Postpartum Complications

A nurse is assessing a 1-day postpartum client who had a spontaneous vaginal delivery over an intact perineum. The fundus is firm at the umbilicus, lochia moderate, and perineum edematous. One hour after receiving ibuprofen 600 mg po, the client is complaining of perineal pain at level 9 on a 10-point scale. Based on this information, which of the following is an appropriate conclusion for the nurse to make about the client? 1. She should be assessed by her doctor. 2. She should have a sitz bath. 3. She may have a hidden laceration. 4. She needs a narcotic analgesic.

ANS: 1 1. The client should be assessed by her health care practitioner. 2. The client may need a sitz bath, but should be assessed first. 3. It is unlikely that this client has a hidden laceration as her lochial flow is normal. 4. The client may benefit from a narcotic, but should be assessed first. TEST-TAKING TIP: This client is complaining of an excessive amount of pain after having received a relatively large dose of ibuprofen. Because the perineum is edematous, the lochial flow is normal, and the pain level is well above that expected, the nurse should suspect that the client has developed a hematoma. The client should be assessed by her health care provider.

The nurse administers RhoGAM to a postpartum client. Which of the following is the goal of the medication? 1. Inhibit the mother's active immune response. 2. Aggressively destroy the Rh antibodies produced by the mother. 3. Prevent fetal cells from migrating throughout the mother's circulation. 4. Change the maternal blood type to Rh-positive.

ANS: 1 1. The goal of the injection of RhoGAM is to inhibit the mother's immune response. 2. Immune globulin is composed of antibodies. When a client receives RhoGAM, she receives passive antibodies to inhibit her immune response. 3. Passive antibodies cannot prevent the migration of fetal cells throughout the mother's bloodstream. 4. A client's blood type is determined by her DNA. RhoGAM cannot change a client's DNA.

The nurse is discharging five Rh-negative clients from the maternity unit. The nurse knows that the teaching was successful when the client who had which of the following deliveries asks why she must receive a RhoGAM injection? Select all that apply. 1. Abortion at 10 weeks' gestation. 2. Amniocentesis at 16 weeks' gestation. 3. Fetal demise at 24 weeks' gestation. 4. Birth of Rh-negative twins at 35 weeks' gestation. 5. Delivery of a 40-week-gestation, Rh-positive baby

ANS: 1, 2, 3, and 5 are correct. 1. The client should receive a RhoGAM injection after a spontaneous abortion. 2. The client should receive a RhoGAM injection after an amniocentesis. 3. The client should receive a RhoGAM injection after the delivery of a fetal demise. 4. The client does not need a RhoGAM injection after the delivery of Rh-negative twins. 5. The client should receive a RhoGAM injection after birth of an Rh-positive baby.

A nurse administered RhoGAM to a client whose blood type is A+ (positive). Which of the following responses would the nurse expect to see? Select all that apply. 1. Fever. 2. Flank pain. 3. Dark-colored urine. 4. Swelling at the injection site. 5. Polycythemia.

ANS: 1, 2, and 3 are correct. 1. The nurse would expect to see fever, flank pain, and dark-colored urine. 2. The nurse would expect to see fever, flank pain, and dark-colored urine. 3. The nurse would expect to see fever, flank pain, and dark-colored urine. 4. Rh- (negative) clients often complain of swelling at the injection site. This is an expected finding. 5. The nurse would expect to see a hemolytic response, not polycythemia. TEST-TAKING TIP: When RhoGAM is administered to an Rh+ (positive) client, antibodies against the client's red blood cells are being injected into her body. A hemolytic response similar to one seen when a client receives the wrong type of blood may develop.

A nurse who is called to a client's room notes that the client's cesarean incision has separated. Which of the following actions is the highest priority for the nurse to perform? 1. Cover the wound with sterile wet dressings. 2. Notify the surgeon. 3. Elevate the head of the client's bed slightly. 4. Flex the client's knees.

ANS: 2 1. After the surgeon has been notified, the nurse should stay with the patient while another staff member gathers supplies, including a suture removal kit and personal protective equipment as well as sterile saline solution and a large syringe. 2. The highest priority action is to notify the surgeon. 3. After the surgeon has been notified, the nurse should elevate the client's bed slightly. 4. After the surgeon has been notified, the nurse should flex the client's knees slightly.

A client is 10 minutes postpartum from a forceps delivery of a 4,500-gram neonate with a cleft lip. The physician performed a right mediolateral episiotomy during the delivery. The client is at risk for each of the following nursing diagnoses. Which of the diagnoses is highest priority at this time? 1. Ineffective breastfeeding. 2. Fluid volume deficit. 3. Infection. 4. Pain.

ANS: 2 1. Because the baby has a cleft lip, this is an appropriate nursing diagnosis, but it is not the highest priority diagnosis. 2. This is the priority nursing diagnosis. Because the baby is macrosomic, the client is high risk for uterine atony that could lead to heavy vaginal bleeding possibly resulting in fluid volume deficit. 3. Although the client is at high risk for infection, it is not highest priority. Infections take time to develop and this client is only 10 minutes postdelivery. 4. Although the client is at high risk for pain, especially from the episiotomy, this is not the highest priority nursing diagnosis.

A breastfeeding woman, 6 weeks postdelivery, must go into the hospital for a hemorrhoidectomy. Which of the following is the best intervention regarding infant feeding? 1. Have the woman wean the baby to formula. 2. Have the baby stay in the hospital room with the mother. 3. Have the woman pump and dump her milk for two weeks. 4. Have the baby bottle fed milk that the mother has stored.

ANS: 2 1. It is unnecessary to wean the baby to formula. 2. Optimally, the baby should stay in the hospital room with the mother. 3. It is unnecessary for the mother to pump and dump for 2 weeks. 4. Although the baby could drink milk stored by the mother, this is not the best solution.

A client is being discharged on Coumadin (warfarin) post-pulmonary embolism after a cesarean delivery. Which of the following laboratory values indicates that the medication is effective? 1. PT (prothrombin time): 12 sec (normal is 10-13 seconds). 2. INR (international normalized ratio): 2.5 (normal is 1.0-1.4). 3. Hematocrit 55%. 4. Hemoglobin 10 g/dL.

ANS: 2 1. The PT is normal. For someone taking warfarin, the PT time should be prolonged 1.5 to 2.0 times normal. 2. The INR should be between 2 and 3. 3. The hematocrit is elevated. It should be within normal limits. 4. The hemoglobin is below normal. It should be within normal limits.

The nurse is performing a postpartum assessment on a client who delivered 4 hours ago. The nurse notes a firm uterus at the umbilicus with heavy lochial flow. Which of the following nursing actions is appropriate? 1. Massage the uterus. 2. Notify the obstetrician. 3. Administer an oxytocic as ordered. 4. Assist the client to the bathroom.

ANS: 2 1. The uterus is contracted. Massaging the uterus will not remedy the problem of heavy lochial flow. 2. It is important for the nurse to notify the physician. The client is bleeding more than she should after the delivery. 3. An oxytocic promotes contraction of the uterine muscle. The muscle is already contracted. 4. The uterus is at the umbilicus. It is unlikely that it is displaced from a full bladder.

The nurse assesses a 2-day postpartum, breastfeeding client. The nurse notes blood on the mother's breast pad and a crack on the mother's nipple. Which of the following actions should the nurse perform at this time? 1. Advise the woman to wash the area with soap to prevent mastitis. 2. Provide the woman with a tube of topical lanolin. 3. Remind the woman that the baby can become sick if he drinks the blood. 4. Get the woman an order for a topical anesthetic.

ANS: 2 1. The woman should not wash with soap. Soaps destroy the natural lanolins produced by the body. 2. A small amount of lanolin should be applied to the nipple after each feeding. 3. The baby will not become sick from the blood. The woman should be warned that he may spit up digested and/or undigested blood after the feeding, however. 4. Topical anesthetics are not used on the breasts. The woman could receive an oral analgesic, however.

A nurse is caring for the following four laboring patients. Which client should the nurse be prepared to monitor closely for signs of postpartum hemorrhage (PPH)? Select all that apply. 1. G1 P0000, delivered a fetal demise at 29 weeks' gestation. 2. G2 P1001, prolonged first stage of labor. 3. G2 P0010, delivered by cesarean section for failure to progress. 4. G3 P0200, delivered vaginally a 42-week, 2,200-gram neonate. 5. G4 P3003, with a succenturiate placenta.

ANS: 2 and 5 are correct. 1. Preterm labor clients are not especially at high risk for postpartum hemorrhage. 2. Clients who have had a prolonged first stage of labor are at high risk for postpartum hemorrhage (PPH). 3. Cesarean section clients are not especially at high risk for PPH. 4. Postdates clients who deliver small babies are not especially at high risk for PPH. 5. Clients with a succenturiate placenta are at high risk for PPH.

A client received general anesthesia during her cesarean section 4 hours ago. Which of the following postpartum nursing interventions is important for the nurse to make? 1. Place the client flat in bed. 2. Assess for dependent edema. 3. Auscultate lung fields. 4. Check patellar reflexes.

ANS: 3 1. The client should not be placed flat in bed. Her bed should be placed in the Sims position to enable her to aerate well. 2. There is nothing in the scenario that suggests that this client is high risk for dependent edema. 3. It is important for the nurse to auscultate the client's lung fields every 4 hours to assess for rales. 4. There is nothing in the scenario that suggests that this client is high risk for an alteration in reflex response.

A client who is post-cesarean section for severe preeclampsia is receiving magnesium sulfate via IV pump and morphine sulfate via patient-controlled anesthesia (PCA) pump. The nurse enters the room on rounds and notes that the client is not breathing. Which of the following actions should the nurse perform first? 1. Give two breaths. 2. Discontinue medications. 3. Call a code. 4. Check carotid pulse.

ANS: 3 1. The nurse should call a code before beginning rescue breathing. 2. The nurse should call a code first and then discontinue the medication. 3. The nurse should call a code first. 4. The nurse should call a code before checking the carotid pulse.

A woman has just had a low forceps delivery. For which of the following should the nurse assess the woman during the immediate postpartum period? 1. Infection. 2. Bloody urine. 3. Heavy lochia. 4. Rectal abrasions.

ANS: 3 1. The nurse should monitor the client for signs of infection after the first 24 hours have passed. 2. The client is not at high risk for bloody urine. 3. The client should be monitored carefully for heavy lochia. 4. The client is not at high risk for rectal abrasions.

A nurse is working on the postpartum unit. Which of the following patients should the nurse assess first? 1. PP1 from vaginal delivery with complaints of burning on urination. 2. PP2 from forceps delivery with blood loss of 500 mL at time of delivery. 3. PP3 from vacuum delivery with hemoglobin of 7.2 g/dL. 4. PO4 from cesarean delivery with complaints of firm and painful breasts.

ANS: 3 1. This client must be assessed—she likely has a urinary tract infection (UTI)—but another client should be checked first. 2. This client must be assessed—although her blood loss is within normal limits— but another client should be checked first. 3. This client should be assessed first. The hemoglobin level is well below normal. 4. This client must be assessed—she is likely engorged—but another client should be checked first.

A gestational diabetic client, who delivered yesterday, is currently on the postpartum unit. Which of the following statements is appropriate for the nurse to make at this time? 1. "Monitor your blood glucose five times a day until your 6-week checkup." 2. "I will teach you how to inject insulin before you are discharged." 3. "Daily exercise will help to prevent you from becoming diabetic in the future." 4. "Your baby should be assessed every 6 months for signs of juvenile diabetes."

ANS: 3 1. This is unnecessary. Gestational diabetic clients need not assess their blood glucose levels during the postpartum. 2. This is unnecessary. Gestational diabetic clients need not inject insulin during the postpartum. 3. This is an appropriate statement to make. 4. This is not appropriate. Babies rarely develop diabetes before age 2. Plus, juvenile diabetes is now called type 1 diabetes.

A woman who wishes to breastfeed advises the nurse that she had a breast reduction one year earlier. Which of the following responses by the nurse is appropriate? 1. Advise the woman that unfortunately she will be unable to breastfeed. 2. Examine the woman's breasts to see where the incision was placed. 3. Monitor the baby's daily weights for excessive weight loss. 4. Inform the woman that reduction surgery rarely affects milk transfer.

ANS: 3 1. This may be true, but the mother may also be a successful breastfeeder. 2. This action can be helpful, but the placement of the incision will not necessarily determine the client's ability to breastfeed. 3. This action is very important. 4. This information is not accurate. Breast reduction surgery often does affect a woman's ability to breastfeed.

The nurse notes the following vital signs of a postoperative cesarean client during the immediate postpartum period: 100.0°F, P 68, R 12, BP 130/80. Which of the following is a correct interpretation of the findings? 1. Temperature is elevated, a sign of infection. 2. Pulse is too low, a sign of vagal pathology. 3. Respirations are too low, a sign of medication toxicity. 4. Blood pressure is elevated, a sign of preeclampsia.

ANS: 3 1. This temperature elevation does not indicate infection. 2. A low pulse rate is expected in the early postpartum period. 3. The respiratory rate of 12 is well below normal. Peripartum clients' respiratory rates average 20 rpm. 4. Although the systolic pressure is slightly elevated, a BP of 130/80 is within normal limits.

The home health nurse is visiting a client with HIV who is 6 weeks postdelivery. Which of the following findings would indicate that patient teaching by the nurse in the hospital was successful? 1. The client is breastfeeding her baby every two hours. 2. The client is using a diaphragm for family planning. 3. The client is taking her temperature every morning. 4. The client is seeking care for a recent weight loss.

ANS: 4 1. Breastfeeding is contraindicated when a mother is HIV positive. 2. It is recommended that HIV-positive clients use condoms for family planning. 3. It is unnecessary to take her temperature every morning. If she should develop a fever, she should seek medical assistance as soon as possible, however. 4. The client should seek care for a recent weight loss. This may be a symptom of full-blown AIDS.

what is the main difference between SVD and DVT?

SVD typically occurs the 3rd or 4th day post partum and DVT occurs much later (about 10 days postpartum)

what are S/S of thrombophlebitis ?

(1) Homan's sign (2) edema, warmth (3) diminished pulse in leg

how is peritonitis managed?

(1) Nasogastric tube to rest bowel and prevent vomiting (2) IV or TPN (3) Analgesics (4) Large dose antibiotics

what are the interventions of a DVT?

(1) Complete bed rest with legs elevated, ted hose (antiembolism stockings) (2) Application of warm moist heat (3) Anticoagulant therapy: Heparin IV or thrombolytic agents (4) Laboratory studies (PT, APTT) (5) Follow up with Doppler studies (6) Lung sounds to R/O pulmonary embolism

what are the parameters for postpartum hemorrhage during a vaginal delivery?

500-750 cc or greater

what is the cause of late (secondary) postpartum hemorrhage?

After the 1st 24 hours up to 6 weeks postpartum. Due to: (1) retained placenta fragments (2) subinvolution (3) hematomas

uterine blood is _______

dark

what changes in the pregnant woman increases the risk of thrombophlebitis

hypercoaguability, and compression of the common iliac vein by the gravid uterus leads to venous stasis.

what is Pelvic Cellulitis (Parametritis)?

infection that has spread to the broad ligament or the connective tissue of the pelvis

what is the best way to prevent cracked nipples?

proper latch-on and let go technique

what is the antidote to IV heparin?

protamine sulfate

what is uterine inversion?

uterus is turned inside out, rare but life threatening complication Coagulation disorders = DIC

what are the parameters for postpartum hemorrhage during a vaginal C/S?

1000 cc or greater in the first 24 hrs after delivery

what is the proper way of emptying the breast with mastitis ?

continue breastfeeding or pump

what is the antidote for coumadin?

vitamin K

what are the S/S of peritonitis ?

(1) Rigid/distended abdomen (2) Abdominal pain (3) High fever (4) N/V (5) Severe pain (6) Anxiety (7) Rapid shallow respirations (8) Excessive thirst (9) Tachycardia

what are the symptoms of superficial vein disease?

(1) Absent or low grade temperature (2) Localized tenderness and pain (3) Swelling and redness (4) Tender palpable cord along portion of vein

what are predisposing factors for thrombophlebitis?

(1) Hx of thrombophlebitis (2) obesity (3) advanced maternal age (>35) (4) smoking, diabetes, PIH, anemia, multigravid, c-section, retained placenta (5) use of estrogen or lactation suppression drugs

what are factors that predispose woman to reproductive tract lacerations?

(1) Nulliparity, (2) epidural anesthesia, (3) precipitous childbirth, (4) macrosomia, (5) forceps/vacuum birth, and oxytocin

what is the conversion for measuring QBL?

1 g= 1 mL of blood loss

what are some causes of uterine atony?

(1) Prolonged, difficult or rapid labor (2) Diminished tone due to multiparity, (3) macrosomia, (4) multiple births (5) Full bladder (6) Infection or retained placenta (7) Anesthetic agents manual removal of the placenta, (8) Maternal complications - PIH, DIC

what are 3 treatments for mastitis?

(1) frequent/complete emptying of the breast (2) antibiotics (3) antifungal for candidal infection

what is Virchow's Triad?

(1) hypercoagulability (2) venous stasis (3) damage to epithelial tissue

how is SVD managed?

(1) moist heat application (2) elevation of limb (3) bed rest (4) analgesics

what are S/S of postpartum depression?

(1) sleep disturbances (2) depersonalization (3) confusion (4) psychomotor disturbances

what are 4 other ways to manage mastitis?

(1) wear supportive bra (2) bed rest (3) proper hygiene: hand washing, etc (4) culture abscess, incision and drainage

what is the treatment of postpartum hemorrhage?

(1) Assess blood loss - Pad count (saturation 50cc) (2) I&O, Foley catheter insertion, Fluid replacement (3) Administer oxytocic drugs: IV pitocin, Methergine or Ergotrate IM or PO if BP is normal - 0.2 mg q2-4hr (max 5 doses), Hemabate in the OR with C/S. Check BP before giving Methergine, as it can cause sudden hypertension/stroke. (4) Bi-manual fundal massage - express clots so the uterus can contract normally. ** Note: Above steps should be done in this order (5) Blood replacement (6) Pre-op preparations (7) Time frame: 1-2 hours tops. If not resolved then OR to do a D&C. (8) Manual compression to try to contract the uterus (9) Elevate legs 20-30 degree angle (10) Prostaglandin directly into the uterus - 0.25 mg. May repeat q15-90 min (max 5 doses) (11) Clotting factor, fibrin, platelet counts to determine abnormal clotting (12) Assess fundus frequently (13) Teach patient to assess her own fundus and massage it. (14) D & C: dilate cervix and scrape uterine lining if measures don't work. (15) Assess for hematoma at C/S site or at episiotomy (episiotomy is an underappreciated source of pp blood loss because of slow, steady bleeding. (16) Blood transfusion prn (17) If all interventions don't work (D&C), hysterectomy is done as a last resort.

A woman states that all of a sudden her 4-day-old baby is having trouble feeding. On assessment, the nurse notes that the mother's breasts are firm, red, and warm to the touch. The nurse teaches the mother manually to express a small amount of breast milk from each breast. Which observation indicates that the nurse's intervention has been successful? 1. The mother's nipples are soft to the touch. 2. The baby swallows after every 5th suck. 3. The baby's pre- and postfeed weight change is 20 milliliters. 4. The mother squeezes her nipples during manual expression.

ANS: 1 1. If the woman has manually removed milk from her breasts, her nipples will soften to the touch. 2. If the baby is latched well, he should swallow after every suck. 3. The nurse would expect the baby to transfer 60 mL or more at the feeding. 4. The mother should not squeeze her nipple. The area behind the areola should be gently compressed.

what is Postpartum Endometritis (metritis)?

Infection limited to the endometrium lining of the uterus - most common infection pp. The placental site provides an excellent culture medium for bacterial growth. Largely associated with chorioamnionitis and cesarean birth.

T/F: Nurse should know that many of the drugs used in treating pp psychiatric conditions are C/I in pregnancy

True

what is postpartum depression?

aka Peripartum major mood episodes. Occurs in 10-20% of postpartum patients. Can occur any time in the 1st year after delivery - greatest risk occurs around the 4th week.

what is postpartum blues?

aka adjustment reaction with depressed mood, mildest condition, occurs in 85% of postpartum patients

the blood from cervical laceration is ______ ______

bright red

Are SSRI's safe for breastfeeding?

yes, Prozac is not a first choice

what characterizes a postpartum psychosis?

(1) Delusional episodes. Delusions make the distinction between pp blues/pp depression and psychosis. (2) Tends to affect primiparas more than multiparas. (3) Previous history of depression or mental illness is a risk factor.

A postoperative cesarean client, who was diagnosed with severe preeclampsia in labor and delivery, is transferred to the postpartum unit. The nurse is reviewing the client's doctor's orders. Which of the following medications that were ordered by the doctor should the nurse question? 1. Methergine (methylergonovine). 2. Magnesium sulfate. 3. Advil (ibuprofen). 4. Morphine sulfate

ANS: 1 1. Methergine is contraindicated for this client. 2. Magnesium sulfate is the drug of choice for the treatment of severe preeclampsia. 3. Ibuprofen is a nonsteroidal antiinflammatory drug (NSAID). It is an appropriate medication for the treatment of postpartum cramping. It is not contraindicated for this client. 4. Morphine sulfate is a narcotic analgesic. It is an appropriate medication for the treatment of postsurgical pain. It is not contraindicated for this client. TEST-TAKING TIP: Methergine is an oxytocic agent. It acts directly on the myofibrils of the uterus. Secondarily, it also contracts the muscles of the vascular tree. As a result, clients' blood pressure tends to elevate when they receive this medication. Methergine should not be administered to a client whose blood pressure is 130/90 or higher.

A client has just received Hemabate (carboprost) because of uterine atony not controlled by IV oxytocin. For which of the following side effects of the medication will the nurse monitor this patient? Select all that apply. 1. Hyperthermia. 2. Diarrhea. 3. Hypotension. 4. Palpitations. 5. Anasarca.

ANS: 1 and 2 are correct. 1. Hemabate can cause nausea, vomiting, diarrhea, and hyperthermia. 2. Hemabate can cause nausea, vomiting, diarrhea, and hyperthermia. 3. Hypotension is not associated with Hemabate. 4. Palpitations are not associated with Hemabate. 5. Anasarca is not associated with Hemabate.

On admission to the labor and delivery suite, the nurse assesses the discharge needs of a primipara who will be discharged home 4 days after a cesarean delivery. Which of the following questions should the nurse ask the client? 1. "Have you ever had anesthesia before?" 2. "Do you have any allergies?" 3. "Do you scar easily?" 4. "Are there many stairs in your home?"

ANS: 4 1. This is an important question to ask the client but it is unrelated to her discharge needs. 2. This is an important question to ask the client but it is unrelated to her discharge needs. 3. This is an important question to ask the client but it is unrelated to her discharge needs. 4. The client has had major surgery. The client will need some assistance when she returns home, especially if she has a number of stairs to climb.

what are the defining characteristics of postpartum infection (puerperal infection)?

Infection of the reproductive system after delivery. Can occur any time up to 6 weeks postpartum. Defined as temperature of 100.4 or greater after the first 24 hr - careful assessment of all pp women with increased temp is essential. Can occur at episiotomy site, C/S site or uterine site.

what is the treatment of a puerperal infection?

(1) C & S first, then antibiotics are started for 5 - 7 days (IV) or 14 days (PO) (Clindamycin, Gentamycin) (2) Culture is done from the infection site, (lochia and vagina for vaginal del or if a systemic infection is suspected, blood cultures are done. (3) May start a broad-spectrum antibiotic while waiting for results of C&S. Tylenol is ok to take for fever and will not affect the results. Antibiotics are continued until the woman has been afebrile for 48 hr. (4) I & O, encourage fluids (5) Sitz bath or good pericare with different antiseptic (betadine)

what are the S/S of postpartum hemorrhage?

(1) Decreased BP, (2) Increasing pulse, (3) Widening pulse pressure, (4) High temp, Thirst, (5) Restlessness, (6) Deceased LOC, and Decreased urinary output. *May not appear until 1000-1000mL or 20% lost. (7) Excessive/bright red bleeding. Abnormal clots. (8) Unusual pelvic discomfort/backache. (9) Slow, steady bleeding. The uterine cavity may distend with up to 1000cc or more of blood while the peri-pad remains suspiciously dry. (10) Boggy uterus: not contracting, soft and wobbly

what is mastitis and how is it defined?

Infection of the breast caused primarily by staphlococcus aureus entering through cracked nipples. Onset between 2-8 weeks pp. Ranges in severity from local inflammation to abscess/septicemia.

what are the S/S of postpartum depression?

(1) Duration varies. Can be symptomatic at 6 months pp. 2) Crying, feelings of helplessness, anger, anxiety, inability to care for self and baby (3) Inability to deal with day to day activities, lack of concern about personal appearance (4) Other signs and symptoms that usually start by 2 months postpartum: Insomnia, prolonged change in appetite, decreased energy, weight change

what are some causes to postpartum blues?

(1) Emotional letdown that follows labor and birth. (2) Severe PMS and depression during or prior to pregnancy. (3) The hormonal changes: in estrogen, progesterone, & prolactin levels that occur postpartum (4) Possible stress from life change. Episodic tearfulness, for no apparent reason, feelings of being overwhelmed. Fatigued, anxious, irritable.

what are the S/S of a puerperal infection?

(1) Fever above 100.4 after 24-48 hours post delivery. Sawtooth temperature spikes, usually between 101 - 104 (2) Uterine tenderness over and above normal, strong afterbirth pains. (3) Lower abdominal pain. (4) Foul smelling lochia (normal lochia has a slightly fleshy or earthy smell) (5) Lochia which is scanty, absent, or profuse, dark brownish in color (6) Tachycardia, Chills, Subinvolution, Loss of appetite, Malaise

what are the causative organisms of puerperal infection?

(1) Group B Hemolytic strep: most common within 24-36hrs pp (2) STIs such as GC/CT: second most common = chlamydia (late onset) (3) E-coli, Staph aureus and other aerobic bacteria (4) Anerobic streptococcus

what are the characteristics of postpartum blues?

(1) Mild depression interspersed with happier feelings. (2) Early onset generally within 2-4 days after birth and lasts from a few hours to 14 days. (3) Self limiting = will resolve itself and is usually short lived and temporary. (4) More common in primagravidas.

what are the S/S of mastitis?

(1) Fever, Chills, Headache, Sudden onset (2) Late onset of nipple pain, followed by: Shooting pain in the nipple during breastfeeding and between feedings (3) Pink and flaking skin of the affected breast (4) Inflamed breast tissue: pain, redness swelling (wedge-shaped) (5) Scant milk flow (6) Flu like symptoms to mother

what can cause early (primary) postpartum hemorrhage?

Due to uterine atony. Occurs in the first 24hrs after childbirth and is more common.

what are the predisposing factors of puerperal infection?

(1) Frequent vaginal exams, especially after rupture of membranes (2) Infection present at time of delivery or with rupture of membranes (3) Poor aseptic technique (for example unsterile catheterization) (4) Anemia, malnutrition, Diabetes, or obesity. Also smoking, use of drugs/alcohol. (5) Multiple, small lacerations attending normal labor and spontaneous birth, especially if the woman has cervical laceration (6) Retained placenta, manual removal of placenta (7) Instrument assisted birth (forceps delivery, vac. ext.) (8) Poor pericare (9) Prolonged ROM (12-24hr) (10) Personnel in delivery room with URI (11) Chorioamnionitis infection (12) Can occur with placement of FSE or IUP (13) C/S (risk of pp infection is 20 times greater than with vaginal delivery)

what are some risk factors of postpartum hemorrhage?

(1) Multiple gestation: twins or multipara can cause atony (2) Anesthesia: certain anesthetic agents, especially halothane, which cause the uterus to relax (3 types of gases they can use = furene, halothane, ethene) (3) LGA and Polyhydramnios causes over distention of the uterus (4) Vacuum extraction, forceps delivery (5) Trauma during the birth process (6) Retained placental fragments. Manual removal of placenta. (7) Prolonged or precipitous labor (fast labor, within 3 hours) (8) Chorioamnionitis: uterine infection during labor (9) PIH = preeclampsia (10) Previous hx of hemorrhage or bleeding disorder (10) Induction or augmentation with Pitocin (11) Mag sulfate: relaxes smooth muscle, must have Pitocin so uterus contracts. Pitocin after delivery does not have to be on a pump because, once the baby is out, there is no chance of uterine rupture. (12) Maternal malnutrition (13) Grand multipara: 7 or more because stretched uterine musculature contracts less vigorously (14) Placenta previa/accrete (15) Obesity and Full bladder

A postpartum woman has been diagnosed with postpartum psychosis. Which of the following is essential to be included in the family teaching for this client? 1. The woman should never be left alone with her infant. 2. Symptoms rarely last more than one week. 3. Clinical response to medications is usually poor. 4. The woman must have her vitals assessed every two days.

ANS: 1 1. It is essential that the client never be left alone with her baby. 2. The statement is untrue. There is no set time frame for the resolution of the symptoms of postpartum psychosis. 3. Clinical response to medications is usually quite good. 4. The client's vital signs need not be assessed frequently.

A client is on magnesium sulfate via IV pump for severe preeclampsia. Other than patellar reflex assessments, which of the following noninvasive assessments should the nurse perform to monitor the client for early signs of magnesium sulfate toxicity? 1. Serial grip strengths. 2. Kernig assessments. 3. Pupillary responses. 4. Apical heart rate checks.

ANS: 1 1. Serial grip strengths can be performed to monitor a client for magnesium sulfate toxicity. 2. Kernig's assessment is performed when checking for nuchal rigidity in a client with meningitis. 3. Pupillary responses are performed when a client has had a head injury or is not responsive. 4. Apical heart rate checks are performed when a client has a cardiac disease or is receiving digoxin.

A client is receiving a blood transfusion after the delivery of a placenta accreta and hysterectomy. Which of the following complaints by the client would warrant immediately discontinuing the infusion? 1. "My lower back hurts all of a sudden." 2. "My hands feel so cold." 3. "I feel like my heart is beating fast." 4. "I feel like I need to have a bowel movement."

ANS: 1 1. Sudden lower back pain is a sign of a transfusion reaction. 2. This is not a sign of a transfusion reaction. The client may be nervous about receiving the blood. 3. This is not a sign of a transfusion reaction. The client may be nervous about receiving the blood. 4. This is not a sign of a transfusion reaction. The client is likely having a normal bowel movement.

A rubella nonimmune, breastfeeding client has just received the rubella vaccine. Which of the following side effects should the nurse warn the client about? 1. The baby may develop a rash a week after the shot. 2. The baby may temporarily reject the breast milk. 3. The mother's milk supply may decrease precipitously. 4. The mother's joints may become painful and stiff.

ANS: 4 1. The mother, not the baby, may develop a macular rash after receiving the injection. The baby will be unaffected. 2. There is no evidence to suggest that babies whose mothers have received the rubella vaccine reject their mother's breast milk. 3. There is no evidence to suggest that the mother's breast milk supply will drop. 4. One out of 4 women complains of painful and stiff joints after receiving the injection.