Postpartum

What actions can non-breastfeeding women do to treat breast engorgement?

Wear a supportive bra *Avoid stimulating the breast Ice packs to breast Analgesics for pain *Cold cabbage leaves in bra.

What is the first question a nurse should ask when a patient is c/o breast engorgement?

When was the last time you fed your baby?

A multiparous patient reports severe uterine cramps the first day after a vaginal delivery. The nurse is aware the patient is breastfeeding and associates the patient's pain primarily with what occurrence? A. An increase in oxytocin release related to the newborn suckling. B. The presence of intense afterbirth pains related to multiparity. C. An expected response to the daily administration of oxytocin. D. The efforts of the uterus to return to a pre-pregnancy condition.

A. An increase in oxytocin release related to the newborn suckling. This is correct because during suckling of a newborn during breastfeeding the stimulation of the uterus to be contracted is increased because of a release of oxytocin.

A postpartum patient states, "I am really in pain." For which sources of pain will the nurse specifically assess the patient? *Select all that apply: A. Uterine contractions. B. Perineal trauma C. Breast engorgement D. Hemorrhoids. E. General soreness

All of the choices are correct. Uterine contractions may be afterpains. Perineal trauma include episiotomy, laceration, and/or ecchymosis. Breast engorgement will cause the mother pain as well as nipple pain from improper latching. Hemorrhoids are a source of pain. General soreness is a source of pain.

The nurse is palpating a patient's uterus 12 hours after a vaginal delivery. For which reason does the nurse place one hand just above the symphysis pubis? A. To prevent uterine prolapse. B. To prevent uterine movement. C. To prevent uterine hemorrhage. D. To prevent uterine inversion.

D. To prevent uterine inversion. This is correct because the nurse should support the lower uterine segment by placing one hand just above the symphysis pubis. Pregnancy stretches the ligaments that hold the uterus in place, and fundal pressure could result in uterine inversion.

If the mother's blood pressure is low and experiences orthostatic hypotension what might the nurse want to implement?

Educate the patient to rise slowly from sitting to standing, and take plenty of time when getting up. She should always have assistance until she is steady.

What actions can breastfeeding women do to treat breast engorgement?

Feed infant frequently Warm compresses/breast massage Express milk either manual or by pump Ice packs after feeding to decrease inflammation and pain. Wear a supportive bra.

S/S of engorgement

Hard, swollen, red, tender and painful breasts. Warm to the touch. Throbbing sensation. Elevated temperature. Infant may not be able to latch.

Directly after birth is a low BP in the mother consider normal or abnormal?

Normal because the mother has been through postpartum bleeding.

You are caring for a 12 hour postpartum mother and upon auscultation you hear what sounds like a murmur. What is your immediate action?

Reassure your client that this is normal, but you will report it to the health care provider. Heart murmurs may be present due to an increased blood volume.

You are caring for a 3 hour postpartum mother who is complaining of chills. As the nurse what is your best action?

Reassure your patient that this is normal and give her a warm/heated blanket.

A nurse is preforming a uterus assessment on a patient who is 20 hours postpartum. The nurse finds the fundus of the uterus to be soft and boggy. In addition, the uterus is displaced to the left and moderate bleeding is noted. If the uterus does not respond the uterine massage, which actions does the nurse implement? *Select all that apply: A. Assist the patient to the bathroom to void. B. Reassess to determine response to treatment. C. Administer oxytocin as prescribed. D. Place an emergency call the the HCP. E. Make the patient NPO for surgery.

A. Assist the patient to the bathroom to void. B. Reassess to determine response to treatment. C. Administer oxytocin as prescribed. E. Make the patient NPO for surgery. The uterus can become displaced if the bladder is full so assist your patient to void before examining uterus. After implementing the appropriate ordered medications the nurse should always reassess. The nurse should administer oxytocin and prescribed in the HCP's orders. Anticipate surgery and make the client NPO.

The nurse is providing teaching to a patient who is breastfeeding a newborn. The patient expresses interest in maintaining a healthy nutritional status for both her and her baby. Which information does the nurse present to meet the patient's needs? *Select all that apply: A. Increase caloric intake by 500-1,000 per day. B. Drink 2-3 liters of fluid each day. C. Abstain from the intake of alcohol. D. Eat fresh fruits and vegetables E. Avoid the intake of processed foods.

A. Increase caloric intake by 500-1,000 per day. B. Drink 2-3 liters of fluid each day. These are correct because when lactating a mother should increased her caloric intake by 500-1,000 per day, and when lactating the mother needs to increase her fluids to 2-3 liters a day. *Some fresh veggies and fruit may give baby gas, cramps, and/or loose stools. *It has not been shown harmful to the infant if the mother consumes alcohol during breastfeeding although it is not recommended. If you consume alcohol make sure it is 2-2.5 hours before feeding.

The nurse is preparing to perform a visual assessment of the perineum of a postpartum patient. The nurse will use the acronym REEDA. Which specific assessments are covered by REEDA? *Select all that apply: A. Perineal coloration B. Suture line appearance C. Amount of swelling. D. Description of pain. E. Soft tissue trauma.

A. Perineal coloration. B. Suture line appearance. C. Amount of swelling. E. Soft tissue trauma. These are correct because REEDA stands for: redness, ecchymosis, edema, discharge, approximation of edges of episiotomy or laceration.

The nurse is reviewing the medical record for a patient who is postpartum. The nurse notices the patient is rubella-non-immune. Which information does the nurse present to the patient? *Select all that apply: A. The risk of the fetuses of any future pregnancies. B. The patient will need to be immunized before discharge. C. Breastfeeding should be avoided for 24 hours after immunization. D. Maternal immunization carries over to the neonate. E. Pregnancy should be avoided for 4 weeks.

A. The risk to the fetuses of any future pregnancies. B. The patient will need to immunized before discharge. E. Pregnancy should be avoided for 4 weeks. These are correct because fetuses exposed to rubella during the first trimester are at risk for birth defects, women cannot be immunized during pregnancy so they need to be immunized before discharge, and the first trimester of pregnancy is said to be the most dangerous time for a fetus to be exposed to rubella.

A postpartum patient calls the OB office 8 days following a vaginal delivery. The patient reports concern regarding vaginal bleeding. Which patient-reported symptom causes the nurse concern? A. Increased flow noticed with physical activity. B. A description of the lochia as being red in color. C. Discharge that is noted to have a fleshy color. D. Bleeding that is described as scant.

B. A description of the lochia as being red in color. This is correct because during the 4-10 days the lochia should be described as lochia serosa [pink or brown to color]. The nurse should be concerned if the patient reports lochia that is red in color, which is indicative of bleeding.

The nurse is preparing a postpartum patient for discharge. What patient teaching is most important for the nurse to provide? A. The S/S of uterine infection. B. The S/S of secondary hemorrhage. C. The S/S of postpartum depression. D. The S/S of a boggy uterus.

B. The S/S of secondary hemorrhage. This is correct because it most often occurs after the patient has been discharged and is at home. The patient needs to understand the normal progression of lochia and uterine involution and report abnormal amounts of bleeding.

The nurse is collecting the urine of a postpartum patient who is passing large clots. For which reason does the nurse examine the large collected clots? A. To validate the presence of clotting. B. To determine the presence of tissue. C. To obtain an accurate description. D. To document the number of clots.

B. To determine the presence of tissue. This is correct because retained placental tissues can be the cause of the clots and interfere with uterine involution and lead to excessive bleeding.

Prior to discharge from the birthing center, the nurse informs the patient that she will be receiving vaccines for rubella, hepatitis B, pertussis and influenza. For which reason does the nurse explain the need for vaccinations? A. Discharge with a neonate is discouraged if the mother is not vaccinated. B. Vaccinating the mother will protect the neonate from a serious illness. C. The mother's immune system has been suppressed during pregnancy. D. Vaccination is more easily accomplished while the mother is under medical care.

B. Vaccinating the mother will protect the neonate from serious illness. This is correct because the mother does not want to pass these diseases to her new infant and vaccinating will help both mother and keep baby safer.

The nurse is providing care to a patient who is postpartum. Using anatomy and physiology knowledge, which expectation does the nurse related to the cardiovascular system? A. Patient reporting being cold related to blood loss. B. WBC laboratory level of 30,000/mm a few hours after delivery. C. Risk for hemorrhage due to decrease in circulating clotting factors. D. A normal postpartum hemoglobin laboratory value of less than 11g/dL

B. WBC laboratory level of 30,000/mm a few hours after delivery. This is correct because it is a normal level as a result of stress after labor and birth.

What acronym is used for postpartum assessment?

BUBBLE HE Breasts Uterus Bladder Bowel Lochia Episiotomy, lacerations, perineum, hemorrhoids, incision Holman's sign Emotions, bonding with infant, fatigue, psychosocial factors.

A patient who is 12 hours postpartum after a vaginal delivery continues to have difficulty in initiating urination. The nurse is aware that an integrative method used when a woman is unable to void is peppermint oil. In which manner with peppermint oil be used? A. A thin layer is applied to the urinary meatus. B. A small amount on a cotton ball is left at the bedside. C. A small amount is added to the water of a vaporizer. D. A saturated cotton ball is placed in a "hat" on the toilet.

D. A saturated cotton ball is placed in a "hat" on the toilet. This is correct because it is known that the vapors will have a relaxing effect on the urinary sphincter.

The nurse is providing postpartum care to a patient 24 hours after vaginal delivery. Which action does the nurse perform prior to assessing the patient's uterus? A. Place the patient on the left side. B. Assess the passage of lochia. C. Ask the patient to void. D. Administer a dose of oxytocin.

C. Ask the patient to void. This is correct because the patient must void prior to palpation of the uterus in order to accurately assess uterine placement and tone. An over distended bladder can result in uterine displacement and atony.

In an attempt to improve the effectiveness of postpartum teaching, the nurse uses AWHONN acronym POST BIRTH. Which teaching points require the patient to call for 911 assistance? *Select all that apply: A. Bleeding that soaks a pad per hour. B. A bad headache with vision changes. C. Thoughts of hurting self or baby. D. Signs an incision is not healing. E. A red, swollen leg painful to touch.

C. Thoughts of hurting self or baby. The rest of the answers are important but not part of the acronym that involves calling 911. The POST part of the acronym is for calling 911, BIRTH is for contacting your doctor.