Exemplar 28.4 Postpartum Depression
The home care nurse determines that a client being treated for postpartum depression is improving. What did the nurse assess in this client? A) Client in casual wear, holding baby while rocking in a chair B) Spouse making dinner, client in bed asleep, baby in rocker in the kitchen C) Dirty dishes in the sink, beds unmade, and client wearing clothing for sleep D) Client watching television in the living room while the baby is in the crib crying
A) The nurse who observes the client in casual wear, holding the baby while rocking in a chair, should determine that treatment for postpartum depression has been effective because these are signs the client is improving. The other choices would indicate disinterest in child care and care of the home. The client who is sleeping while the spouse is making dinner and watching the baby would indicate treatment has not been effective at all.
The home care nurse is planning care for a client with a history of postpartum depression with previous children. What should be included in this plan of care? Select all that apply. A) Take advantage of those who want to help and maintain outside interests. B) Contact the physician to ensure the client is prescribed medication for postpartum depression. C) Encourage as much sleep as possible. D) Focus on the care the other children need. E) Instruct to eat a healthful diet with limited alcohol intake.
A, E Because the client has a history of postpartum depression with other children, the nurse needs to plan prevention strategies for the client. By taking advantage of those who want to help and maintaining outside interests, the client may prevent the onset of postpartum depression. Instructing to eat a healthful diet with limited alcohol intake is another strategy to prevent postpartum depression. The other interventions would not help prevent postpartum depression.
A nurse manager working in labor and delivery is providing educational material to staff nurses regarding postpartum depression and the maternal role attainment (MRA) process. What information is true regarding the MRA process? A) Maternal role attainment occurs in five stages. B) During the formal stage of the MRA process, the woman is still influenced by the guidance of others and tries to act as she believes others expect her to act. C) During the formal stage of the MRA process, the woman looks to role models, especially her own mother, for examples of how to mother. D) The personal stage of the MRA process begins when the mother starts making her own choices about mothering.
B) Maternal role attainment occurs in four stages. During the formal stage of the MRA process, the woman is still influenced by the guidance of others and tries to act as she believes others expect her to act. During the anticipatory stage of the MRA process, the woman looks to role models, especially her own mother, for examples of how to mother. The informal stage of the MRA process begins when the mother starts making her own choices about mothering.
The postpartum client states that she cannot understand why she does not enjoy being with her baby. What should cause the nurse concern? A) Postpartum infection B) Postpartum depression C) Postpartum psychosis D) Postpartum blues
B) Postpartum depression is characterized by feelings of failure and self-accusation, among others. Postpartum psychosis is more severe, and includes hallucinations and irrationality, which are not represented in this situation. Postpartum infection has nothing to do with this situation. Postpartum blues is characterized by mild depression interspersed with happier feelings, and is self-limiting
The nurse caring for a postpartum client would consider the nursing diagnosis of ineffective individual coping when the client demonstrates which behavior? A) Reading material on care of a newborn B) Lying in bed, lights dim, and refusing to spend time with the baby C) Cuddling the new infant D) Talking with friends and family on the phone
B) The postpartum client who is lying in bed in a darkened room and not wanting to spend time with the new baby is demonstrating signs of ineffective individual coping. The other behaviors would not indicate ineffective copying but rather effective coping and are incorrect.
A nurse working in labor and delivery is aware of the risk for postpartum clients to develop postpartum depression. What is a risk factor for the development of postpartum depression? A) Multiparity (multiple pregnancies) B) Overwhelming family support C) History of bipolar disorder D) History of anxiety disorder
C) A history of bipolar disorder is a risk factor for the development of postpartum depression. Primiparity (first pregnancy) is a risk factor, not multiparity. A lack of family support, not overwhelming family support, is a risk factor for the development of postpartum depression.
The nurse, who has been calling postpartum clients, learns that one client reports having no appetite and wants to sleep all day. What does this information suggest to the nurse? A) The client is feeling blue, which is normal. B) The client's sleep-wake cycle is disrupted. C) The client may be experiencing postpartum depression. D) The client is developing postpartum psychosis.
C) Lack of appetite and the desire to sleep are symptoms of developing postpartum depression. The client could be developing postpartum depression and not just "the blues." The client would need to have more acute symptoms such as hearing voices to consider postpartum psychosis. The nurse has no way of knowing what the client's sleep-wake cycle is, so this choice is incorrect.
A client of Eastern European descent who gave birth to her third child on the previous shift tells the nurse that she wants to get cleaned up and have something to eat so that she can be ready to go home in the morning. What should the nurse do to assist this client? A) Suggest that the client take advantage of the rest since she has other children at home who will also need her care. B) Instruct the client to pace herself and that there is no hurry rush to go home. C) Assist the client with self-care requests and check on when the meals will be delivered. D) Suggest that her plans to go home depend upon her physician.
C) To provide culturally sensitive care, the nurse should assist the client with self-care requests and check on when the meals will be delivered because clients of European descent often want to ambulate, shower, dress, and plan to go home quickly. The nurse should not suggest that the discharge is dependent upon the physician. Telling the client to pace herself or to take advantage of rest because she has other children at home who will also need her care does not allow for cultural differences surrounding childbirth.
A client who is breastfeeding has been diagnosed with postpartum depression after delivering a first child. Which medications might be prescribed for this client? Select all that apply. A) Diazepam B) Phenytoin C) Paroxetine D) Fluoxetine E) Sertraline
C, E )Sertraline is recommended to be the first-line treatment for postpartum depression. Paroxetine is the alternative first-line treatment for postpartum depression. Fluoxetine is not recommended for lactating women because of the long half-life and the risk of the medication crossing into the breast milk. Diazepam and phenytoin are not used to treat postpartum depression.
The nurse is instructing a new mother on the strategies to prevent the development of postpartum depression. What should the nurse include in these instructions? Select all that apply. A) Restricting fluids and eating a low-fat diet help to avoid the onset of postpartum depression. B) Realize that feeling depressed after delivering a baby is normal and can last for months. C) The only way to avoid postpartum depression is to not have children. D) Encourage the client to plan how to manage the baby's care needs at home to help adjust to motherhood. E) Instruct the client to recognize the signs and symptoms of postpartum depression and phone the health care provider if these occur.
D, E) The nurse should instruct the client on the signs and symptoms of postpartum depression with the direction to phone her health care provider if this occurs. The nurse should also encourage the client to plan how to manage the baby's care needs at home to help adjust to motherhood. It is not normal to feel depressed for months after delivering a baby. Not having children is not the only way to avoid postpartum depression. Restricting fluids and eating a low-fat diet will not prevent postpartum depression and could harm the new mother's physiological status.
