Chapter 23: Conditions Occurring After Birth

A client presents to the clinic with her 3-week-old infant complaining of general flu-like symptoms and a painful right breast. Assessment reveals temperature 101o8F (38.8oC) and the right breast nipple with a hard area that is red and warm. Which instruction should the nurse prioritize for this client?

Complete the 10-day antibiotic prescription even if she begins to feel better.

Which assessment would lead the nurse to believe a postpartal woman is developing a urinary complication?

At 8 hours post-delivery she has voided a total of 100 mL in four small voidings.

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?

Postpartum psychosis

A postpartum client who had a cesarean birth reports right calf pain to the nurse. The nurse observes that the client has nonpitting edema from her right knee to her foot. The nurse knows to prepare the client for which test first?

Venous duplex ultrasound of the right leg

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 RN and/or health care provider?

Weak and rapid pulse

A client has had a cesarean birth. Which amount of blood loss would the nurse document as a postpartum hemorrhage in this client?

1000 mL

The nurse is teaching a prenatal class about preparing for their expanding families. What is helpful advice from the nurse?

"The hormones of pregnancy may cause anxiety or depression postpartum."

After teaching a postpartum client about postpartum blues, the nurse determines that the teaching was effective when the client makes which statement?

"I might feel like laughing one minute and crying the next."

After the nurse teaches a local woman's group about postpartum affective disorders, which statement by the group indicates that the teaching was successful?

"Postpartum depression develops gradually, appearing within the first 6 weeks."

What postpartum client should the nurse monitor most closely for signs of a postpartum infection?

A client who had a nonelective cesarean birth

A postpartal woman is developing a thrombophlebitis in her right leg. Which assessments would the nurse make to detect this?

Assess for pedal edema.

A client in her sixth week postpartum reports general weakness. The client has stopped taking iron supplements that were prescribed to her during pregnancy. The nurse would assess the client for which condition?

hypovolemia

The nurse is explaining the discharge instructions to a client who has developed postpartum cystitis. The client indicates she is not drinking a glass of fluid every hour because it hurts too much when she urinates. What is the best response from the nurse?

Teach that adequate hydration helps clear the infection quicker.

The postpartum nurse is assessing clients, and all have given birth within the past 24 hours. Which client assessment leads the nurse to suspect the woman is experiencing postpartal blues?

a 30-year-old woman who is teary-eyed when asked how she and the baby are doing with breastfeeding

A client experienced prolonged labor with prolonged premature rupture of membranes. The nurse would be alert for which condition in the mother and the newborn?

infection

The nurse is reviewing orders written for a postpartum patient with a fourth-degree perineal laceration. Which order should the nurse question before implementing?

Administering an enema

A nurse is assessing a client who gave birth vaginally about 4 hours ago. The client tells the nurse that she changed her perineal pad about an hour ago. On inspection, the nurse notes that the pad is now saturated. The uterus is firm and approximately at the level of the umbilicus. Further inspection of the perineum reveals an area, bluish in color and bulging just under the skin surface. Which action would the nurse do next?

Notify the health care provider.

The nurse is teaching a discharge session to a group of postpartum clients. When asked how long to expect the bleeding, which time frame should the nurse point out?

In approximately 10 days

A postpartum client with thrombophlebitis states that her leg is very painful. Which nursing instruction is most appropriate to decrease the pain?

Keep covers off the leg.

During a home visit, a postpartum patient is complaining of a painful area on one breast. The nurse notes a local area on one breast to be red and warm to touch. For which health problem should the nurse plan care for this patient?

Mastitis

Which instruction should the nurse offer a client as primary preventive measures to prevent mastitis?

Perform handwashing before breast-feeding.

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?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 depression

Which factor in a client's history would alert the nurse to an increased risk for postpartum hemorrhage?

uterine atony, placenta previa, operative procedures