Chapter 16: Nursing Management During the Postpartum Period

For the woman who is not breast-feeding her newborn, which measure would be most appropriate to relieve engorgement? a. Warm showers b. Nipple stimulation c. Ice to the breasts d. Manually expressing milk

c. Ice to the breasts

Women who had a cesarean birth will have less lochia discharge than those who had a vaginal birth but with the same stages and color. a. True b. False

a. True

A nurse is assessing a postpartum client. Which measure is appropriate? a. Place the client in a supine position with her arms overhead for the examination of her breasts and fundus. b. Instruct the client to empty her bladder before the examination. c. Wear sterile gloves when assessing the pad and perineum. d.Perform the examination as quickly as possible.

b

A full bladder in a postpartum woman can lead to which complication? a. permanent urinary incontinence b. increased lochia drainage c. fluid volume overload d. ruptured bladder

b If the bladder is full in a postpartum mother, lochia drainage will be more than normal because the uterus cannot contract to suppress the bleeding.

Lochia can have either a musky scent or foul-smelling. a. True b. False

b. False

During the second hour after birth, postpartum assessment typically is A. every 15 minutes B. every 30 minutes C. every 45 minutes D. every 4 hours

B. every 30 minutes

A nurse is conducting a class on various issues that might develop after going home with a new infant. After discussing how to care for hemorrhoids, the nurse understands that which statement by the class would indicate the need for more information? a. "I only eat a low-fiber diet." b. "I already have some pads with witch hazel at home." c. "My mom always used dibucaine." d. "Sitz baths worked the last time."

a

Ice and sitz bath can be used to relief discomfort, reduce edema, and promote perineal healing after birth. a. True b. False

a. True

Risk Factors for Postpartum Infection

• Operative procedures (vacuum extraction, forceps, cesarean) • History of diabetes, including gestation diabetes • Prolonged labor (> 24 hours) • Use of indwelling urinary catheter • Anemia (hemoglobin < 10.5 mg/dL) • Multiple vaginal examination during labor • Prolonged rupture of membranes (>24hours) • Manual extraction of placenta • Compromised immune system (HIV +)

Risk factors for postpartum Hemorrrhage

• Precipitous labor (< 3hours) • Uterine atony • Placenta previa or abruptio placenta • Labor induction or augmentation • Operative procedures (vacuum extraction, forceps, cesarean) • Retained placental fragments • Prolonged third stage of labor (>30minutes) • Multiparity, more than 3 births closely spaced • Uterine over distention (large infant, twins, hydramnios)

Postpartum danger signs: a. Blood pressure of 140/90 mm Hg b. Pulse rate of 61 bpm c. Fever of 100.9 F d. Bleeding that saturates a peripad in an hour e. Shortness of breath

c. Fever of 100.9 F d. Bleeding that saturates a peripad in an hour e. Shortness of breath

Put the following steps in order when assessing a postpartum woman 1. Palpating the fundus 2. Palpating the abdomen for tenderness 3. Inspect the abdomen for distension 4. Auscultate for bowel sounds in all four quadrants

3, 4, 1, 2

Engorged breasts are: a. Soft, tender, and filling b. Soft, tender, and taut c. Hard, tender, and taut d. Hard, tender, and filling

c. Hard, tender, and taut

For a bottle-feeding woman, which of the following action(s) can be used to suppressing lactation: a. Warm showers b. Nipple massage c. Ice to the breasts d. Wear a snugly fitting bra e. Restrict water intake

c. Ice to the breasts d. Wear a snugly fitting bra

Before assess the fundus after birth, have the woman do the following: a. Drink some warm water b. Empty her bladder c. Stay in Fowler position d. Stay in Sims position

b. Empty her bladder

Postpartum assessment of the mother typically includes (select all that apply): A. vital signs B. last bowel movement C. pain level D. epidural site inspection for infection E. input and output in the last 8 hours

A. vital signs C. pain level D. epidural site inspection for infection

A mother is postpartum 2 hours after a cesarean birth with epidural anesthesia. The nurse notes the urine output in the Foley bedside drainage bag is 50 mL. What should the nurse do first? a. Check the catheter tubing for kinks or obstruction. b. Call the obstetric provider. c. Increase IV fluids. d. Remove the catheter and get the mother up to bathroom.

a

A nurse is reviewing the medical record of a postpartum woman in preparation for assessment. Which factor would the nurse identify as increasing the woman's risk for infection? Select all that apply. a. urinary stasis b. denuded endometrial arteries c. episiotomy d. white blood cell count 25,000/mm³ e. hemoglobin 11.0 g/100 mL

a, b, c

a. Temperature more than 100.4 F (38 C). b. Foul-smelling or unexpected change in color or amount of lochia. c. Large blood clots/bleeding that saturates a peripad in an hour. d. Severe headaches. e. Visual changes, blurred vision or spots. f. Calf pain with dorsiflexion of the foot. h. Swelling, redness, or discharge at the episiotomy, epidural, or abdominal sites. i. Dysuria, burning, or incomplete emptying of the bladder. j. Shortness of breath/difficulty breathing without exertion k. Depression or extreme mood swings

Postpartum Danger Signs

For hemorrhoids discomfort, select applicable actions: a. Sitz baths, topical anesthetic ointments, rectal suppositories. b. Stool softeners. c. Decrease fluid intake. d. Sitting in Flower position. e. Witch hazel pads

a, b, e

When assessing the episiotomy site of a postpartum client that delivered 3-hours ago, the nurse would document which findings as expected? Select all that apply. a. Edema b. Redness c. Slight bruising d. Discharge e. Bleeding

a, c

After birth, the fundus typically is between the umbilicus and the symphysis pubis around: a. One to 2 hours b. Two to 4 hours c. 6 to 12 hours d. 24 hours

a. One to 2 hours

The normal episiotomy site should not have redness, discharge, or edema. a. True b. False

a. True

After giving birth, the woman pulse rate range is 60 - 80 beats per minutes. a. True b. False

a. True This decreased heart rate is normal during the first week after birth. It is called puerperal bradycardia.

A nursing instructor teaching students how to check the client's uterus postpartum realizes that further instruction is needed when one of the students says: a. "One to two hours after birth the fundus is typically between the umbilicus and symphysis pubis." b. "One to two hours after birth the fundus is typically at the level of the umbilicus." c. "Six to twelve hours after birth the fundus is typically at the level of the umbilicus." d. "Normally the fundus progresses downward at a rate of 1 fingerbreadth per day after birth."

b One to two hours after birth the fundus is typically between the umbilicus and symphysis pubis. At 6 to 12 hours after birth the fundus usually is at the level of the umbilicus. Normally the fundus progresses downward at at rate of one fingerbreadth per day after birth.

Approximately 6 to 12 hours after birth, the nurse assess the fundus and find it is 1 cm above the umbilicus. What should the nurse do next? a. Record it as 1/U b. Ask the woman to empty her bladder and reassess c. Notify the provider

b. Ask the woman to empty her bladder and reasses

After birth, the cervix returns to its prepregnant shape. a. True b. False

b. False After delivery, the cervix closes but never regains its prepregnant appearance. It is no longer circular but appears as a jagged slit-like opening.

After giving birth, it is normal for some woman to experience a slight fever where temperature is up to 101.4 F . a. True b. False

b. False After giving birth, it is normal for some woman to experience a slight fever where temperature is up to 100.4 F during the first 24 hrs

Bonding is the close emotional attraction to a new born by the parents that develops during the first 30 to 60 minutes after birth. It is bidirectional. a. True b. False

b. False Bonding is unidirectional, from parent to infant

After giving birth, the woman can resume her pre-pregnancy diet. a. True b. False

b. False Breastfeeding mothers increase intake by 300 kcal Nonbreastfeeding mothers decrease intake by 200 kcal

Bonding is the development of strong affection between an infant and a significant other such as mother, father, sibling, and caretaker. a. True b. False

b. False This is the definition of attachment

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 clean 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.

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.