High risk postpartum nursing care

A postpartum patient informs the nurse of a frequent urge and burning when attempting to urinate. The nurse reviews the patient's medical record and associates which risk factors related to a possible urinary tract infection (UTI)? Select all that apply. 1. Neonatal macrosomia 2. Use of a vacuum extractor 3. Poor oral fluid intake 4. Urinary catheter during labor 5. Low-grade fever (101.3°F [38.5°C])

ANS: 1, 2, 3, 4 Neonatal macrosomia, which can cause edema around the urethra, is a risk factor for UTI, Operative vaginal deliveries, forceps, or vacuum extractor, which can cause edema around the urethra, is a risk factor for UTI. The postpartum patient needs to drink a minimum of 3,000 mL/day; poor oral fluid intake is a risk factor for UTI. Urinary catheter inserted during the labor process is a risk factor for UTI.

The nurse is aware of concern about the increasing numbers of severe maternal morbidity (SMM). It is believed to be related to changes in the overall health of the population of women giving birth. Which reasons does the nurse identify as causes of SMM? Select all that apply. 1. Increases in maternal age 2. Prepregnancy obesity 3. Cesarean deliveries 4. Inability to pay for health care 5. Preexisting chronic medical conditions

ANS: 1, 2, 3, 5 Documented increases in maternal age is a likely cause for SMM; older women have increased risk. Obesity is a general health risk in the United States; prepregnancy obesity causes increased incidences of SMM. Due to improved diagnostic technology and increased litigation related to childbirth, cesarean deliveries are increasing. Surgical procedures always carry a risk for complications. Preexisting chronic medical conditions are a contributor to the increasing rates of SMM. Due to a decrease in overall general health of women, complications are more likely

The nurse is collecting information during a follow-up OB appointment with a patient who delivered 3 months ago. The patient reports her partner has become cynical, irritable, and verbally abusive. The nurse will screen for which risks related to paternal postnatal depression (PPND)? Select all that apply. 1. The father exhibited depression during the pregnancy. 2. The birth of this fourth child was unexpected and unplanned. 3. The father expresses feeling bored and underappreciated in his job. 4. The father is recently estranged from his parents and siblings. 5. The mother experienced a prolonged labor and a cesarean birth

ANS: 1, 2, 4 Exhibiting paternal depression during the pregnancy can be a risk factor for the development of PPND. An unexpected or unplanned pregnancy can be a risk factor for the development of PPND. The father's estrangement from his parents and siblings can be a stressful life event and/or indicate a lack of social support. Both manifestations can be a risk factor for the development of PPND

The labor and delivery unit nurses are adopting methods to reduce the number of women who develop postpartum depression. Research from Dennis and Dowswell (2013) provides evidence-based suggestions regarding beneficial interventions. Which suggestions do the nurses consider? Select all that apply. 1. Telephone-based peer support 2. Partner report of symptoms 3. Interpersonal psychotherapy 4. Teaching for self-recognition of problems 5. Professionally based postpartum home visits

ANS: 1, 3, 5 Research from Dennis and Dowswell (2013) reveals that psychosocial and psychological interventions significantly reduce the number of women who develop postpartum depression. Beneficial interventions include telephone-based peer support. Research from Dennis and Dowswell (2013) reveals that psychosocial and psychological interventions significantly reduce the number of women who develop postpartum depression. Beneficial interventions include interpersonal psychotherapy. Research from Dennis and Dowswell (2013) reveals that psychosocial and psychological interventions significantly reduce the number of women who develop postpartum depression. Beneficial interventions include professionally based postpartum home visits

The nurse is assessing a patient who is 36 hours postpartum following a cesarean delivery. Which findings cause the nurse to conclude that a wound infection is developing? Select all that apply. 1. Temperature increase from 99.8°F to 100.5°F 2. Incisional tenderness with palpation 3. Increased margins of incisional redness 4. Notably warm skin around the incision 5. Serosanguinous drainage from the suture li

ANS: 3, 4 An increase in redness in the incisional margins is a likely sign of developing wound infection. When the skin around a surgical incision is notably warm to the touch, it is likely a sign of a developing wound infection

19. A patient who is 8 months postpartum arrives for an OB appointment. The nurse notices that both the patient and the infant appear unkempt. The nurse anticipates a diagnosis of _________________________.

postpartum depression

The nurse is preparing a postpartum patient for discharge. For which reasons does the nurse instruct the patient to call the primary care provider? Select all that apply. 1. Foul-smelling lochia 2. Hot, red, painful breasts 3. Mild headache 4. Not sleeping well 5. Frequent, painful urination

ANS 1,2,5 Foul-smelling lochia is a sign of infection. Hot, red, painful breasts are a sign of infection. Frequent, painful urination is a sign of infection

The nurse on a postpartum unit observes a patient who delivered 2 days ago. The nurse notices extreme agitation and depressed mood. The patient states, "I think that my baby is deformed inside and we have to fix him." Which risk factor is most strongly related to possible postpartum psychosis (PPP)? 1. Separation from the baby's father 2. Personal history of bipolar disorder 3. Prolonged labor resulting in cesarean 4. Loss of first child from a heart defect

ANS 2 A patient history of either bipolar disorder or affective disorder can result in postpartum psychosis (PPP).

The nurse works in a labor and delivery facility with new protocols for estimating postpartum blood loss. Which method for estimating blood loss is implemented in the delivery room? 1. Ask the patient how many peripads she considered to be "soaked." 2. Collect blood in calibrated, under-buttocks drapes for vaginal birth. 3. Place a basin at the foot of the delivery table to catch any blood. 4. Rely on the primary health care provider's estimate of blood loss

ANS 2 Collecting blood in calibrated, under-buttocks drapes for vaginal birth and then weighing the drapes is the easiest way to estimate blood loss in the delivery room.

The nurse is preparing discharge teaching for a postpartum patient who exhibits signs and symptoms of an episiotomy infection and is on oral antibiotic therapy. Which discharge teaching will the nurse provide regarding pain management? 1. Application of hot packs to the perineal area 2. Information applicable to medication therapy 3. Instructions to improve circulation by ambulating 4. Medicating for pain above level 4 on a 0 to 10 scale

ANS 2 The nurse will need to provide applicable discharge teaching for both antibiotic and analgesic therapy. Antibiotics need to be taken as ordered and until they are gone.

The nurse is aware the greatest source of bleeding during childbirth occurs following detachment of the placenta. Which physiological change takes place immediately after the expulsion of the placenta to decrease the amount of blood loss? 1. Contractions of the uterine myometrium 2. Factor VIII complex increases during gestation 3. Platelet activity increases before labor and delivery 4. Fibrin formation increases before the birth occurs

ANS 1 After placenta detachment, contractions of the myometrium compress the blood vessels at the placental site, thus decreasing the amount of blood loss.

The nurse is providing postpartum care for a patient after a vaginal delivery. Which assessment finding causes the nurse to suspect endometritis from beta-hemolytic streptococcus? 1. Scant amount of odorless lochia 2. Presence of headache, malaise, and chills 3. Pain or discomfort in the midline lower abdomen 4. Elevated temperature greater than 100.4°F (38°C)

ANS 1 Endometritis from beta-hemolytic streptococcus specifically exhibits scant, odorless lochia in addition to the more universal signs of infection

The nurse is assisting the primary care provider with the third stage of a vaginal delivery. The patient is multiparous, experienced a precipitous birth, and has a history of hypertension. Which medical prescription does the nurse anticipate for this patient? 1. Methylergonovine 2. Fresh frozen plasma 3. Carboprost-tromethamine 4. Magnesium sulfate

ANS 3 Carboprost-tromethamine is classified as a prostaglandin and is prescribed to maintain contraction of the uterine muscles. It is injected into a large muscle or directly into the uterine muscle. The nurse will expect this prescription because the patient has multiple risks for PP

The nurse in a labor and delivery department carefully assesses postpartum patients for signs of complications related to hemorrhage. Which factor makes it most difficult to identify the risk of hemorrhage through vital sign evaluation? 1. Blood pressure may be elevated from prenatal conditions. 2. Respirations are increased due to activity of labor. 3. Changes in blood pressure may not be an immediate sign. 4. Heart rate may increase with intensity of labor

ANS 3 Changes in blood pressure may not be an immediate sign of hemorrhage in a postpartum patient. OB patients may not show the same signs and symptoms observed in nonpregnant patients during hemorrhage until approximately one-third of the woman's entire blood volume is lost. The postpartum patient has an increased blood volume from pregnancy, which delays vital sign indications. A decrease in BP is a late sign of postpartum hemorrhage

The nurse is providing care for a patient who is 1 day postpartum and exhibiting symptoms of postpartum psychosis. Which medical management does the nurse expect for this patient? 1. Prescriptions for antidepressant/antipsychotic drugs 2. Discharge to home with 24-hour observation in place 3. Immediate hospitalization in a psychiatric unit 4. Prescribed neonate visits during in-patient treatment

ANS 3 The nurse expects the health care provider to immediately hospitalize the patient in a psychiatric unit. Maintaining the patient in the postpartum unit delays necessary psychiatric treatment.

The nurse is providing care for a patient who is 8 hours postpartum after a vaginal delivery. The patient reports severe perineal pain unaffected by pain medication. The nurse notices a 4 cm area of discoloration on the labia that is tender to the touch. Which action does the nurse take? 1. Continue to apply ice to the area for 24 hours. 2. Monitor vital signs and report any abnormal readings. 3. Contact the primary care provider for further evaluation. 4. Relieve pressure by placing patient in a side-lying position

ANS 3 The primary care provider needs to be contacted about assessment findings; the hematoma may need to be evaluated further and/or evacuation of the hematoma performed

The nurse continues to monitor a patient after a vaginal delivery with an estimated blood loss of 1,000 mL. Which assessment finding does the nurse recognize as requiring Stage 3 hemorrhage protocol? 1. Increased patient restlessness. 2. Manifestations of severe pain. 3. Development of abnormal vital signs. 4. Patient requests water for extreme thirst.

ANS 3 Vital signs will remain normal during Stages 1 and 2. The evidence of abnormal vital signs is one indicator of Stage 3 hemorrhage. Other Stage 3 indicators include continued bleeding, more than 2 units red blood cells (RBCs) given, patient at risk for occult bleeding/coagulopathy, abnormal laboratory values, or oliguria

The lactation nurse takes a phone call from a mother who is breastfeeding her 2-month-old infant. The mother reports an area of redness and warmth on the breast and a painful burning sensation when breastfeeding. Which statement by the nurse is correct if mastitis is suspected? 1. "If your nipples are cracked, you will need to stop breastfeeding." 2. "Pump your milk and throw it away until the infection is gone." 3. "The baby gave you an infection and needs to be on antibiotics." 4. "Continuing to breastfeed will help clear up the condition."

ANS 4 Mastitis is generally self-limiting, and continued breastfeeding can help clear up the infection and condition. If antibiotic therapy is indicated, the infection generally resolves within 24 to 48 hours of antibiotic therapy

The nurse is closely monitoring a patient who is postpartum and at risk for PPH. Which assessment finding will cause the nurse to contact the primary care provider immediately? 1. The ute1rus is displaced. 2. The uterine fundus is boggy. 3. Small clots are expressed with massage. 4. Peripad weighs 100 g within 15 minutes

ANS 4 The nurse will monitor the amount and characteristics of each patient's lochia. If bleeding seems excessive, the nurse will weigh peripads to ascertain the amount of blood loss. This patient's EBL is 100 mL in 15 minutes (1 g = 1 mL of blood). The nurse will contact the primary care provider and report postpartum hemorrhage