M.32: Dynamic Study Module Postpartum Adaptation and Nursing Assessment

A postpartum patient is experiencing uterine atony. Which assessment finding should the nurse expect? ANSWER Fundus at level of umbilicus Fundus firm and grapefruit sized Fundus in midline Fundus above the umbilicus

Fundus above the umbilicus

A postpartum patient is experiencing watery, white vaginal discharge. Which action should the nurse take? ANSWER Suggest a prescription for vaginal miconazole (Monistat). Request laboratory testing for candida. Encourage the patient to douche. Document the finding as normal.

Document the finding as normal. Lochia alba is a white, watery discharge and is the final discharge after delivery during the postpartum period. This should be documented as a normal finding. Candida is a thick, white, curdy discharge that requires laboratory testing and treatment with an antifungal medication. Douching should be avoided because it can cause infection. Additional Learning Lochia alba is composed primarily of: Leukocytes Decidual cells Epithelial cells Fat Cervical mucus Cholesterol crystals Bacteria

A postpartum patient has a white blood cell (WBC) count of 23,000/mm3. Which action should the nurse take? ANSWER Place the patient on isolation precautions. Administer an antipyretic. Wear a face mask when caring for the patient. Document the finding as normal.

Document the finding as normal. Nonpathologic leukocytosis often occurs during labor and in the immediate postpartum period, with WBC counts up to 20,000 to 25,000/mm3. WBC levels typically return to normal by the end of the first postpartum week. Because this is an expected finding, an antipyretic, isolation precautions, and face mask are not necessary. Additional Learning Leukocytosis combined with the normal increase in erythrocyte sedimentation rate may obscure the diagnosis of acute infection.

A postpartum patient reports hemorrhoidal pain. Which action should the nurse take? ANSWER Monitor the patient's fluid intake and output. Position the patient supine. Encourage the patient to eat a high-fat diet. Have the patient sit in a bathtub filled with several inches of warm water.

Have the patient sit in a bathtub filled with several inches of warm water.

A postpartum patient reports increased comfort with handling the infant's care and identifying as a mother. Which process should the nurse note the patient is experiencing? ANSWER Taking hold Mutual regulation Acquaintance Maternal role attainment

Maternal role attainment

A postpartum patient feels overwhelmed about the duties of motherhood. Which action should the nurse take to reduce the risk of postpartum depression? ANSWER Suggest hiring a postpartum doula. Suggest a personal day out at least once a week. Suggest asking family members to babysit. Encourage placement of the infant in day care.

Suggest hiring a postpartum doula. Postpartum doulas are trained professionals whose services are tailored to help the postpartum patient feel as rested and well-nourished as possible, and to keep the household in good order so that the patient can focus on the new baby. Placing the infant in day care, taking a personal day out, and having family babysit may not be options for the patient, and would not be as helpful in addressing postpartum depression as a postpartum doula. Additional Learning Postpartum doulas act as "mother's helpers."

A patient who is 12-weeks postpartum and breastfeeding is concerned because menses has not returned. Which response should the nurse make? ANSWER "The cycle should have returned by now, so I will notify the healthcare provider." "Progesterone levels should be checked to determine why the cycle hasn't returned yet." "In some cases, it can take up to 3 years for the cycle to start again after breastfeeding." "Don't worry, the cycle will return by 1 year postpartum."

"In some cases, it can take up to 3 years for the cycle to start again after breastfeeding." The return of menstruation and ovulation varies for each postpartum patient. While menstruation generally returns by 12 weeks for nonlactating patients, in breastfeeding patients it can take as long as 3 years. The healthcare provider does not need to be notified as this is an expected finding. There is no guarantee the patient's cycle will return 1 year postpartum. Measuring progesterone levels would only indicate whether or not ovulation is occurring. Additional Learning The return of menstruation and ovulation in breastfeeding patients is associated with the length of time the patient breastfeeds and whether formula supplements are used.

A postpartum patient of African American heritage requests that female family members be approved for extended visiting hours. Which response should the nurse make? ANSWER "I must first check with the nurse manager for permission." "We can arrange that, but you'll be so exhausted you won't even notice your family's presence." "That can be arranged as long as the other patients are not disturbed." "I'm sorry, but the hospital has set visitation hours for liability reasons."

"That can be arranged as long as the other patients are not disturbed." African American patients may model parenting behaviors after older female relatives, and the extended family plays an essential role during the puerperium. Because of this, visiting hours may be waived to show respect and foster a blending of old and new behaviors to meet the goals of all concerned. The hospital's visitation hours are not set for liability reasons, and permission is not needed from the nurse manager. It is inappropriate to assume the patient will be too exhausted to notice the family's presence. Additional Learning In many cultures, the newborn's grandmother is often the primary helper to the mother and newborn.

A postpartum patient who is ready to resume sexual relations asks if a prepregnancy diaphragm can be used. Which response should the nurse make? ANSWER "It is more appropriate for your partner to wear a condom." "The diaphragm that you have can be used." "A diaphragm cannot be used after pregnancy and switching to a hormonal method of birth control is recommended." "You will need to be refitted for a new diaphragm."

"You will need to be refitted for a new diaphragm."

A family member is observed giving advice about self-care measures to a postpartum patient. Which action should the nurse take? ANSWER Encourage the patient's autonomy from the family member. Inform the family member that these opinions are not needed. Ask the patient to voice personal preferences. Incorporate the family member's suggestions into the plan of care.

Ask the patient to voice personal preferences. The postpartum patient should be engaged in patient-centered care. It is inappropriate to comment about the family member's opinions or become involved in family dynamics. The family member's suggestions should only be incorporated into the plan of care if they are sound and approved by the patient. Additional Learning Interactive therapeutic nurse-patient relationships have a greater impact on the progress of becoming a mother than formal teaching.

A postpartum patient and newborn are discharged. Which action should the nurse take after discharge? ANSWER Send the patient a follow-up email. Call the patient 3 to 4 days later. Notify the patient's insurance company of discharge. Mail the patient a satisfaction survey.

Call the patient 3 to 4 days later.

The nurse assesses the abdomen of a postpartum patient. Which should the nurse suspect as the primary reason for slack muscles with areas of separation? ANSWER Hernia Cesarean birth Poor nutrition Forceps delivery

Cesarean birth Diastasis recti abdominis, a separation of the rectus abdominis muscles, occurs more often in patients who had a cesarean birth, as the abdominal muscles are manually separated to access the uterine muscle. Forceps delivery, hernia, and poor nutrition do not cause diastasis recti abdominis. Additional Learning Improvement of diastasis recti abdominis depends on the physical condition of the patient, the total number of pregnancies, pregnancy spacing, and the type and amount of physical exercise.

A single postpartum patient reports feeling stressed, alone, and unfit for motherhood. For which concern should the nurse assess the patient? ANSWER Anxiety Fatigue Child neglect Delayed healing

Child neglect Single postpartum patients who lack support systems and feel isolated can feel tremendous stress, all of which are contributing factors to situations of child neglect or abuse. The child's safety is a concern. There is no indication that the patient is experiencing delayed healing. The patient may be fatigued or anxious, but these are not as important as assessing the child's safety. Additional Learning New mother support groups are helpful for postpartum patients who lack a social support system.

A postpartum patient who is Jewish delivers on the Sabbath and requests help with adjusting the electric bed and lighting. Which action should the nurse take? ANSWER Comply with the patent's requests. Teach the patient the importance of self-care. Tell the patient that the requests are inappropriate. Ask a family member to assist the patient.

Comply with the patent's requests.

The healthcare provider documents the "postpartum blues" in a patient's medical record. Which should the nurse expect to assess in this patient? ANSWER Crying and feeling let down Inability to get out of bed Feeling isolated and stressed Refusing to hold or breastfeed the newborn

Crying and feeling let down

A postpartum patient's vagina is swollen and bruised after delivery. Which action should the nurse take? ANSWER Document the finding as normal. Prepare the patient for episiotomy. Administer a corticosteroid. Apply a perineal pad.

Document the finding as normal.

A postpartum patient reports discomfort due to high amounts of flatulence. Which should the nurse recommend? ANSWER Increase dietary fiber Lie on the left side Increase hydration Drink peppermint tea

Drink peppermint tea Peppermint tea can help relieve the discomfort of excessive flatulence. Ambulation, not lying down, can improve flatulence. Increased fiber and hydration can help relieve constipation, but not necessarily flatulence. Additional Learning Chamomile tea can also help reduce flatulence discomfort.

The nurse is caring for a postpartum patient. For which assessment finding should the patient be catheterized? ANSWER Failure to void after 8 hours Nonpalpable bladder Fever Flank pain

Failure to void after 8 hours

The nurse is caring for a postpartum patient who recently immigrated from a European country. Which patient request should the nurse anticipate? ANSWER Hot coffee Soda from the vending machine Iced water Room temperature Gatorade

Iced water Patients from a European heritage may request iced fluids, such as iced water. The cultural preference for iced fluids means the patient is not as likely to request hot coffee, soda from the vending machine, or room temperature Gatorade. Additional Learning After delivery, the nurse should ask the patient about fluid or food preference.

The nurse is caring for a postpartum patient. For which health problem should a lower crib be placed in the patient's room? ANSWER Multiple sclerosis Cognitive deficit Obesity Postpartum chill

Multiple sclerosis

A postpartum patient is experiencing slow involution. Which health problem should the nurse expect to find in the patient's history? ANSWER Short labor Microsomia Polyhydramnios Deflated bladder

Polyhydramnios Involution is the rapid reduction in size of the uterus and its return to a status similar to the nonpregnant state, although it remains slightly larger than it was before the first pregnancy. An overdistended uterus caused by polyhydramnios can impede involution. Extended labor, an overdistended bladder, and macrosomia can also cause involution. Additional Learning Factors that enhance involution include: Uncomplicated labor and birth Complete expulsion of the amniotic membranes and the placenta Manual removal of the placenta during a cesarean birth Breastfeeding Early ambulation

A postpartum patient reports feeling let down. For which health problem should the nurse plan interventions? ANSWER Maladaptive parenting Postpartum blues Postpartum depression Generalized anxiety disorder

Postpartum blues The postpartum blues are a transient period of depression that occurs during the first few days of the puerperium. Symptoms may include mood swings, anger, weepiness, anorexia, difficulty sleeping, and a feeling of letdown. The patient does not have postpartum depression, maladaptive parenting, or generalized anxiety disorder. Additional Learning Contributing factors to the postpartum blues include: Changing hormone levels An unsupportive environment Maternal insecurity Fatigue Discomfort Overstimulation Postpartum pain

A patient is in the taking-in phase of postpartum adaptation. Which behavior should the nurse expect to observe? ANSWER Gets to know the infant Looks for reassurance about mothering skills Preoccupied with personal needs Balances personal needs with the needs of the infant

Preoccupied with personal needs

A postpartum patient's lochia rubra has a musty, stale odor. Which action should the nurse take? ANSWER Instruct on perineal care. Provide perineal ice pack. Provide perineum pads. Monitor temperature.

Provide perineum pads. A musty, stale odor to the lochia rubra is a normal finding, and the patient should be provided with perineal pads to absorb the discharge. Perineal care is not required unless personally desired. This finding does not indicate an infection or the need for an ice pack. Additional Learning Lochia rubra does not cause infection because it is nonvirulent.

The nurse is developing the plan of care for a postpartum patient who delivered 4 hours ago. Which intervention supports psychologic adaptation to motherhood? ANSWER Providing resources that detail different parenting styles Sharing personal experiences about parenting with the patient Providing adequate rest periods Permitting visitors to socialize quietly while the patient naps

Providing adequate rest periods Maternal psychologic adaptation is promoted by providing adequate rest periods that give the patient the energy needed to parent. Visitors should leave the room when the patient is napping to ensure rest. Teaching about parenting styles occurs after discharge when the infant is older and requires more than just basic newborn care. Teaching should focus on the patient's needs. Additional Learning The patient should be provided with opportunities to discuss the birth experience in a nonjudgmental atmosphere, if desired.

A postpartum patient experienced polyhydramnios during pregnancy. For which health problem should the nurse monitor? ANSWER Hypertension Slow involution Infection Hypoglycemia

Slow involution

A postpartum patient requests help for personal comfort but has not asked about the newborn's care. Which phase of postpartum adaptation should the nurse document? ANSWER Binding in Taking hold Taking in Acquaintance

Taking in The taking-in phase occurs soon after birth, during which the postpartum patient is still rather preoccupied with personal needs and reliant on others. During the taking-hold phase, the patient exhibits a readiness to take control over personal needs and mothering. During the acquaintance phase, the patient gets to know the infant. A postpartum patient binds in to the infant as the patient grows to know and form a relationship with the child. Additional Learning The patient in the taking-in phase may desire to talk about the labor and birth process.

The nurse assesses the status of a postpartum patient's lochia. Which should the nurse expect if the patient is experiencing lochia alba? ANSWER White, thick, curdlike discharge White, watery discharge Red, dark discharge Pink, watery discharge

White, watery discharge Lochia alba is a white, watery discharge and is the final discharge of the postpartum period. Candida is a yeast that produces a thick, white, curdy discharge. Pink, watery discharge is lochia serosa. Dark red blood is lochia rubra. Additional Learning Lochia alba is composed primarily of: Leukocytes Decidual cells Epithelial cells Fat Cervical mucus Cholesterol crystals Bacteria