Ch 25: Nursing Care of a Family Experiencing a Postpartum Complication
b) Palpate her fundus Pg. 650-651 The nurse should assess the status of the uterus by palpating the fundus and determining its condition. If it is boggy, the nurse would then initiate fundal massage to help it contract and encourage the passage of the lochia and any potential clots that may be in the uterus. Assessing the blood pressure and assessing her perineum would follow if indicated. It would be best if the woman is in the semi-Fowler position to allow gravity to help the lochia to drain from the uterus. The nurse would also ensure the bladder was not distended.
12. The nurse is assessing a client who is 14 hours postpartum and notes very heavy lochia flow with large clots. Which action should the nurse prioritize? a) Assess her blood pressure b) Palpate her fundus c) Have her turn to her left side d) Assess her perineum
a) Apply ice Pg. 662 Women who do not breastfeed often experience moderate to severe engorgement and breast pain when no treatment is applied. Ice promotes comfort by decreasing blood flow (vasoconstriction), numbing the area, and discouraging further letdown of milk. Restricting fluids does not reduce engorgement and should not be encouraged. Warm compresses will promote blood flow and hence, milk production, worsening the problem of engorgement. Bromocriptine has been removed from the market for lactation suppression.
3. Which intervention would be helpful to a client who is bottle feeding her infant and experiencing hard, engorged breasts? a) Applying ice b) Restricting fluids c) Applying warm compresses d) Administering bromocriptine
d) Client's temperature remains below 100.4°F (38.8°C) orally Pg. 656-657 As fever would accompany a postpartum infection, a likely expected outcome would be to reduce the client's temperature and keep it in a normal range. The other expected outcomes do not pertain as directly to postpartum infection as does the reduced temperature.
33. It is discovered that a new mother has developed a postpartum infection. What is the most likely expected outcome that the nurse will identify for this client related to this condition? a) Lochia discharge amount is 6 inches or less on a perineal pad in 1 hour b) Fundus remains firm and midline with progressive descent c) Client maintains a urinary output greater than 30 ml per hour d) Client's temperature remains below 100.4°F (38.8°C) orally
b) Postpartum psychosis Pg. 667-668 The client's signs and symptoms suggest that the client has developed postpartum psychosis. Postpartum psychosis is characterized by clients exhibiting suspicious and incoherent behavior, confusion, irrational statements, and obsessive concerns about the baby's health and welfare. Delusions, specific to the infant, are present. Sudden terror and a sense of impending doom are characteristic of postpartum panic disorders. Postpartum depression is characterized by a client feeling that life is rapidly tumbling out of control. The client thinks of oneself as an incompetent parent. Emotional swings, crying easily—often for no reason—and feelings of restlessness, fatigue, difficulty sleeping, headache, anxiety, loss of appetite, decreased ability to concentrate, irritability, sadness, and anger are common findings are characteristic of postpartum blues.
1. A nurse is caring for a client in the postpartum period. When observing the client's condition, the nurse notices that the client tends to speak incoherently. The client's thought process is disoriented, and they frequently indulge in obsessive concerns. The nurse notes that the client has difficulty in relaxing and sleeping. The nurse interprets these findings as suggesting which condition? a) Postpartum panic disorder b) Postpartum psychosis c) Postpartum blues d) Postpartum depression
b) Oxytocin Pg. 651 Oxytocin causes the uterus to contract to improve uterine tone and reduce bleeding. Magnesium sulfate is administered to clients with preeclampsia or eclampsia or hypertension problems. Domperidone is used to increase lactation in women. Calcium gluconate is an antagonist used in clients experiencing side effects of magnesium sulfate.
10. What medication would the nurse administer to a client experiencing uterine atony and bleeding leading to postpartum hemorrhage? a) Magnesium sulfate b) Oxytocin c) Calcium gluconate d) Domperidone
d) Obtain a clean-catch urine specimen Pg. 664-665 The client in this scenario shows classic signs of a urinary tract infection. The priority nursing action at this point is to obtain a clean-catch urine specimen to confirm the infection. The other answers are therapeutic management interventions that would take place after confirmation of the infection via the clean-catch urine specimen.
11. A woman recovering from cesarean birth in the hospital and who was catheterized complains of a feeling of burning on urination and a feeling of frequency. Which of the following should be the next nursing action? a) Encourage her to drink large amounts of fluid b) Administer amoxicillin, as prescribed c) Suggest that she take an oral analgesic d) Obtain a clean-catch urine specimen
d) Perform handwashing before breastfeeding Pg. 662 As a primary preventive measure to prevent mastitis, the nurse should instruct the client to perform good handwashing before breastfeeding. The nurse should instruct the client to frequently breastfeed to prevent engorgement and milk stasis. If the breast is distended before feeding, the nurse should instruct the client to apply cold (not warm) moist heat to the breast. Gently massaging the affected area of the breast also helps.
13. Which instruction should the nurse offer a client as primary preventive measures to prevent mastitis? a) Avoid frequent breastfeeding b) Avoid massaging the breast area c) Apply cold compresses to the breast d) Perform handwashing before breastfeeding
b) Complete the full course of antibiotic prescribed, even if you begin to feel better Pg. 663-664 Mastitis is an infection of the breast tissue with common reports of general flu-like symptoms that occur suddenly, along with tenderness, pain, and heaviness in the breast. Inspection reveals erythema and edema in an area localized to one breast, commonly in a pie-shaped wedge. The area is warm and moves or compresses on palpation. Nursing care focuses on supporting continued breastfeeding, preventing milk stasis, and administering antibiotics for a full 10 to 14 days. The client should empty the breasts every 1.5 to 2 hours to help prevent milk stasis and limit the spread of the mastitis. The use of analgesics, warm showers, and warm compresses to relieve discomfort may be encouraged; increasing the fluid intake will keep the client well-hydrated and able to produce an adequate milk supply. However, these actions would not be considered the most important aspects of self-care for this client at this time.
14. A client presents to the clinic with a 3-week-old infant reporting general flu-like symptoms and a painful right breast. Assessment reveals temperature 101.8°F (38.8°C) and the right breast nipple with a movable mass that is red and warm. The client is diagnosed with mastitis. Which instruction should the nurse prioritize for this client? a) Use NSAIDs, warm showers, and warm compresses to relieve discomfort b) Complete the full course of antibiotic prescribed, even if you begin to feel better c) Increase your fluid intake to ensure that you will continue to produce adequate milk d) Breastfeed or otherwise empty your breasts at least every 3 hours
c) Assess the woman's fundus Pg. 650-651 The nurse should prioritize assessing the uterine fundus to eliminate it as a source of the bleeding. Assessing the vital signs would be the next step, especially if the massage is ineffective, to determine if the client is becoming unstable. The nurse would then alert the RN or health care provider about the increased bleeding and/or unstable vital signs. The LPN would not initiate an IV infusion without an order from the health care provider but should be prepared to do so, if it is ordered.
15. The nurse is monitoring a client who is 5 hours postpartum and notes her perineal pad has become saturated in approximately 15 minutes. Which action should the nurse prioritize? a) Assess the woman's vital signs b) Initiate Ringer's lactate infusion c) Assess the woman's fundus d) Call the woman's health care provider
d) Assess for warmth, erythema, and pedal edema Pg. 659-660 This client is demonstrating potential symptoms of DVT, but is avoiding putting pressure on the leg and limping when ambulating. DVT manifestations are caused by inflammation and obstruction of venous return and can be assessed by the presence of calf swelling, warmth, erythema, tenderness, and pedal edema. The client would not need to bend the knee to assess for pain in the calf. Asking the client to raise her toe and draw a circle is assessing reflexes, and blanching a toe is assessing capillary refill (which may be affected by the DVT but is not indicative of a DVT).
16. The nurse observes an ambulating postpartum woman limping and avoiding putting pressure on her right leg. Which assessments should the nurse prioritize in this client? a) Bend the knee and palpate the calf for pain b) Ask the client to raise the foot and draw a circle c) Blanch a toe, and count the seconds it takes to color again d) Assess for warmth, erythema, and pedal edema
c) "You need to avoid medications which contain acetylsalicylic acid" Pg. 659 The nurse should caution the client to avoid products containing acetylsalicylic acid, or aspirin, and other nonsteroidal anti-inflammatory medications while on anticoagulation therapy. These medications inhibit the synthesis of clotting factors and can further prolong clotting time and precipitate bleeding. The nurse should instruct the client to avoid crossing the legs as a preventive measure. Hematuria is not expected and indicates internal bleeding. The client would be instructed to notify the primary health care provider for any prolonged bleeding. The client may not be able to breastfeed while taking anticoagulation medications. Warfarin is not thought to be excreted in breastmilk; however, most medications are excreted in breast milk. Therefore, breastfeeding is generally not recommended for the client on anticoagulation therapy.
17. The nurse is assigned to care for a postpartum client with a deep vein thrombosis (DVT) who is prescribed anticoagulation therapy. Which statement will the nurse include when providing education to this client? a) "You can breastfeed your newborn while taking any anticoagulation medication" b) "It is appropriate for you to sit with your legs crossed over each other" c) "You need to avoid medications which contain acetylsalicylic acid" d) "It is expected for you to have minimal blood in your urine during therapy"
d) The bladder is distended Pg. 651-664 If a postpartum client's bladder becomes full, the client's uterus is displaced to the side. The client should be taught to void on demand to prevent the uterus from becoming soft and increasing the flow of lochia.
18. The nurse palpates a postpartum woman's fundus 2 hours after birth and finds it located to the right of midline and somewhat soft. What is the correct interpretation of this finding? a) The uterus is filling up with blood b) The uterine placement is normal c) There is an infection inside the uterus d) The bladder is distended
b) Staphylococcus aureus Pg. 662 The most common cause of mastitis is S. aureus, transmitted from the neonate's mouth. Mastitis is not harmful to the neonate. E. coli, GBS, and S. pyogenes are not associated with mastitis. GBS infection is associated with neonatal sepsis and death.
19. The nurse is teaching a client with newly diagnosed mastitis about her condition. The nurse would inform the client that she most likely contracted the disorder from which organism? a) Escherichia coli b) Staphylococcus aureus c) Streptococcus pyogenes (group A strep) d) Group B streptococcus (GBS)
a) Infection Pg. 656-657 Temperatures elevated above 100.4° F (38° C) 24 hours after birth are indicative of possible infection. All but the temperature for this client are within normal limits, so they are not indicative of shock or dehydration.
2. The nurse is assessing a client 48 hours postpartum and notes on assessment: temperature 101.2oF (38.4oC), HR 82, RR 18, BP 125/78 mm Hg. The nurse should suspect the vital signs indicate which potential situation? a) Infection b) Normal vital signs c) Dehydration d) Shock
a) Appearance of petechiae Pg. 655 A complication of abruptio placentae is disseminated intravascular coagulation (DIC), which is manifested by petechiae, ecchymoses, and other signs of impaired clotting. Severe uterine pain, a board-like abdomen, and uterine inversion are not associated with DIC and placental abruption.
20. A nurse suspects that a client may be developing disseminated intravascular coagulation. The woman has a history of placental abruption (abruptio placentae) during birth. Which finding would help to support the nurse's suspicion? a) Appearance of petechiae b) Inversion of the uterus c) Severe uterine pain d) Board-like abdomen
d) "I need to apply pressure to any cut for 5 to 10 minutes" Pg. Anticoagulant therapy increases the woman's risk for bleeding. The statement about applying pressure to a cut would be correct. The woman should use an electric razor for shaving and avoid aspirin-containing products while on anticoagulant therapy. Black stools are not expected but indicate bleeding and should be reported.
21. A postpartum woman is being discharged with anticoagulant therapy for treatment of deep vein thrombosis. After teaching the woman about this therapy, the nurse determines that the teaching was successful based on which statement? a) "I should avoid taking acetaminophen if I have a headache" b) "The medicine will make my stools turn black" c) "It's okay for me to use a regular razor to shave my legs" d) "I need to apply pressure to any cut for 5 to 10 minutes"
b) Thrombophlebitis Pg. 659 The woman is at risk for thrombophlebitis due to the prolonged second stage of labor, necessitating an increased amount of time in bed, and venous pooling that occurs when the woman's legs are in stirrups for a long period of time. These findings are unrelated to retained placental fragments, which would lead to uterine subinvolution, or hypertension.
22. Review of a primiparous woman's labor and birth record reveals a prolonged second stage of labor and extended time in the stirrups. Based on an interpretation of these findings, the nurse would be especially alert for which condition? a) Uterine subinvolution b) Thrombophlebitis c) Hypertension d) Retained placental fragments
d) Dyspnea, diaphoresis, hypotension, and chest pain Pg. 661 Sudden unexplained shortness of breath and reports of chest pain along with diaphoresis and hypotension suggest pulmonary embolism, which requires immediate action. Other signs and symptoms include tachycardia, apprehension, hemoptysis, syncope, and sudden change in the woman's mental status secondary to hypoxemia. Anorexia, seizures, and jaundice are unrelated to a pulmonary embolism.
23. A multipara client develops thrombophlebitis after birth. Which assessment findings would lead the nurse to intervene immediately? a) Weakness, anorexia, change in level of consciousness, and coma b) Pallor, tachycardia, seizures, and jaundice c) Dyspnea, bradycardia, hypertension, and confusion d) Dyspnea, diaphoresis, hypotension, and chest pain
d) Pierced nipple Pg. 662 Certain risk factors contribute to the development of mastitis. These include inadequate or incomplete breast emptying during feeding or lack of frequent feeding leading to milk stasis; engorgement; clogged milk ducts; cracked or bleeding nipples; nipple piercing; and use of plastic-backed breast pads.
24. The nurse is giving an educational presentation to the local Le Leche league chapter. One woman asks about risk factors for mastitis. Which condition would the nurse most likely include in the response? a) Use of breast pumps b) Complete emptying of the breast c) Frequent feeding d) Pierced nipple
a) Risk for fatigue related to chronic bleeding due to subinvolution Pg. 655 Subinvolution is incomplete return of the uterus to its prepregnant size and shape. With subinvolution, at a 4- or 6-week postpartal visit, the uterus is still enlarged and soft. Lochial discharge usually is still present. The symptoms in the scenario are closest to those of subinvolution.
25. A woman arrives at the office for her 4-week postpartum visit. Her uterus is still enlarged and soft, and lochial discharge is still present. Which nursing diagnosis is most likely for this client? a) Risk for fatigue related to chronic bleeding due to subinvolution b) Risk for impaired breastfeeding related to development of mastitis c) Ineffective peripheral tissue perfusion related to interference with circulation secondary to development of thrombophlebitis d) Risk for infection related to microorganism invasion of episiotomy
d) Ambulate the client as soon as her vital signs are stable Pg. 660 The best prevention for thrombophlebitis is ambulation as soon as possible after recovery. Ambulation requires blood movement throughout the cardiovascular system, decreasing thrombophlebitis risks. Placing a bath blanket behind the knees interrupts circulation and could cause a thrombus. Fluids are encouraged not limited. Leg exercises may put strain on the abdominal incision.
26. The nurse is caring for a mother within the first four hours after a cesarean birth. Which nursing intervention would be most appropriate to prevent thrombophlebitis in the mother? a) Assist client in performing leg exercises every 2 hours b) Roll a bath blanket or towel and place it firmly behind the knees c) Limit oral intake of fluids for the first 24 hours to prevent nausea d) Ambulate the client as soon as her vital signs are stable
a) Escherichia coli Pg. 656 E. coli is the most common causative organism for urinary tract infections. S. aureus is the most common causative organism for mastitis. G. vaginalis is a common cause of metritis. K. pneumoniae is a common cause of endometritis, but some species of Klebsiella may cause urinary tract infections.
27. The nurse collects a urine specimen for culture from a postpartum woman with a suspected urinary tract infection. Which organism would the nurse expect the culture to reveal? a) Escherichia coli b) Staphylococcus aureus c) Klebsiella pneumoniae d) Gardnerella vaginalis
a) Weak and rapid pulse Pg. 650-651 Excessive hemorrhage puts the client at risk for hypovolemic shock. Signs of impending shock include a weak and rapid pulse, decreased blood pressure, tachypnea, and cool and clammy skin. These findings should be reported immediately to the health care provider so that proper intervention for the client may be instituted.
28. A postpartum client is recovering from the birth and emergent repair of a cervical laceration. Which sign on assessment should the nurse prioritize and report to the health care provider? a) Weak and rapid pulse b) Warm and flushed skin c) Decreased respiratory rate d) Elevated blood pressure
b) Postpartum hemorrhage Pg. 650 The nurse should know that a client with uterine fibroids or other uterine anomalies is likely to experience postpartum hemorrhage. Altered uterine contractility is one of the risk factors that will lead to postpartum hemorrhage. Altered uterine contractility does not occur as a result of uterine fibroids. Endometritis is the primary cause of postpartum infections. Postpartum infections are not caused by uterine fibroids. Uterine fibroids are not known to cause urinary tract infections.
29. A nurse is caring for a pregnant client. The client has been diagnosed with uterine fibroids. The nurse knows that which of the following is likely to occur in this client in the postpartum period? a) Urinary tract infection b) Postpartum hemorrhage c) Postpartum infections d) Altered uterine contractility
a) "When I am sleeping or lying in bed, I should lie flat on my back" Pg. 657 With a uterine infection, the client needs to be in a semi-Fowler position to facilitate drainage and prevent the infection from spreading. Changing the perineal pads regularly; walking to promote drainage; and contacting the doctor if her uterus becomes rigid (or if she notes a decrease in urinary output) are all correct actions.
30. The nurse is providing education to a postpartum woman who has developed a uterine infection. Which statement by the woman indicates that further instruction is needed? a) "When I am sleeping or lying in bed, I should lie flat on my back" b) "I will change my perineal pad regularly to remove the infected drainage" c) "If my abdomen becomes firm, or if I don't urinate as much, I need to call the doctor" d) "I will take frequent walks around my home to promote drainage"
c) Thromboembolic complications Pg. 659 The nurse should monitor the client for thromboembolic complications. The risk for thromboembolic complications increase when the client is older than 35, is obese, and has a history of diabetes or a pre-existing cardiovascular disease. Uterine prolapse occurs more commonly in perimenopausal clients. A client diagnosed with a puerperal infection is at increased risk for septic pelvic thrombophlebitis. Endometritis is the primary cause of postpartum infections.
31. The nurse would be alert for which of the following complications when caring for a 38-year-old postpartum client with a history of obesity and diabetes? a) Septic pelvic thrombophlebitis b) Uterine prolapse c) Thromboembolic complications d) Postpartum infections
d) "I can continue breastfeeding my infant, but it may be somewhat uncomfortable" Pg. 662 Breastfeeding on antibiotics for mastitis is fine, and the mother is encouraged to empty the infected breast to prevent milk stasis. However, the nurse should prepare the mother for the process being somewhat painful because the breast is tender. It is recommended to start the infant nursing on the uninvolved breast first as vigorous sucking may increase the mother's pain. Unless contraindicated by the antibiotic, the breast milk will be stored for later if the mother needs to pump her breasts; she does not need to throw the milk away.
32. The nurse is administering a postpartum woman an antibiotic for mastitis. Which statement by the mother indicates that she understood the nurse's explanation of care? a) "When breastfeeding, it is recommended to begin nursing on the infected breast first" b) "I will stop breastfeeding until I finish my antibiotics" c) "I am able to pump my breast milk for my baby and throw away the milk" d) "I can continue breastfeeding my infant, but it may be somewhat uncomfortable"
a) Check for bladder distention, while encouraging the client to void Pg. 662 If the nurse finds a previously firm fundus to be relaxed, displaced, and boggy, the nurse should assess for bladder distention and encourage the woman to void or initiate catheterization as indicated. Emptying a full bladder facilitates uterine contraction and decreased bleeding. The nurse should not perform vigorous fundal massage. Excessive massage leads to overstimulation of uterine muscle, resulting in excessive bleeding. The nurse should place the client in a semi-Fowler position to encourage uterine drainage in the client with postpartum endometritis. The nurse should offer analgesics as prescribed by the health care provider to minimize perineal discomfort in clients experiencing postpartum lacerations.
34. The nurse notes that a client's uterus, which was firm after the fundal massage, has become boggy again. Which intervention would the nurse do next? a) Check for bladder distention, while encouraging the client to void b) Perform vigorous fundal massage for the client c) Offer analgesics prescribed by health care provider d) Use semi-Fowler position to encourage uterine drainage
c) A woman with diabetes, vaginal birth, HR 110, temperature 101.7°F (38.7°C) on the third postpartum day. The next day, appears ill; temperature now 102.9°F (39.3°C); WBC 31,500/mm3; negative blood cultures Pg. 657 Endometritis is an infection of the endometrium of the uterus. Clinical manifestations include a fever of 100.4°F (38°C) or higher, usually between the 2nd and 10th day after delivery; tachycardia, chills, anorexia, and general malaise; client may also report abdominal cramping and pain. Reports of severe perineal pain and signs of fever and separation of the episiotomy edges would be suspicious for a wound infection. An elevated temperature of up to 100.4°F (38°C) within the first 24 hours is a normal response to the birthing process. Reports of severe burning on urination accompanied by fever and malaise would be suspicious of a UTI.
35. The nurse is caring for several postpartum clients and notes various warning signs that are concerning. Which client should the nurse suspect is developing endometritis? a) A woman with PROM before birth; reports severe burning with urination, malaise and severe temperature spikes on the 7th postpartum day. WBC is 21,850/mm3; temperature 101°F (38.3°C); skin pale and clammy b) A woman with a history of infection and smoking, temperature 101°F (38.3°C) on the fourth postpartum day; reports severe perineal pain; edges of the episiotomy have separated c) A woman with diabetes, vaginal birth, HR 110, temperature 101.7°F (38.7°C) on the third postpartum day. The next day, appears ill; temperature now 102.9°F (39.3°C); WBC 31,500/mm3; negative blood cultures d) An obese woman with temperature 100.4°F (38°C) at 12 hours after birth; lochia is moderate; negative vaginal cultures
a) "I believe my newborn is losing weight because I will not feed him because my milk was poisoned by the health care provider" b) "The newborn is not really mine emotionally, since I was never pregnant and do not have children" c) "When the newborn is sleeping, I can see his thoughts projected on my phone and I do not like the thoughts" Pg. 668 Postpartum psychosis is a serious and emergent condition in which the new mother has lost touch with reality and needs immediate psychiatric intervention. Visual hallucinations such as seeing the newborn's thoughts projected on her phone is a sign of postpartum psychosis. Denying the pregnancy or that the newborn is hers is a sign of postpartum psychosis. The delusion that her milk is poisoned is a sign of postpartum psychosis. Being concerned about time with the toddler is a sign of postpartum blues or possibly depression. Reaching out for family to visit is a positive coping skill.
4. The nurse is caring for several women in the postpartum clinic setting. Which statement(s), when made by one of the clients, would alert the nurse to further assess that client for postpartum psychosis? Select all that apply. a) "I believe my newborn is losing weight because I will not feed him because my milk was poisoned by the health care provider" b) "The newborn is not really mine emotionally, since I was never pregnant and do not have children" c) "When the newborn is sleeping, I can see his thoughts projected on my phone and I do not like the thoughts" d) "I am sad because I am not spending as much time with my toddler now that my newborn is here" e) "Sometimes I get tired of being with only the newborn, so I call my mom and sister to come visit"
b) "It's not uncommon after birth for you to have a full bladder even though you can't sense the fullness" Pg. 662 After a vaginal birth, the client should be encouraged to void every 4 to 6 hours. As a result of anesthesia and trauma, the client may be unable to sense the filling bladder. It is premature to catheterize the client without allowing her to attempt to void first. There is no need to contact the care provider at this time as the client is demonstrating common adaptations in the early postpartum period. Allowing the client's bladder to fill for another 2 to 3 hours might cause overdistention.
5. A client who gave birth vaginally 16 hours ago states she does not need to void at this time. The nurse reviews the documentation and finds that the client has not voided for 7 hours. Which response by the nurse is indicated? a) "I'll contact your health care provider" b) "It's not uncommon after birth for you to have a full bladder even though you can't sense the fullness" c) "If you don't attempt to void, I'll need to catheterize you" d) "I'll check on you in a few hours"
a) Blood pressure, pulse, reports of dizziness Pg. 651 Continue to monitor the woman's vital signs for changes. If she reports dizziness or light-headedness when getting up, obtain her blood pressure while lying, sitting, and standing, noting any change of 10 mm Hg or more.
6. The nurse is caring for a postpartum woman who exhibits a large amount of bleeding. Which areas would the nurse need to assess before the woman ambulates? a) Blood pressure, pulse, reports of dizziness b) Height, level of orientation, support systems c) Attachment, lochia color, complete blood cell count d) Degree of responsiveness, respiratory rate, fundus location
c) Finish all antibiotics to decrease a genital tract infection Pg. 656 A postpartum infection is an infection of the genital tract after delivery through the first 6 weeks postpartum. It is most important to include finishing all antibiotics in nursing instructions. Endometritis is an infection of the mucous membrane or endometrium of the uterus. Cystitis is an infection of the bladder. Infection of the perineum or episiotomy is a localized infection and not inclusive of the entire genital tract.
7. A client is diagnosed with a postpartum infection. The nurse is most correct to provide which instruction? a) Change the perineal pad every 3 to 4 hours to decrease the uterine infection b) Apply ice to the perineum to decrease pain of a perineal infection c) Finish all antibiotics to decrease a genital tract infection d) Drink plenty of fluids to decrease a bladder infection
b) Postpartum psychosis Pg. 667-668 Postpartum psychosis in a client can present with extreme mood changes and odd behavior. Her sudden change in behavior from normal, along with a lack of self-care and care for the infant, are signs of psychosis and need to be assessed by a provider as soon as possible. Postpartum depression affects the woman's ability to function; however, her perception of reality remains intact. Postpartum blues is a transitory phase of sadness and crying common among postpartum women.
8. The father of a 2-week-old infant presents to the clinic with his disheveled wife for a postpartum visit. He reports his wife is acting differently, is extremely talkative and energetic, sleeping only 1 or 2 hours at a time (if at all), not eating, and appears to be totally neglecting the infant. The nurse should suspect the client is exhibiting signs and symptoms of which disorder? a) Postpartum depression b) Postpartum psychosis c) Postpartum blues d) Maladjustment
b) Symptoms include fever, chills, malaise, and localized breast tenderness Pg. 662 Mastitis is an infection of the breast characterized by flu-like 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.
9. The nurse is teaching a client about mastitis. Which statement should the nurse include in her teaching? a) The most common pathogen is group A streptococcus (GAS) b) Symptoms include fever, chills, malaise, and localized breast tenderness c) Mastitis usually develops in both breasts of a breastfeeding client d) A breast abscess is a common complication of mastitis
