Chapter 16 Nursing Management During the Postpartum Period

What suggestions can a nurse provide to the parents to minimize sibling rivalry during the postpartum period?

- Expect and tolerate some regression - Discuss the new infant during relaxed family times - Teach safe handling of the newborn with a doll - Encourage older children to verbalize emotions about the newborn - Move the sibling from the crib to a youth bed months in advance of the birth of the newborn

What are the postpartum physiologic danger signs?

- Fever more than 38/100.4 after the first 24 hrs following birth - Foul smelling lochia or an unexpected change in color or amount - Visual changes, such as blurred vision or spots, or headaches - Calf pain experienced with dorsiflexion on the foot - Swelling, redness, or discharge at the episiotomy site - Dysuria, burning, or incomplete emptying of the bladder - Shortness of breath or difficulty breathing - Depression or extreme mood swings

Discuss ways a nurse can model behavior to facilitate parental role adaptation and attachment during the postpartum period>

- Holding the newborn close and speaking positively - Referring to the newborn by name in front of the parents - Speaking directly to the newborn in a calm voice - Encouraging both parents to pick up and hold the newborn - Monitoring newborn's response to parental stimulation - Pointing out positive physical features of the newborn

Contact

Sensory experiences such as touching, holding, and gazing at the newborn

Postpartum Blues

Transient emotional disturbances

A client has been discharged from the hospital after a c-section. Which should the nurse include in the discharge teaching? a) follow up with your HCP within 3 weeks of being discharged b) Notify the HCP if your temp is greater than 99 c) you should she be seen by your HCP if you have blurred vision d) call your HCP if you saturate a peripad in less than 4 hours

C Rationale: The client needs to notify the HCP for blurred vision as this can indicate preeclampsia in the postpartum period. The client should also notify their HCP for a temp greater than 100.4 or if a peripad is saturated in less than 1 hour. The nurse should ensure that the follow up appointment is fixed for within 2 weeks for hospital discharge.

During assessment of the mother during the postpartum period, what sign should alter the nurse that the client is likely experiencing uterine atony? a) fundus feels firm b) foul smelling urine c) purulent vaginal drainage d) boggy or relaxed uterus

D Rationale: A boggy or relaxed uterus is a sign of uterine atony. This can be the result of bladder distention, which displaces the uterus upward and to the right, or retained placental fragments. Foul-smelling urine and purulent drainage are signs of infections but are not related to uterine atony. The firm fundus is normal and is not a sign of uterine atony.

A postpartum client is having difficult stopping her urine stream. Which should the nurse do next? a) determine if the client is emptying her bladder b) ask the client when she last urinated c) perform an in and out catheter on the client d) educate the client on how to perform Kegel excercises

D Rationale: Client should begin Kegel exercises on the first postpartum day to increase the strength of the pernineal floor muscles. Priority for this client would be to educate her how to perform Kegel exercises as strengthening these muscles will allow her to stop her urine stream.

Bonding

Development of a close emotional attachment to a newborn by the parents during the first 30-60 minutes after birth.

Process of attachment

Development of strong affectionate ties between an infant and a significant other.

_____________ hypotension can occur when the woman changes rapidly from a lying or sitting position to a standing one

Orthostatic

___________ is considered the fifth vital sign

Pain

_____________________ is the process by which the infant's capabilities and behavioral characteristic elicit parental response.

Reciprocity

A nurse is to care for a client during the postpartum period. The client reports pain and discomfort in her breasts. What signs should a nurse look for to find out if the client has engorged breasts? SATA a) breasts are hard b) breasts are tender c) nipples are fissured d) nipples are cracked e) breasts are soft

a, b Rationale: Engorged breasts are hard and tender, and the nurse should assess for these signs. Improper positioning of the infant on the breast, not engorged breasts, results in cracked, blistered, , bruised, or bleeding nipples in the breastfeeding woman.

A nurse is assessing a client during the postpartum period. Which findings indicate normal postpartum adjustment? SATA a) abdominal pain b) active bowel sounds c) tender abdomen d) passing gas e) nondistended abdomen

b, d, e Rationale: Finding active bowel sounds, verification of passing gas, and a non-distended abdomen are normal assessment results. The abdomen should be non tender and soft. Abdominal pain is not a normal assessment finding and should be immediately looked into

Any discharge from the nipple should be described and documented if it is not _________________ also called foremilk.

colostrum

The top portion of the uterus, also known as the ________________, is routinely assessed to determine uterine involution

fundus

Elevations in blood pressure from the woman's baseline might suggest pregnancy induced _____________________

hypertension

When palpating the breasts, any evidence of any nodules, masses, or areas of warmth, may indicate a plugged duct that may progress to _____________ if not treated properly.

mastitis

The ______________ is a plastic squeeze bottle filled with warm tap water that is sprayed over the perineal area after each voiding and before applying a new perineal pad.

peri-bottle

Proximity

physical and psychological experience of the parents being close to their infant

The nurse observes a 2 inch (5cm) lochia stain on the perineal pad of a 1 day postpartum client. Which of the following should the nurse do next? a) reassess the client in 1 hr b) document the lochia as scant c) ask when the peripad was changed d) massage the client's fundus

B Rationale: Scant would describe a 1-2 inch lochia stain on the perineal pad, or an approximate 10 mL loss. This is a normal finding in the postpartum client. The nurse would document this and continue to assess the client as ordered.

A nurse has been assigned to the care of a client who has just given birth. How frequently should the nurse perform the assessments during the first hour after birth? a) every 30 minutes b) every 15 minutes c) after 60 minutes d) after 45 minutes

B Rationale: Postpartum assessment is typically performed every 15 minutes for the first hour. After the second hour, assessment is performed every 30 minutes. The client has to be monitored closely during the first hour after birth; assessment frequencies of 45 or 60 minutes are too long.

Women who experience ______________ births will have less lochia discharge than those having a vaginal birth

Cesarean

______________________ refers to the enduring nature of the attachment relationship

Commitment

Upon assessment, a nurse notes the client has a pulse of 90 beats per minute, moderate lochia, and a boggy uterus. What should the nurse do next? a) notify the HCP b) assess the client's BP c) change the client's peripad d) massage the client's fundus

D Rationale: Tachycardia and a boggy fundus in the postpartum woman indicate excessive blood loss. The nurse would massage the fundus to promote uterine involution. It is not priority to notify the health care provider, assess BP, or change the peripad at this time

What nutritional recommendations can a nurse provide to a client during the postpartum period

Eat a wide variety of foods with high nutrient density use foods and recipes that require little to no prep avoid high fat, fast foods and fad weight reduction diets drink plenty of fluids avoid harmful substances such as alcohol, tobacco, and drugs avoiding excessive intake of fat, salt, sugar, and caffeine eat the recommended daily servings from each food group

What are the causes of postpartum stresses?

The physical stress of pregnancy and birth, the required care-giving tasks associated with a newborn, meeting the needs of other family members, and fatigue can cause the postpartum period to be quite stressful for the mother.

What does the postpartum assessment of the mother include?

Vital signs, pain level, systematic head to toe review of the body systems: breasts, uterus, bladder, bowels, lochia, episiotomy/perineum, extremities, and emotional status.

A client is Rh negative and has given birth to her newborn. What should the nurse do next? a) determine the newborn's blood type and rhesus b) determine if this is the client's first baby c) administer Rh immunoglobulins IM d) ask if the client received Rh immunoglobulins during the pregnancy

A Rationale: The nurse first needs to determine the rhesus of the newborn to know if the client needs Rh immunoglobulins. Mothers who are Rh negative and have given birth to an infant who is Rh positive should receive an injection of Rh immunoglobulin with 72 hours after birth; this prevents a sensitization reaction to Rh positive blood cells received during the birthing process. Women should receive the injection regardless of how many children they have had in the past.

A client who has given birth is being discharged. She wants to know how safe it would be for her to have intercourse. Which instructions should the nurse provide to the client regarding intercourse after birth? a) avoid use of water based gel lubricants b) resume intercourse if bright red bleeding stops c) avoid performing pelvic floor excercises d) use oral contraceptives for contraception

B Rationale: The nurse should inform the client that intercourse can be resumed if bright red bleeding stops. Use of water based gel lubricants can be helpful and should not be avoided. Pelvic floor exercises may enhance sensation and should not be avoided. Barrier methods such as a condom with spermicidal gel or foam should be used instead of oral contraceptives.

A nurse is caring for a client who has just received an episiotomy. The nurse observes that the laceration extends through the perineal area and continues through the anterior rectal wall. How does the nurse classify the laceration. a) first degree b) second degree c) third degree d) fourth degree

D Rationale: The nurse should classify the laceration as fourth degree because it continue through the anterior rectal wall. First degree laceration involves only skin and superficial structures above muscle; second degree laceration extends through perineal muscles; and third degree laceration extends through the anal sphincter muscle but not through the anterior rectal wall.

A nurse is applying ice packs to the perineal area of a client who has had a vaginal birth. Which intervention should the nurse perform to ensure that the client gets the optimum benefits of the procedure? a) apply ice pack directly to the perineal area b) apply ice pack for 40 minutes continuously c) Ensure ice pack is changed frequently d) Use ice packs for a week after birth

C Rationale: The nurse should ensure that the ice pack is changed frequently to promote normal hygiene and to allow for periodic assessments. Ice packs are wrapped in a disposable covering or clean washcloth and then applied to the perineal area, not directly. The nurse should apply the ice pack for 20 minutes, not 40. Ice packs should be used for the first 24 hours, not fora week after birth.

A client who has a breastfeeding newborn reports sore nipples. Which intervention can the nurse suggest to alleviate the client's condition? a) recommend a moisturizing soap to cleanse the nipples b) encourage use of breast pads with plastic liners c) offer suggestions based on observation to correct positioning or latching d) fasten nursing bra flaps immediately after feeding

C Rationale: The nurse should observe positioning and latching on technique while breastfeeding so that she may offer suggestions based on observation to correct positioning/latching This will help minimize trauma to the breast. The client should use only water, not soap, to clean the nipples to prevent dryness. Breast pads with plastic liners should be avoided. Leaving the nursing bra flaps down after feeding allows nipples to air dry.

When teaching the new mother about breastfeeding, the nurse is correct when providing what instructions? SATA a) give newborns water and other foods to balance nutritional needs b) help the mother initiate breastfeeding within 30 minutes of birth c) encourage breastfeeding of the newborn infant on demand d) provide breastfeeding newborns with pacifiers e) place baby in uninterrupted skin to skin contact with the mother.

b, c, e Rationale: The nurse should show mothers how to initiate breastfeeding within 30 minutes of birth. To ensure bonding, place the baby in uninterrupted skin to skin contact with the mother. Breastfeeding on demand should be encouraged. Pacifiers do not help fulfill nutritional requirements and are not a part of breastfeeding instruction. The nurse should also ensure than no food or drink other breast milk is given to newborns.

A first time mother is nervous about breast feeding. Which intervention would the nurse perform to reduce maternal anxiety about breastfeeding? a) Reassure the mother that some newborns "latch on and catch on" right away, and some newborns take more time and patience b) Explain that breastfeeding comes naturally to all mothers c) Tell her that breastfeeding is a mechanical procedure that involves burping once in a while and that she should try finishing it quickly d) Ensure that the mother breastfeeds the newborn using the cradle method

A Rationale: The nurse should reassure the mother than some newborns "latch on and catch on" right away, and some newborns take more time and patience; this information will help to reduce the feelings of frustration and uncertainty about their ability to breastfeed. The nurse should also explain the breastfeeding is a learned skill for both parties. It would not be correct to say that breastfeeding is a mechanical procedure. In fact, the nurse should encourage the mother to cuddle and caress the newborn while feeding. The nurse should allow sufficient time to the mother and child to enjoy each other in an unhurried atmosphere. The nurse should teach the mother to burp the newborn frequently. Different positions such as cradle and food ball holds and side lying positions, should be shown to the mother.