prepU ch 22 Nursing Management of the Postpartum Woman at Risk
A client who had an emergency cesarean birth for fetal distress 3 days ago is preparing for discharge. When reviewing the home care instructions with the nurse, the client reveals she is saddened about her cesarean and feels let down that she was not able to have a vaginal birth. When questioned further, the client states she feels "weepy about everything" and cannot stop crying. What nursing action is indicated first?
Ask the client to elaborate on her feelings.
The nurse is caring for a postpartum woman who exhibits a large amount of bleeding. Which areas would the nurse need to assess before the woman ambulates?
Blood pressure, pulse, reports of dizziness
The nurse is conducting discharge teaching with a postpartum woman. What would be an important instruction for this client?
Call her caregiver if lochia moves from serosa to rubra.
A client presents to the clinic with her 3-week-old infant reporting general flu-like symptoms and a painful right breast. Assessment reveals temperature 101.8°F (38.8°C) and the right breast nipple with a movable mass that is red and warm. The client is diagnosed with mastitis. Which instruction should the nurse prioritize for this client?
Complete the full course of antibiotic prescribed, even if you begins to feel better.
A nurse is caring for a client with a postpartum laceration. Which nursing diagnoses would be most appropriate? Select all that apply.
Ineffective tissue perfusion Risk for injury Impaired tissue integrity
A postpartum client who was discharged home returns to the primary health care facility after 2 weeks with reports of fever and pain in the breast. The client is diagnosed with mastitis. What education should the nurse give to the client for managing and preventing mastitis?
Perform hand-washing before and after breastfeeding
Which situation should concern the nurse treating a postpartum client within a few days of birth?
The client feels empty since she gave birth to the neonate.
A postpartum client is recovering from the birth and emergent repair of a cervical laceration. Which sign on assessment should the nurse prioritize and report to the health care provider?
Weak and rapid pulse
Which intervention would be helpful to a client who is bottle feeding her infant and experiencing hard, engorged breasts?
applying ice
A nurse is assigned to care for a client with lacerations. The nurse knows that which factor would be the most likely cause of lacerations of the genital tract?
birth of a large newborn
Which measurement best describes postpartum hemorrhage?
blood loss of 1,000 ml, occurring at least 24 hours after birth
The nurse recognizes that the postpartum period is a time of rapid changes for each client. What is believed to be the cause of postpartum affective disorders?
drop in estrogen and progesterone levels after birth
Manual manipulation is used to reposition the uterus of a client experiencing uterine inversion. After the repositioning, which type of medication would the nurse administer as prescribed to the client?
oxytocin agent
Which assessment would lead the nurse to believe a postpartum woman is developing a urinary complication?
At 8 hours postdelivery she has voided a total of 100 mL in four small voidings.
About 10 days following birth, a new mother visits her primary care provider with localized symptoms of redness, swelling, warmth, and a hard, inflamed vessel in one leg. The nurse should suspect which condition?
femoral thrombophlebitis
The nurse is administering methylergonovine 0.2 mg to a postpartum client with uterine subinvolution. Which assessment will the nurse need to make prior to administering the medication?
if blood pressure is lower than 140/90 mm Hg
Which nursing diagnosis would be most appropriate for a client with a postpartum hematoma?
Risk for impaired urinary elimination
A client in her seventh week of the postpartum period is experiencing bouts of sadness and insomnia. The nurse suspects that the client may have developed postpartum depression. What signs or symptoms are indicative of postpartum depression? Select all that apply.
inability to concentrate loss of confidence decreased interest in life
In talking to a mother who is 6 hours post-delivery, the mother reports that she has changed her perineal pad twice in the last hour. What question by the nurse would best elicit information needed to determine the mother's status?
"How much blood was on the two pads?"
The nurse is administering a postpartum woman an antibiotic for mastitis. Which statement by the mother indicates that she understood the nurse's explanation of care?
"I can continue breastfeeding my infant, but it may be somewhat uncomfortable."
A postpartum woman is being discharged with anticoagulant therapy for treatment of deep vein thrombosis. After teaching the woman about this therapy, the nurse determines that the teaching was successful based on which statement?
"I need to apply pressure to any cut for 5 to 10 minutes."
A woman who is experiencing postpartum hemorrhage is extremely apprehensive and diaphoretic. The woman's extremities are cool and her capillary refill time is increased. Based on this assessment, the nurse suspects that the client is experiencing approximately how much blood loss?
20%
A client who gave birth vaginally 16 hours ago states she does not need to void at this time. The nurse reviews the documentation and finds that the client has not voided for 7 hours. Which response by the nurse is indicated?
"It's not uncommon after birth for you to have a full bladder even though you can't sense the fullness."
The nurse is monitoring a client who is 5 hours postpartum and notes her perineal pad has become saturated in approximately 15 minutes. Which action should the nurse prioritize?
Assess the woman's fundus
The nurse is giving an educational presentation to the local Le Leche league chapter. One woman asks about risk factors for mastitis. Which condition would the nurse most likely include in the response?
Pierced nipple
A woman arrives at the office for her 4-week postpartum visit. Her uterus is still enlarged and soft, and lochial discharge is still present. Which nursing diagnosis is most likely for this client?
Risk for fatigue related to chronic bleeding due to subinvolution
Which recommendation should be given to a client with mastitis who is concerned about breastfeeding her neonate?
She should continue to breastfeed; mastitis will not infect the neonate.
A 17-year-old nulliparous client presents in active labor. It is discovered that she received no prenatal care. Which information would be important to collect first?
coagulation studies
Two weeks after giving birth, a woman is feeling sad, hopeless, and guilty because she cannot take care of the infant and partner. The woman is tired but cannot sleep and has isolated herself from family and friends. The nurse recognizes that this client is exhibiting signs of:
postpartum depression.
A nurse is caring for a client in the postpartum period. When observing the client's condition, the nurse notices that the client tends to speak incoherently. The client's thought process is disoriented, and she frequently indulges in obsessive concerns. The nurse notes that the client has difficulty in relaxing and sleeping. The nurse interprets these findings as suggesting which condition?
postpartum psychosis
A fundal massage is sometimes performed on a postpartum woman. The nurse would perform this procedure to address which condition?
uterine atony
The nurse is caring for several women in the postpartum clinic setting. Which statement(s), when made by one of the clients, would alert the nurse to further assess that client for postpartum psychosis? Select all that apply.
"The newborn is not really mine emotionally, since I was never pregnant and do not have children." "When the newborn is sleeping, I can see his thoughts projected on my phone and I do not like the thoughts." "I believe my newborn is losing weight because I will not feed him because my milk was poisoned by the health care provider."
The nurse is assigned to care for a postpartum client with a deep vein thrombosis (DVT) who is prescribed anticoagulation therapy. Which statement will the nurse include when providing education to this client?
"You need to avoid medications which contain acetylsalicylic acid."
The nurse is assessing a client 48 hours postpartum and notes on assessment: temperature 101.2oF (38.4oC), HR 82, RR 18, BP 125/78 mm Hg. The nurse should suspect the vital signs indicate which potential situation?
infection
