Postpartum Period

The nurse is teaching a client how to perform perineal care to reduce the risk of puerperal infection. Which activity indicates that the client understands proper perineal care? 1. Using a peri bottle to clean the perineum after each voiding or bowel movement 2. Cleaning the perineum from back to front after a bowel movement 3. Spraying water from peri bottle into the vagina 4. Changing perineal pads every 8 hours

1. Using a peri bottle to clean the perineum after each voiding or bowel movement RATIONALES: Cleaning with a peri bottle (squirt or spray bottle) should be performed after each voiding or bowel movement. The perineum should be cleaned from front to back, to avoid contamination from the rectal area. To keep the perineum clean, perineal pads must be changed when they are soiled. Water from the peri bottle isn't sterile and should never be directed into the vagina.

A 24-year-old multigravida client who had an uncomplicated, spontaneous vaginal delivery 7 hours ago is uninterested in her baby and wants to sleep. The student nurse assigned to care for the client is concerned and tells the licensed practical nurse (LPN) who's also assigned to her care. Which response by the LPN is most effective in educating the student nurse? 1. "It's important to observe these types of behaviors and make necessary referrals to the social worker." 2. "Extreme fatigue from the delivery is common, and new mothers initially focus on recovery and taking in the birth experience." 3. "Make sure you don't assume the care for the baby. Encourage the mother to change diapers and take responsibility for feeding." 4. "It's sad that some women don't seem to appreciate the gift of a healthy baby."

2. "Extreme fatigue from the delivery is common, and new mothers initially focus on recovery and taking in the birth experience." RATIONALES: Postpartum fatigue is common and many clients go home with a sleep deficit. A multigravida client has already experienced the challenges of sleep deprivation with a newborn and understands the need to recuperate. In Rubin's taking-in phase, the mother is commonly focused on her own needs and is only passively involved with the infant for 1 to 2 days postpartum. As the mother integrates her birth experience, she'll start the taking-hold phase and will increasingly shift her attention to the infant. Referral to a social worker is premature at this time. Although nurses need to allow mothers to care for their infants as much as possible, rest for the mother is also important.

During an annual checkup, a client tells the nurse that she and her husband have decided to start a family. Ideally, when should the nurse plan for childbirth education to begin and end? 1. It should begin early in the third trimester and end 1 month after delivery. 2. It should begin before conception and end 3 months after delivery. 3. It should begin when the client learns she's pregnant and end after delivery. 4. It should begin at about 5 months' gestation and end at facility discharge.

2. It should begin before conception and end 3 months after delivery. RATIONALES: Ideally, childbirth education should begin before conception (or as soon after conception as possible) and continue for about 3 months after delivery. Beginning childbirth education later and ending it earlier wouldn't provide enough time for optimal preparation of the client and her partner.

The nurse is assisting in developing a care plan for a client with an episiotomy. Which interventions would be included for the nursing diagnosis Acute pain related to perineal sutures? Select all that apply: 1. Apply an ice pack intermittently to the perineal area for 3 days. 2. Avoid the use of topical pain gels. 3. Administer sitz baths three to four times per day. 4. Encourage the client to do Kegel exercises. 5. Limit the number of times the perineal pad is changed.

3. Administer sitz baths three to four times per day. 4. Encourage the client to do Kegel exercises. RATIONALES: Sitz baths help decrease inflammation and tension in the perineal area. Kegel exercises improve circulation to the area and help reduce edema. Ice packs should be applied to the perineum for only the first 24 hours; after that time, heat should be used. Topical pain gels should be applied to the suture area to reduce discomfort, as ordered. The perineal pad should be changed frequently to prevent irritation caused by the discharge.

Which assessment finding in a nonlactating postpartum client requires further evaluation? 1. Progression of lochia from rubra to serosa 2. Lack of menses 4 weeks after childbirth 3. Return of menses within 2 weeks 4. No menstrual cycle 8 weeks after childbirth

3. Return of menses within 2 weeks RATIONALE: In nonlactating clients, menstruation typically resumes 6 to 10 weeks after childbirth. Progression of lochia from rubra to serosa is normal.

A nurse is palpating the uterine fundus of a client who gave birth to a neonate 8 hours ago. Identify the level in the abdomen where the nurse should expect to feel the fundus?

RATIONALE: The uterus should be felt at the level of the umbilicus from 1 hour after birth and for approximately the next 24 hours.

The nurse is palpating the uterine fundus of a client who delivered 8 hours ago. At what level in the abdomen would the nurse expect to feel the fundus?

RATIONALES: The nurse should be able to feel the uterus at the level of the umbilicus from 1 hour after birth to approximately 24 hours after birth.