ch15: postpartum adaptations
A new mother is concerned because it is 24 hours after birth and her breasts have still not become engorged with breast milk. How should the nurse respond to this concern? "You may have developed mastitis. I'll ask the primary care provider to examine you." "I'm sorry to hear that. There are some excellent formulas on the market now, so you will still be able to provide for your infant's nutritional needs." "You are experiencing lactational amenorrhea. It may be several weeks before your milk comes in." "It takes about 3 days after birth for milk to begin forming."
"It takes about 3 days after birth for milk to begin forming." The formation of breast milk (lactation) begins in a postpartal woman regardless of her plans for feeding. For the first 2 days after birth, an average woman notices little change in her breasts from the way they were during pregnancy, since midway through pregnancy she has been secreting colostrum, a thin, watery, prelactation secretion. On the third day postpartum, her breasts become full and feel tense or tender as milk forms within breast ducts and replaces colostrum. There is no need to recommend formula feeding to the mother. Mastitis is inflammation of the lactiferous (milk-producing) glands of the breast; there is no indication that the client has this condition. Lactational amenorrhea is the absence of menstrual flow that occurs in many women during the lactation period.
A 2-day old newborn is crying after being circumcised and the mother is attempting to comfort the infant but he continues to be fussy. Which statement by the nurse would best support the mother's actions? "Let me show you how to calm him down. I've been doing this for many years." "Many mothers find that offering a nipple dipped in sugar water helps soothe a baby after a painful procedure." "You would probably be more successful if you wrapped him in on a warm blanket." "Maybe you your husband will have better luck calming him down. Why don't you let him hold him?"
"Many mothers find that offering a nipple dipped in sugar water helps soothe a baby after a painful procedure." Parents need support when trying to care for their newborn infants. By offering positive phrases and encouraging the mother in her caretaking, the nurse conveys acceptance and confirms the mother's abilities.
The postpartum client and her husband are excited about their new baby. However, they are also concerned about getting pregnant again too soon and ask about using birth control. Which instruction should the nurse include in their discharge education to address this issue? "You will not ovulate until your menstrual cycle returns." "Ovulation may return as soon as 3 weeks after birth." "Ovulation does not return for 6 months after birth." "You may have intercourse until next month with no fear of pregnancy."
"Ovulation may return as soon as 3 weeks after birth." Ovulation may start at soon as 3 weeks after birth. The client needs to be aware and use a form of birth control. She needs to be cleared by her health care provider prior to intercourse if she has a vaginal birth, but in the event that she has intercourse, needs to be prepared for the possibility of pregnancy. Ovulation can occur without the return of the menstrual cycle, and ovulation does return sooner than 6 months after birth.
A woman who delivered her infant 2 days ago asks the nurse why she wakes up at night drenched in sweat. She is concerned that this is a problem. The nurse's best reply would be: "Often, when a postpartum woman perspires like you are reporting, it means that they have an infection." "Many women sweat after delivery but you seem to be perspiring far more than normal. I'll call the doctor." "I need to get your vital signs and check your fundus to be sure you are not going into shock." "Sweating is very normal for the first few days after childbirth because your body needs to get rid of all the excess water from pregnancy."
"Sweating is very normal for the first few days after childbirth because your body needs to get rid of all the excess water from pregnancy." Diaphoresis often occurs in postpartum women as a way to get rid of both excess water and waste through the skin. It is not uncommon for a woman to wake up drenched in sweat during the first few days following delivery. This is a normal finding and is not a cause for concern.
A client who had a vaginal birth 2 days ago asks the nurse when she will be able to breathe normally again. Which response by the nurse is accurate? "You should notice a change in your respiratory status within the next 24 hours." "Everyone is different, so it is difficult to say when your respirations will be back to normal." "It usually takes about 3 months before all of your abdominal organs return to normal, allowing you to breathe normally." "Within 1 to 3 weeks, your diaphragm should return to normal, and your breathing will feel like it did before your pregnancy."
"Within 1 to 3 weeks, your diaphragm should return to normal, and your breathing will feel like it did before your pregnancy." The abdominal organs, including the diaphragm, typically return to prepregnancy state within 1 to 3 weeks after birth. Discomforts such as shortness of breath and rib aches lessen, and tidal volume and vital capacity return to normal values.
The nurse is preparing to assess a client who is 1 day postpartum. The nurse predicts the client's fundus will be at which location on assessment? 1 cm below the umbilicus At the symphysis pubis 1 cm above the umbilicus At level of umbilicus
1 cm below the umbilicus The fundus of the uterus should be at the umbilicus after birth. Every day after birth it should decrease 1 cm until it is descended below the pubic bone.
A nurse is assessing a postpartum client and notes an elevated temperature. Which temperature protocol should the nurse prioritize? 100.3ºF (37.9ºC) at 24 hours postbirth and remains the same for the second postpartum day 99.1ºF (37.3ºC) at 12 hours postbirth and decreases after 18 hours 100.5ºF (38.1ºC) at 48 hours postbirth and remains the same the third day postpartum 100.1ºF (37.8ºC) at 24 hours postbirth and decreases the second postpartum day
100.5ºF (38.1ºC) at 48 hours postbirth and remains the same the third day postpartum A temperature that is greater than 100.4ºF (38ºC) on two postpartum days after the first 24 hours puts the client at risk for a postpartum infection. A fever in the first 24 hours of birth is considered normal and could be caused by dehydration and analgesia.
A nurse is making a home visit to a new mother who gave birth vaginally 5 days ago. The woman tells the nurse that she has lost some weight but still feels as if she has a long way to go to return to her prepregnancy weight. The woman asks the nurse about the average weight loss for 5 days postpartum. Which information would the nurse incorporate into the response? 19 lb 9 lb 24 lb 14 lb
19 lb The rapid diuresis and diaphoresis during the second to fifth days after birth usually result in a weight loss of 5 lb (2 to 4 kg), in addition to the approximately 12 lb (5.8 kg) lost at birth. Lochia flow causes an additional 2- to 3-lb (1-kg) loss, for a total weight loss of about 19 lb.
The nursing instructor is conducting a class exploring the various changes that occur in the early postpartum period. The instructor determines the session is successful when the students correctly point out which definition of bonding? The skin-to-skin contact that occurs in the birth room Family growing closer together after the birth of a new baby A process of developing an attachment and becoming acquainted with each other An ongoing process in the year after birth
A process of developing an attachment and becoming acquainted with each other Bonding in the maternal-newborn world is the attachment process that occurs between a mother and her newborn infant. This is how the mother and infant become engaged with each other and is the foundation for the relationship. Bonding is a process and not a single event. The process of bonding is not a yearlong process, and the family growing closer together after the birth of a new baby is not bonding.
The nurse discharging a newly delivered mother and her newborn infant needs to assess the mother's knowledge about how to take care of herself and her baby. This is her second child. Which approach would be best to verify the client's understanding of these topics? Have her fill out a questionnaire on the subject. Ask her questions and observe her caring for the baby. Since she has had a previous child, she should already know how to do most everything. Have her demonstrate how to do all the baby care tasks as well as her self-care tasks.
Ask her questions and observe her caring for the baby. The best way to determine if a mother understands the information given to her regarding caring for herself and her baby is to ask her and watch her as she cares for the newborn in the hospital.
The nurse is performing an assessment on a 2-day postpartum client and discovers a boggy fundus at the umbilicus and slightly to the right. The nurse determines that this is most likely related to which situation? Uterine atony Bladder distention Poor bladder tone Full bowel
Bladder distention Most often the cause of a displaced uterus is a distended bladder. Ask the client to void and then reassess the uterus. According to the scenario described, the most likely cause of the uterine findings would not be uterine atony. A full bowel or poor bladder tone would not cause a boggy and displaced fundus.
The nurse is performing an assessment on a 2-day postpartum client and discovers a boggy fundus at the umbilicus and slightly to the right. The nurse determines that this is most likely related to which situation? Uterine atony Full bowel Bladder distention Poor bladder tone
Bladder distention Most often the cause of a displaced uterus is a distended bladder. Ask the client to void and then reassess the uterus. According to the scenario described, the most likely cause of the uterine findings would not be uterine atony. A full bowel or poor bladder tone would not cause a boggy and displaced fundus.
A new mother is in the second developmental stage of becoming a mother and is becoming independent in her actions. Which action by the nurse would best foster this stage? Correcting the mother when she holds the newborn incorrectly. Telling the mother to feed the baby when it cries. Demonstrating how to do cord care on the newborn Changing the infant's diapers for the mother
Demonstrating how to do cord care on the newborn When a mother enters the independent period of the second stage of becoming a mother, the nurse can assist her best by supporting her and praising her when she cares for the newborn. By demonstrating cord care to her, it empowers her to do the cord care the next time it is needed. The nurse's job is to not take over but to assist the mother in caring for her newborn.
A nurse is performing an assessment on a female client who gave birth 24 hours ago. On assessment, the nurse finds that the fundus is 2 cm above the umbilicus and boggy. Which intervention is a priority? Notify the primary care provider, and document the findings. Check and inspect the lochia, and document all findings. Have the client void, and then massage the fundus until it is firm. Assess a full set of vital signs.
Have the client void, and then massage the fundus until it is firm. The fundus in a postpartum client should decrease 1 cm below the umbilicus each day. The fundus should also be firm to decrease the risk of postpartum hemorrhage. All of the listed interventions are appropriate, but a firm fundus is the priority.
The nurse is inspecting a new client's perineum. What action(s) will the nurse take for this client? Select all that apply. Inspect the episiotomy for sutures and ensure that the edges are approximated. Gently palpate for any hematomas. Place the client in Trendelenburg position for inspection. Palpate the episiotomy for pain. Note any hemorrhoids.
Inspect the episiotomy for sutures and ensure that the edges are approximated. Gently palpate for any hematomas. Note any hemorrhoids. The client is placed in the Sims position, not Trendelenburg position, for inspection. The nurse will then use a light to look at the perineum, noting any hemorrhoids, inspecting the episiotomy (if present), and palpating for any hematomas. The episiotomy is not palpated due to the pain associated with it, and the nurse can visually inspect it.
What two elements play the biggest role in becoming a mother after delivery of her newborn? Confidence and happiness with the pregnancy Love and attachment to the child and engagement with the child Planned and desired pregnancy and previous experience with infants Interactions with the child and support systems
Love and attachment to the child and engagement with the child A mother begins the process of becoming a mother during the pregnancy and this continues for the rest of her life. The two critical elements of becoming a mother are developing love and attachment to the newborn and becoming engaged with the child by assuming caregiving for the child as he grows and changes.
A client reports pain in the lower back, hips, and joints 10 days after the birth of her baby. What instruction should the nurse give the client after birth to prevent low back pain and injury to the joints? Apply ice to the sore joints. Try to avoid carrying the baby for a few days. Soak in a warm bath several times a day. Maintain correct posture and positioning.
Maintain correct posture and positioning. The nurse should recommend that clients maintain correct position and good body mechanics to prevent pain in the lower back, hips, and joints. Avoiding carrying her baby and soaking several times per day is unrealistic. Application of ice is suggested to help relieve breast engorgement in nonbreastfeeding clients.
The nurse is admitting to the floor a woman who just gave birth. What medical and pregnancy history would the labor and delivery nurse include in the report? Length of labor Maternal blood type The newborn's weight Apgar scores
Maternal blood type Medical and pregnancy history would include information pertinent to the mother, which would be the mother's blood type, Rh, and rubella status. History of the length of labor are part of the labor and birthing history. The infant's Apgar scores and birth weight are part of the newborn history.
A new mother tells the postpartum nurse that she thinks her baby does not like her since it cries often when she holds it. How should the nurse respond to this statement? Tell the mother that it is natural to have feelings of uncertainty when adjusting to a new baby. Recommend that she talk to the unit social worker to get the mother some counseling prior to discharge. Dismiss the mother's concerns by telling her that you are sure she doesn't really mean it. Recommend rooming-in to foster attachment and confidence by the mother.
Tell the mother that it is natural to have feelings of uncertainty when adjusting to a new baby. Negative comments are often made by mothers who lack confidence in their mothering abilities and are experiencing hormonal fluctuations. The best response by the nurse is to acknowledge the mother's concerns and be accepting and supportive to her. Trying to force attachment will only make the situation worse. The mother does not need psychological counseling nor should the nurse dismiss the mother's concerns.
A woman birth her infant 24 hours ago by cesarean. Which assessment findings should be reported to the assigned nurse? Select all that apply. The client reports breakthrough pain level of 7 to 8. Fundal height is one fingerbreadth below the umbilicus. Uterus feels boggy. The client's abdomen is mildly distended and bowel sounds are hypoactive. Bleeding is noted on the abdominal dressing 2 x 5 cm in size.
The client reports breakthrough pain level of 7 to 8. Uterus feels boggy. Following a cesarean birth, the client may experience numerous discomforts and problems. In this incidence, the fundal height is normal, the amount of bleeding is not abnormal, and mild abdominal distention with hypoactive bowel sound is expected. The concerning findings that need to be reported to the RN are the boggy uterus and the increased pain level. A boggy uterus can lead to hemorrhage and the pain level of 7 to 8 needs to be addressed with prescribed opioids.
A new mother asks the nurse what she is allowed to do when she goes home from the hospital. Which statement by the nurse would be correct? You should not lift anything heavier than your infant in its carrier. You should be able to resume normal activities after 2 weeks. Only clean half of the house per day to allow yourself more rest. You need to hire a maid for the first month after delivery to help out around the house.
You should not lift anything heavier than your infant in its carrier. New mothers need their rest. They should focus on caring for their newborn and themselves. Nurses should suggest that the mother not overexert herself and limit any heavy lifting. However, mild exercise can be resumed within 1 week after delivery if approved by the physician. Performing postpartum exercises to strengthen muscle groups and walking are good exercises to begin with.
A client has come to the office for her first postpartum visit. On evaluating her blood work, the nurse would be concerned if the hematocrit is noted to have: acutely increased. acutely decreased. slightly increased. slightly decreased.
acutely decreased. Despite the decrease in blood volume, the hematocrit remains relatively stable and may even increase, reflecting the predominant loss of plasma. An acute decrease in hematocrit is not an expected finding and may indicate hemorrhage.
While making a follow-up home visit to a client in her first week postpartum, the nurse notes that she has lost 5 pounds. Which reason for this loss would be the most likely? diuresis lactation blood loss nausea
diuresis Diuresis is the most likely reason for the weight loss during the first postpartum week. Lactation accelerating postpartum weight loss is a popular notion, but it is not statistically significant. Blood loss or nausea in the first postpartum week does not cause major weight loss.
The nurse is caring for a client who had been administered an anesthetic block during labor. For which risks should the nurse watch in the client? Select all that apply. incomplete emptying of bladder bladder distention ambulation difficulty urinary retention perineal laceration
incomplete emptying of bladder bladder distention urinary retention Many women have difficulty with feeling the sensation to void after giving birth if they have received an anesthetic block during labor, which inhibits neural functioning of the bladder. This client will be at risk for incomplete emptying, bladder distention, difficulty voiding, and urinary retention. Ambulation difficulty and perineal lacerations are due to episiotomy.
The nurse is assessing a client at a postpartum visit and notes the client is emotionally sensitive, complains about being a failure, and appears extremely sad. The nurse concludes the client is presenting with which potential condition? postpartum blues postpartum depression postpartum psychosis anxiety disorders
postpartum depression The client is showing signs of postpartum depression. Postpartum blues are due to lack of sleep and emotional labilities. Postpartum psychosis is symbolized by confusion, hallucinations, and delusions. Postpartum anxiety disorders involve shortness of breath, chest pain, and tightness.
A nurse is teaching a postpartum woman about breastfeeding. When explaining the influence of hormones on breastfeeding, the nurse would identify which hormone that is responsible for milk production? progesterone estrogen prolactin oxytocin
prolactin Prolactin from the anterior pituitary gland, secreted in increasing levels throughout pregnancy, triggers the synthesis and secretion of milk after the woman gives birth. During pregnancy, prolactin, estrogen, and progesterone cause synthesis and secretion of colostrum, which contains protein and carbohydrate but no milk fat. It is only after birth takes place, when the high levels of estrogen and progesterone are abruptly withdrawn, that prolactin is able to stimulate the cells to secrete milk instead of colostrum.
The nurse is assessing a postpartum client's vital signs 24 hours after the birth of her infant and notes: respirations 18, pulse 110 bpm, temperature 100.1°F (37.8°C), and blood pressure 128/88. Which assessment finding should the nurse prioritize for further attention? blood pressure respiration pulse temperature
pulse Tachycardia (heart rate above 100 bpm) in the postpartum woman warrants further investigation. It may indicate hypovolemia, dehydration, or hemorrhage. The other assessment findings would be considered within normal range for that time period. The nurse would want to initiate additional measures if the temperature was above 100.4°F (38°C) as this can indicate an infection.
A nurse is making a postpartum home visit to a woman who gave birth vaginally about 12 days ago. The woman's partner is present during the visit. When assessing the woman and the family, which finding related to the partner would lead the nurse to suspect that the partner may be experiencing postpartum depression? Select all that apply. reports of feeling highly stressed use of encouraging statements about the infant reports of frequent headaches statements that the woman is getting all the attention feelings of being unprepared for the role
reports of feeling highly stressed reports of frequent headaches statements that the woman is getting all the attention A partner's stress, irritability and frustration in the days, weeks, and months after the birth of the child can turn into depression, just like that experienced by the mother. Unfortunately, partners rarely discuss their feelings or ask for help, especially during a time when they are supposed to be the "strong one" for the new mother. Symptoms of depression appear 1 to 3 weeks after birth and can include feelings of high stress, anxiety, discouragement, fatigue, headaches, and resentment toward the infant and the attention he or she is getting. Partners experiencing these symptoms should understand that it is not a sign of weakness, and professional help can be helpful. Partner statements about not being prepared for the role is a common feeling and part of the role development process indicating reality.
The nurse is assessing a client at a postpartum visit. Which hemodynamic change will the nurse expect the client to exhibit? increase in cardiac output transient tachycardia rise in hematocrit increase in circulatory blood volume
rise in hematocrit Hemoglobin and erythrocyte values vary during the early postpartum period, but they should approximate or exceed prelabor values within 2 to 6 weeks. As the woman excretes extracellular fluid, hemoconcentration occurs, with a concomitant rise in hematocrit. Puerperal bradycardia, with rates of 50 to 70 beats per minute, is common during the first 6 to 10 days postpartum. Blood volume decreases following placental separation, contraction of the uterus, and increased stroke volume. Cardiac output begins to increase early in pregnancy and peaks at 20 to 24 weeks' gestation at 30% to 50% above prepregnant levels. Cardiac output decreases during the postpartum period following placental separation, contraction of the uterus, and increased stroke volume.
While providing care to a postpartum client on her first day at home, the nurse observes which behavior that would indicate the new mother is in the taking-hold phase? pointing out specific features in the newborn talking about her labor experience to others around her having feelings of grief or guilt showing increased confidence when caring for the newborn
showing increased confidence when caring for the newborn Showing increased confidence when caring for the newborn is an important aspect of the taking-hold phase. Recounting her labor experience is usually part of the taking-in phase. Identifying specific features of the newborn is typical of the taking-in phase. Feelings of grief, guilt, and anxiety are part of the letting-go phase where the mother accepts the infant as it is and lets go of any fantasies.
A client gave birth 1 day ago and the nurse is monitoring the client's blood pressure. In which position will the nurse place the client to get the most accurate reading? standing next to the bed after 3 minutes lying flat in the bed on the back lying on the right side for 5 minutes sitting on the side of the bed for 2 minutes
sitting on the side of the bed for 2 minutes To get the most accurate reading on a 1-day postpartum client's blood pressure, it is advised to have the client sit up on the side of the bed for several minutes to prevent orthostatic hypotension and a falsely low blood pressure.
A nurse is providing care to a postpartum woman during the immediate postpartum period. The nurse recognizes that the mother will need assistance with meeting her basic needs based on the understanding that the mother is most likely in which phase? taking-in phase attachment phase letting-go phase taking-hold phase
taking-in phase During the first 24 to 48 hours after giving birth, mothers often assume a very passive and dependent role in meeting their own basic needs, and allow others to take care of them. This is referred to as the taking-in phase. The taking-hold phase occurs when the client begins to assume control over her bodily functions. She is also showing strong interest in caring for the infant by herself. The letting-go phase occurs when the woman has assumed the responsibility for caring for herself and her infant.
Rubin identified a series of changes that a new mother makes during the postpartum period. The correct sequence of these changes is: taking-in, taking-hold, letting-go. taking, holding-on, letting-go. taking-in, holding-on, letting-go. taking-in, taking-on, letting-go.
taking-in, taking-hold, letting-go. The new mother makes progressive changes to know her infant ("taking-in"), review the pregnancy and labor, validate her safe passage through these phases ("taking-hold"), learn the initial tasks of mothering, and let go of her former life to incorporate this new child.
A woman comes to the clinic for her first postpartum visit. She gave birth to a healthy term neonate 2 weeks ago. As part of this visit, the woman has a complete blood count drawn. Which result would the nurse identify as a potential problem? platelets 350,000/µL (350 ×109/L) hemoglobin 12.5 g/dL (125 g/L) hematocrit 42% (0.42) white blood cell count 14,000/mm3 (14 ×109/L)
white blood cell count 14,000/mm3 (14 ×109/L) The white blood cell count, which increases in labor, remains elevated for the first 4 to 6 days after birth but then falls to 6,000 to 10,000/mm3 (6 to 10 ×109/L). An elevated white blood cell count would be suspicious for infection. The hemoglobin, hematocrit and platelet levels are within normal parameters for this woman.
