Ch 22: Nursing Management of the Postpartum Woman at Risk

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) "I need to avoid using any aspirin-containing products." B) "If I get a cut, I need to apply direct pressure for about 5 minutes or more." C) "If my lochia increases, I need to call my health care provider." D) "I should brush my teeth vigorously to stimulate the gums."

D) "I should brush my teeth vigorously to stimulate the gums." 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 teaching a client about mastitis. Which statement should the nurse include in her teaching? A) Symptoms include fever, chills, malaise, and localized breast tenderness. B) A breast abscess is a common complication of mastitis. C) The most common pathogen is group A beta-hemolytic streptococci. D) Mastitis usually develops in both breasts of a breastfeeding client.

A) Symptoms include fever, chills, malaise, and localized breast tenderness. Mastitis is an infection of the breast characterized by flulike 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.

On examining a woman who gave birth 5 hours ago, the nurse finds that the woman has completely saturated a perineal pad within 15 minutes. Which action by the nurse should be implemented first? A) Call the woman's health care provider. B) Assess the woman's fundus. C) Assess the woman's vital signs. D) Begin an IV infusion of Ringer's lactate solution.

B) Assess the woman's fundus. To have a suggested idea of the location of the bleeding, the nurse would need to assess the fundus of the client first.

Which behavior exhibited by a 4-hour postpartum woman requires further interventions by the nurse? A) returns her son to the nursery because of fatigue B) absent verbalization about the birthing process C) cuddles her son close to her while feeding D) tells visitors about her son and the labor

B) absent verbalization about the birthing process After birth the woman would be excited and interested in the birth and the infant. A woman may be tired and to ask for sleep is also expected; unexpected is the absent verbalization of the activities and birth.

Methylergonovine is prescribed for a woman experiencing postpartum hemorrhage. The nurse monitors the woman closely for which adverse A) headache B) uterine hyperstimulation C) flushing D) seizures

D) seizures 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.

A nurse is caring for a postpartum client diagnosed with von Willebrand disease. What should be the nurse's priority for this client? A) Monitor the pain level. B) Check the lochia. C) Assess the temperature. D) Assess the fundal height.

B) Check the lochia. 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 (30.0° 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 postpartal woman calls the nurse into her room because she is having a very heavy lochia flow containing large clots. The nurse's first action would be to: A) assess her blood pressure. B) palpate her fundus. C) have her turn to her left side. D) assess her perineum.

B) palpate her fundus Palpating the fundus will cause it to contract and reduce bleeding.

What is the most frequent reason for postpartum hemorrhage? A) endometritis B) uterine atony C) perineal lacerations D) disseminated intravascular coagulation

B) uterine atony When a uterus does not contract well, the denuded placental surface can bleed excessively.

Which complication is most likely responsible for a late postpartum hemorrhage? A) perineal laceration B) uterine subinvolution C) clotting deficiency D) cervical laceraion

B) uterine subinvolution 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.

A client who is hypertensive and who received corticosteroids during pregnancy gave birth by cesarean and subsequently developed endometritis. Her incision is red, warm, and very sensitive to touch, and she remains febrile despite antibiotic therapy. What is the most important aspect of post hospital care the nurse should teach her? A) use of warm compresses and sitz baths B) proper perineal care C) wound care and hand washing D) strict adherence to antibiotic therapy

C) wound care and hand washing The use of systemic corticosteroids prior to birth has increased her risk for development of an infection. She has been treated for endometritis and is now at greater risk for infection. Hand washing is the best defense again transmission of any infection. While adherence to antibiotic therapy, proper perineal care, and use of warm compresses and sitz baths may be indicated, they would not be a higher priority than wound care and hand washing.