Chapter 22: Nursing Management of the Postpartum Woman at Risk (Chapter Worksheet)
Which of the following would the nurse expect to include in the plan of care for a woman with mastitis who is receiving antibiotic therapy? Stop breast-feeding and apply lanolin. Administer analgesics and bind both breasts. Apply warm or cold compresses and administer analgesics. Remove the nursing bra and expose the breast to fresh air.
Apply warm or cold compresses and administer analgesics. Applying compresses and giving analgesics would be helpful in providing comfort to the woman with painful breasts. Treatment for mastitis encourages frequent breast-feeding to empty the breasts. Lanolin applied to the breasts will have little impact on mastitis other than to keep them moist. Binding both breasts will not bring relief; in fact, it could cause additional discomfort. Emptying the breasts frequently through breast-feeding would be helpful. Although wearing a nursing bra will help support the heavy breasts and fresh air is helpful to prevent cracked nipples, these are ineffective once mastitis develops.
A postpartum mother appears very pale and states she is bleeding heavily. The nurse should first: Call the client's health care provider immediately. Immediately set up an intravenous infusion of magnesium sulfate. Assess the fundus and ask her about her voiding status. Reassure the mother that this is a normal finding after childbirth.
Assess the fundus and ask her about her voiding status. It is important to assess the situation before intervening. In addition, checking the bladder status and emptying a full bladder will correct uterine displacement so that effective contractions to stop bleeding can occur. Assessment of the situation is needed before the nurse can notify the health care provider. At this point, the nurse has no facts to report about the client's condition. Magnesium sulfate would relax the uterus and increase bleeding. Pallor and heavy bleeding are not normal findings during the postpartum period.
Methergine has been ordered for a postpartum woman because of excessive bleeding. The nurse should question this order if which of the following is present? Mild abdominal cramping Tender inflamed breasts Pulse rate of 68 beats per minute Blood pressure of 158/96 mmHg
Blood pressure of 158/96 mmHg Methergine can cause hypertension. Therefore, if the woman's blood pressure was already elevated, the nurse would need to question the order for the drug. Typically if methergine is ordered, her lochia flow would be increased, not minimal. Methergine is not used to treat mastitis, which would be evidenced by tender, inflamed breasts. A pulse rate of 68 beats per minute is not an unusual finding and would not be a reason to question the order.
Which of the following findings would lead the nurse to suspect that a woman is developing a postpartum complication? Moderate lochia rubra for the first 24 hours Clear lung sounds upon auscultation T emperature of 100 degrees F Chest pain experienced when ambulating
Chest pain experienced when ambulating this may suggest a pulmonary embolism and the health care provider needs to be notified immediately. Response "A" is incorrect since this is a normal finding for a postpartum woman. Response "B" is incorrect since lung sounds that are clear are a normal finding. Response "C" is incorrect since a postpartum infection would produce a temperature of 101 or higher. This temperature may indicate mild dehydration and encouraging fluids will reduce it.
When giving report to the nurse who will be caring for a woman and her newborn in the postpartum period, what information should the labor nurse convey?
Information the nurse needs to care for this mother and her newborn should include vital signs, fundal assessment (firm or boggy and location), lochia characteristics (color, amount, smell, consistency), appearance of perineum (episiotomy site, lacerations, swelling, bruising), breast status (wearing a soft, supportive bra; any nipple problems), and elimination status (empty or not voiding).
Which of the following factors in a postpartum woman's history would lead the nurse to monitor the woman closely for an infection? Hemoglobin of 12 mg/dL Manually extracted placenta Labor of 10 hours length Multiparity of 5 pregnancies
Manually extracted placenta since manual removal of a placenta increases the risk for infection since the uterus was entered and traumatized during the procedure. This extraction places her at high risk for a subsequent infection. Response "A" is incorrect since hemoglobin of 12 g is within normal limits and indicates she is not anemic, which would be a risk factor for infection. Response "C" is incorrect since 10 hours would not be considered a prolonged labor span. A labor longer than 24 hours would place her at increased risk for a postpartum infection, especially if the membranes were ruptured all that time. Response "D" would not place her at increased risk for infection, but instead for a postpartum hemorrhage.
While assessing a postpartum multiparous woman, the nurse detects a boggy uterus midline 2 cm above the umbilicus. Which intervention would be the priority? Assessing vital signs immediately Measuring her next urinary output Massaging her fundus Notifying the woman's obstetrician
Massaging her fundus A boggy uterus that is midline and above the umbilicus suggests that the uterus is not contracting properly. Therefore, the nurse should massage the fundus to aid in stimulating the uterine muscles to contract. In addition, the nurse should assess the client's lochia. Vital signs are taken once fundal massage has been initiated. Monitoring uterine output is important to evaluate the woman's fluid balance, but this would have no effect at all on alleviating the current situation. Since the uterus is midline, it is unlikely that a full bladder is the cause. Notifying the woman's obstetrician would be necessary if fundal massage did not alleviate the problem.
Compare and contrast postpartum blues, postpartum depression, and postpartum psychosis in terms of their features and medical management.
Postpartum blues are usually self-limiting and benign, occurring a few days after childbirth and ending within 2 weeks. The woman cries easily, is irritable, and is more emotionally labile than normal. This emotional disorder usually resolves without specific treatment other than reassurance and support from the family. Postpartum depression occurs within 6 months after childbirth and is similar to other depressive disorders. The woman feels inadequate as a parent and has disturbances in appetite, mood, sleep, concentration, and energy. Psychotherapy and antidepressants are helpful to address this disorder, which may take months to resolve. Family patience and support are very important for her. Postpartum psychosis may result in suicidal or homicidal behavior and requires immediate medical and psychiatric intervention. Clinical manifestations include hallucinations, delusions, or both within 3 weeks after giving birth. Inpatient psychiatric services may be needed for this severe emotional disorder.
When implementing the plan of care for a multigravida postpartum woman who gave birth just a few hours ago, the nurse vigilantly monitors the client for which complication? Deep venous thrombosis Postpartum psychosis Uterine infection Postpartum hemorrhage
Postpartum hemorrhage Hemorrhage is possible if the uterus cannot contract and clamp down on the vessels to reduce bleeding. When the placenta is expelled, open vessels are then exposed and the risk of hemorrhage is great. Thrombophlebitis typically is manifested later in the postpartum period rather than within the first few hours after birth. Infection usually is manifested 24 to 48 hours after birth, not within the first few hours.
A postpartum woman reports hearing voices and says, "The voices are telling me to do bad things to my baby." The clinic nurse interprets these findings as suggesting postpartum psychosis. anxiety disorder. depression. blues.
psychosis. Psychotic persons tend to lose touch with reality and frequently attempt to harm themselves or others. This behavior may occur when a woman experiences postpartum psychosis. Anxiety typically does not induce hallucinations or cause a person to want to harm herself or others. Depression involves feelings of sadness rather than hallucinations or thoughts of harming herself or others. Feeling "down," but not to the extreme of wanting to harm herself or her newborn, is suggestive of postpartum blues.
The number one cause of postpartum hemorrhage is ___________________.
uterine atony
