethra and the base of the bladder either increases or is lost. This may ultimately lead to incontinence. Urine may spurt out when the patient sneezes or coughs. Disorders of the bladder and urethra cause urge incontinence. Pathologic conditions of the spinal cord cause neuropathies, which disturb the control of urine but are not associated with sneezing. An acquired urinary tract abnormality can also cause impaired urine control, but incontinence is not associated with sneezing or coughing.
Which postpartum conditions are considered medical emergencies that require immediate treatment? 1 Inversion of the uterus and hypovolemic shock 2 Hypotonic uterus and coagulopathies 3 Subinvolution of the uterus and idiopathic thrombocytopenic purpura 4 Uterine atony and disseminated intravascular coagulation (DIC)
Inversion of the uterus and hypovolemic shock Inversion of the uterus and hypovolemic shock are considered medical emergencies . A hypotonic uterus can be managed with massage and oxytocin. Coagulopathies should be identified before birth and treated accordingly. Although subinvolution of the uterus and ITP are serious conditions, they do not always require immediate treatment. ITP can be safely managed with corticosteroids or IV immunoglobulin. DIC and uterine atony are very serious obstetric complications; however, uterine inversion is a medical emergency requiring immediate intervention.
The nurse is caring for a postpartum patient who had a cesarean delivery. Following the assessment, the nurse reports that the patient has secondary postpartum hemorrhage. Based on which patient findings did the nurse come to this conclusion? 1 Loss of 500 mL of blood within 24 hours of delivery 2 Loss of 1250 mL of blood 48 hours after the delivery 3 Hematocrit value reduced by 2% after the delivery 4 Hematocrit values reduced by 5% 6 weeks after the delivery
Loss of 1250 mL of blood 48 hours after the delivery Postpartum hemorrhage (PPH) is characterized by excessive bleeding after childbirth. If a patient has lost more than 1000 mL (1250 mL) of blood after a cesarean section, she is diagnosed with PPH. Based on the onset of bleeding, PPH is divided into two types: primary and secondary. If the bleeding occurs more than 24 hours after delivery, the patient has secondary PPH. Loss of excessive blood within 24 hours of delivery is considered primary PPH. Therefore the loss of 500 mL of blood within 24 hours of delivery does not indicate the patient has secondary PPH. A reduction of the hematocrit value by 10% after the labor indicates that the patient has PPH. Therefore the reduction of hematocrit values by 2% to 7% does not indicate that the patient has PPH.
Which postpartum infection is most often contracted by first-time mothers who are breastfeeding? 1 Endometritis 2 Wound infections 3 Mastitis 4 Urinary tract infections (UTIs)
Mastitis Mastitis is an infection in a breast, usually confined to a milk duct. Most women who suffer this are first-time mothers who are breastfeeding. Endometritis is the most common postpartum infection. Incidence is higher after a cesarean birth and not limited to first-time mothers. Wound infections are also a common postpartum complication. Sites of infection include both a cesarean incision and the episiotomy or repaired laceration. The gravidity of the mother and her feeding choice are not factors in the development of a wound infection. UTIs occur in 2% to 4% of all postpartum women. Risk factors include catheterizations, frequent vaginal examinations, and epidural anesthesia.
The nurse caring for a patient finds excessive postpartum bleeding caused by uterine atony. Upon further assessment, the nurse finds no improvement in the bleeding after administration of oxytocin (Pitocin). What does the primary health care provider prescribe to the patient? Paroxetine (Paxil) Sertraline (Zoloft) Misoprostol (Cytotec) Mirtazapine (Remeron)
Misoprostol (Cytotec) Oxytocin (Pitocin) is the primary drug administered to induce uterine contractions (UCs). When the uterus fails to respond to oxytocin, misoprostol (Cytotec) is administered to induce contractions. Paroxetine (Paxil) is an antidepressant drug used in the treatment of postpartum depression. Sertraline (Zoloft) is a selective serotonin reuptake inhibitor (SSRI) that serves as an antidepressant and is administered for postpartum depression. Mirtazapine (Remeron) is a drug used in the treatment of depression.
The nurse is assessing a patient who has urinary incontinence. Which condition most likely increased the risk of the patient's urinary incontinence? 1 Nulliparous, underweight, and has undergone a colectomy 2 Nulliparous, underweight, and has undergone a splenectomy 3 Multiparous, overweight, and has undergone a hysterectomy 4 Primiparous, underweight, and has undergone a cholecystectomy
Multiparous, overweight, and has undergone a hysterectomy Patients who have had multiple childbirths (multiparous) have a higher risk of urinary incontinence because of increased laxity of the pelvic floor muscles. An obese patient who has undergone a hysterectomy has a higher risk of developing urinary incontinence, because the hysterectomy can damage the nerve supply to the bladder. This, in turn, causes urinary incontinence. A patient who is nulliparous, is underweight, and has undergone colectomy is not at risk of urinary incontinence. Colectomy is the surgical removal of the colon and does not cause urinary incontinence. A patient who is nulliparous, is underweight, and has undergone splenectomy has a lower risk of developing urinary incontinence. Splenectomy is the surgical removal of the spleen and does not increase the risk of developing urinary incontinence. A patient who is primiparous, is underweight, and has undergone cholecystectomy has a lower risk of developing urinary incontinence. Cholecystectomy is the surgical removal of the gallbladder and does not cause urinary incontinence.
A pregnant patient with idiopathic thrombocytopenic purpura who is receiving corticosteroid therapy is scheduled for a splenectomy. In what clinical situation would this surgery be beneficial to the patient? If the patient had: No improvement from the administration of corticosteroids 2 An adverse reaction from the administration of corticosteroids 3 Increased platelet count from the administration of corticosteroids 4 Increased white blood cell (WBC) count from the administration of corticosteroids
No improvement from the administration of corticosteroids Idiopathic thrombocytopenic purpura (ITP) is a condition characterized by a very low platelet count and is treated by administering corticosteroids. When corticosteroids improve platelet count, patients do not need a splenectomy. However, splenectomy is needed if a patient does not respond to conventional medications. Adverse reactions to corticosteroids are not treated by splenectomy. White blood cell (WBC) count is normal in ITP, and corticosteroids inhibit their production.
A postpartum patient has uterine atony. What medication does the nurse expect the primary health care provider to prescribe to the patient? Oxytocin (Pitocin) Misoprostol (Cytotec) Ergonovine (Ergotrate) Methylergonovine (Methergine)
Oxytocin (Pitocin) Continuous I.V. infusion of 10 to 40 units of oxytocin (Pitocin) added to 1000 mL of lactated Ringer's or normal saline solution is a primary intervention in the management of postpartum bleeding. Drugs like misoprostol (Cytotec), ergonovine (Ergotrate), and methylergonovine (Methergine) are prescribed only if the patient is not responding to oxytocin (Pitocin).
It has been determined after ultrasound that a small piece of the placenta remains in the uterus over an hour after birth, causing the fundus not to be firm and excessive bleeding to continue. Because the patient delivered a large infant with a small dose of intravenous pain medication, what action would the nurse be taking? Preparing the patient for the removal of the retained placental fragment, including the use of anesthesia. Encouraging the consumption of oral fluids to expand the fluid volume. Preventing the mother from nursing her infant until her vital signs are stable. Encouraging the mother to nurse as much as possible to clamp down the fundal vessels.
Preparing the patient for the removal of the retained placental fragment, including the use of anesthesia. The patient will need to have the retained placental fragment removed under anesthesia because of the time period since delivery. The patient should be nothing by mouth (NPO) at this time because of the expected anesthesia. The infant can nurse, but the retained placental fragment will not allow the uterus to contract. After removal of a retained placenta, the woman is at continued risk for post partum hemorrhage (PPH) and infection.
A patient who has undergone cesarean surgery reports to the nurse persistent perineal pain and feeling pressure in the vagina. The nurse finds that the patient is in shock. What clinical condition should the nurse suspect based on this assessment? Rectocele Endometritis Impaired lactation Retroperitoneal hematoma
Retroperitoneal hematoma Retroperitoneal hematoma is the accumulation of blood in the retroperitoneal space. It is caused by the rupture of the cesarean scar during labor. Retroperitoneal hematoma is characterized by such symptoms as persistent perineal pain, a feeling of pressure in the vagina, and shock. Therefore it is evident that the patient has this condition. Persistent perineal pain, a feeling of pressure in the vagina, and shock are not associated with rectocele, endometritis, or impaired lactation. Rectocele is the herniation of the anterior rectal wall through the relaxed or ruptured vaginal fascia and rectovaginal septum. Endometritis is characterized by fever, increased pulse rate, chills, anorexia, nausea, fatigue, pelvic pain, uterine tenderness, and foul-smelling lochia. Because the patient did not report these symptoms, the patient does not have endometritis. Perineal pain, a feeling of pressure in the vagina, and shock do not affect lactation, so the patient does not have impaired lactation.
While caring for a postpartum patient with uterine displacement, the nurse suggests the patient perform Kegel exercises at least twice a day. What would be the probable reason for giving this suggestion to the patient? Kegel exercises: Prevent vaginitis. Maintain the vaginal pH. Prevent pressure necrosis. Strengthen pelvic muscles
Strengthen pelvic muscles After childbirth the patient may have uterine displacement because of pelvic muscle relaxation and loss of pelvic support. To strengthen the pelvic muscles, the patient must be encouraged to perform Kegel exercises several times a day. Vaginitis and pressure necrosis are caused by the use of pessaries, which provide structural support to the vagina. Kegel exercises do not prevent vaginitis and pressure necrosis. Maintaining proper hygiene and removing the pessaries at night can prevent these complications. Vaginal pH can be maintained by regularly douching the vagina with a weak vinegar solution.
After delivery the nurse finds that the patient has a retained placenta. The primary health care provider instructs the nurse to remove the placenta by manual separation without administering anesthesia to the patient. What patient clinical condition is the reason behind this instruction? The patient has increased respiratory rate and blood pressure. The patient was administered regional anesthesia before delivery. The patient has a history of acute stress disorder and hypothyroidism. The patient may not have much pain from manual separation of the placenta.
The patient was administered regional anesthesia before delivery If the placenta is retained longer than 30 minutes after delivery, it is removed by manual separation either by the nurse or the PHP. Manual separation is a very painful procedure and must be done after administering anesthesia. However, if the patient was administered regional anesthesia before delivery, anesthesia is not administered while manually separating the placenta, because regional anesthesia has a longer half life and influences the lower half of the body. Therefore the patient may not feel pain during the process. Anesthesia usually causes respiratory depression, but it does not increase the respiratory rate and blood pressure. Anesthesia does not worsen the symptoms of stress and hypothyroidism. Therefore it can be administered if the patient has an increased respiratory rate or blood pressure or a history of stress and hypothyroidism.
The nurse finds that despite gentle traction to the umbilical cord and uterine massage, a patient's placenta has not expelled 30 minutes after childbirth. The primary health care provider instructs the nurse to administer I.V. nitroglycerin (Nitrostat) to the patient. What could be the reason for this instruction? To prevent pelvic hematoma To increase the effects of regional anesthesia To promote uterine relaxation To prevent postpartum hemorrhage
To promote uterine relaxation The placenta is usually expelled within 30 minutes after birth. A retained placenta is a condition in which the placenta is not expelled within 30 minutes after birth despite using manual measures, such as gentle traction on the umbilical cord and uterine massage. In this condition I.V. nitroglycerin (Nitrostat) is administered to the patient to promote uterine relaxation. Nitroglycerin does not affect blood coagulation; therefore it does not prevent pelvic hematoma. Nitroglycerin is not an anesthetic agent; therefore it does not provide regional anesthesia. Nitroglycerin does not cause uterine contractions (UCs), so it does not prevent postpartum hemorrhage.
A woman with a history of a cystocele should contact the health care provider if she experiences: 1 Backache. 2 Constipation. 3 Urinary frequency and burning. 4 Involuntary loss of urine when she coughs
Urinary frequency and burning. Urinary frequency and burning are symptoms of cystitis, a common problem associated with cystocele. Back pain is a symptom of uterine prolapse. Constipation may be a problem with rectoceles. Involuntary loss of urine during coughing is stress incontinence and is not an emergency.
The nurse is caring for a patient who is diagnosed with disseminated intravascular coagulation. Which finding would indicate that the patient has developed a renal complication? 1 Urine pH less than 6 2 Urine output less than 30 mL/hr 3 Presence of pus cells in the blood 4 Red blood cells in the urine
Urine output less than 30 mL/hr Renal failure is the most significant complication associated with disseminated intravascular coagulation (DIC). A urine volume of less than 30 mL/hr indicates renal failure. The presence of pus cells in the urine indicates renal infection, which is not a complication associated with DIC. The presence of red blood cells in the urine indicates hemorrhage in the renal tubules. The normal pH of urine is 7. A pH of less than 6 indicates that the urine is acidic, which may be caused by diabetes.
During an assessment the nurse finds that a patient is multiparous, has multifetal gestation, and has polyhydramnios. What does the nurse expect the patient to be at risk for after the delivery? Hematomas Uterine atony Retained placenta Impaired lactation
Uterine atony A patient who has delivered a live baby more than once (multiparous), has multiple births (multifetal gestation), or has increased amniotic fluid volume (polyhydramnios) is at a high risk for uterine atony. In these conditions, the uterus is overstretched and contracts poorly after birth. Hematomas usually occur in primiparous conditions. Retained placenta is not necessarily seen in multiparous patients or patients with multifetal gestation. Parity and gestation do not affect the patient's lactation.
Following the assessment of a postpartum patient, the nurse suspects that the patient requires removal of uterine contents using a vacuum suction. Which patient clinical findings led the nurse to this conclusion? Select all that apply. Uterus feels hard. Uterus feels boggy. Excessive bleeding. Placental fragments. Scanty amniotic fluid
Uterus feels boggy. Excessive bleeding. Placental fragments. When the placenta is retained in the patient, it is typically removed by manual separation. This may leave some placental fragments in the uterus, causing excessive bleeding and making the uterus feel boggy. It may also lead to infection, so the uterine contents must be removed using vacuum suction. Therefore excessive bleeding, a boggy uterus, and the presence of placental fragments in the uterus indicate the need for vacuum suction. Usually the amniotic membrane is ruptured and the amniotic fluid is lost after childbirth, although this may not cause infection. The presence of a hard uterus indicates that the patient is free from infection and uterus atony and does not suggest the need for removing the uterine contents by vacuum suction.
The nurse suspects that a postpartum patient has deep vein thrombosis (DVT). Which diagnostic test should the nurse expect the health care provider to order to confirm DVT? Chest radiograph Arterial blood gases Pulmonary angiogram Venous ultrasonography
Venous ultrasonography The most commonly used diagnostic tool for deep venous thrombosis (DVT) is venous ultrasonography with or without color Doppler. Arterial blood gases are usually used to check acidosis or alkalosis. A pulmonary angiogram is performed to assess for pulmonary embolism. A chest radiograph is useful for detecting disorders of the lungs.
When a nurse observes profuse postpartum bleeding, the first and most important nursing intervention is to: 1 call the woman's primary health care provider. 2 administer the standing order for an oxytocic. 3 palpate the uterus and massage it if it is boggy. 4 assess maternal blood pressure and pulse for signs of hypovolemic shock
palpate the uterus and massage it if it is boggy. The most important nursing intervention is to stop the bleeding. Once the nurse has applied firm massage of the uterine fundus, the primary health care provider should be notified or the nurse can delegate this task to another staff member. This intervention is appropriate after assessment and immediate steps have been taken to control the bleeding. The initial management of excessive postpartum bleeding is firm massage of the uterine fundus. Vital signs will need to be ascertained after fundal massage has been applied.
Postpartum women experience an increased risk for urinary tract infection. A prevention measure the nurse could teach the postpartum woman would be to: acidify the urine by drinking three glasses of orange juice each day. maintain a fluid intake of 1 to 2 L/day. empty her bladder every 4 hours throughout the day. perform perineal care on a regular basis
perform perineal care on a regular basis Urine is acidified with cranberry juice. The woman should drink at least 3 L of fluid each day. The woman should empty her bladder every 2 hours to prevent stasis of urine. Keeping the perineum clean will help prevent a urinary tract infection.
The primary health care provider prescribed desmopressin (DDAVP) to a postpartum patient. What does the nurse expect the patient to have? 1 von Willebrand disease 2 Venous thromboembolism 3 Idiopathic thrombocytopenic purpura 4 Disseminated intravascular coagulation
von Willebrand disease von Willebrand disease (vWD) is a type of hemophilia caused by a deficiency of blood clotting protein and is treated by administering desmopressin (DDAVP). Venous thromboembolism is caused by the formation of clots, and is not treated with DDAVP. Idiopathic thrombocytopenic purpura is a condition in which the patient has a decreased platelet count, which is treated by administering corticosteroids. Disseminated intravascular coagulation results in a deceased fetus, which has to be surgically removed.