The Postpartum Family at Risk

The postpartum client is suspected of having acute cystitis. Which symptoms would the nurse expect to see in this​ client?

Frequency Suprapubic pain

The postpartum client is concerned about mastitis because she experienced it with her last baby. Preventive measures the nurse can teach include which of the​ following?

Frequent breastfeedings

The nurse is assisting a multiparous woman to the bathroom for the first time since her delivery 3 hours ago. When the client stands​ up, blood runs down her legs and pools on the floor. The client turns pale and feels weak. What would be the first action of the​ nurse?

Help the client back to bed to check the fundus

Which of the following would be considered a clinical sign of​ hemorrhage?

Increasing pulse

A postpartum woman is at increased risk for developing urinary tract problems because of which of the​ following?

Inhibited neural control of the bladder following the use of anesthetic agents

Clinical features of posttraumatic stress disorder​ (PTSD) include which of the​ following?

Irritability Flashbacks Difficulty sleeping

Risk factors associated with increased risk of thromboembolic disease include which of the​ following?

Malignancy Diabetes mellitus Varicose veins

A postpartum client reports​ sharp, shooting pains in her nipple during breastfeeding and​ flaky, itchy skin on her breasts. Which of the following does the nurse​ suspect?

Mastitis

The client delivered by cesarean birth 3 days ago and is being discharged. Which statement should the nurse include in the discharge​ teaching?

"If your incision becomes increasingly​ painful, call the​ doctor."

The client delivered her second child 1 day ago. The​ client's temperature is​ 101.4° F, her pulse is​ 100, and her blood pressure is​ 110/70. Her lochia is​ moderate, serosanguinous, and malodorous. She is started on IV antibiotics. The nurse provides education for the client and her partner. Which statement indicates that teaching has been​ effective?

"My Beta-strep​ culture's being positive might have contributed to this​ problem."

The nurse is assessing a client who has been diagnosed with an early postpartum hemorrhage. Which findings would the nurse​ expect?

1) Hematoma formation or​ bulging/shiny skin in the perineal area 2) Rise in the level of the fundus of the uterus 3) A boggy fundus that does not respond to massage

Which interventions can the nurse utilize to provide continuity of care for the postpartal client who experienced a complication and is now ready to return​ home?

1)Encourage the client to take advantage of home visits. 2)Make telephone calls as a​ follow-up to check on the client and newborn. 3)Provide information about postpartal support groups. 4)Supply information about postpartum expectations designed to meet the specific needs of a variety of families.

The nurse is caring for a postpartum client who is at risk for developing early postpartum hemorrhage. What interventions would be included in the plan of care to detect this​ complication?

1)Obtain blood specimens for hemoglobin and hematocrit. 2)Weigh perineal pads if the client has a​ slow, steady, free flow of blood from the vagina.

The postpartum patient who delivered 2 days ago has developed endometritis. Which charting entry would the nurse expect to find in this patient's chart? A) "Cesarean birth performed secondary to arrest of dilation." B) "Rupture of membranes occurred 2 hours prior to delivery." C) "External fetal monitoring used throughout labor." D) "Patient has history of pregnancy-induced hypertension."

A) "Cesarean birth performed secondary to arrest of dilation." Cesarean birth is the greatest predictor of postpartum endometritis. The frequent cervical exams necessary to assess for arrest of dilation are another risk factor for postpartum infection. Prolonged rupture of membranes (longer than 12 hours) is a risk factor for postpartum endometritis (2 hours are not prolonged). Internal (both internal fetal scalp electrode and intrauterine pressure catheter) NOT external fetal monitoring are risk factors for postpartum endometritis. Pregnancy-induced hypertension is not a risk factor for development of postpartum endometritis.

The postpartum multipara is breastfeeding her new baby. The patient states that she developed mastitis with her first child, and asks if there is something she can do to prevent mastitis this time. The best response of the nurse is: A) "Massage your breasts on a daily basis, and if you find a hardened area, massage it towards the nipple to unblock that duct." B) "Most first-time moms experience mastitis. It is really quite unusual for a woman having her second baby to get it again." C) "Apply cold packs to any areas that feel thickened or firm in order to relieve the swelling and stasis of the milk in that area." D) "Take your temperature once a day. This will help you to pick up the infection early, before it becomes severe."

A) "Massage your breasts on a daily basis, and if you find a hardened area, massage it towards the nipple to unblock that duct." A hardened area could indicate a blocked duct. Massage of the blocked duct toward the nipple will help to unplug the duct and relieve stasis of the milk, thereby preventing mastitis. It is not unusual for mothers to develop complications similar to those experienced in prior pregnancies. Warm packs, not cold packs, should be applied to areas that are warm, red, or hardened. The onset of mastitis is quite rapid, and taking the temperature daily is not likely to be helpful for catching early onset of the infection. Massaging the area to unplug the duct and relieve milk stasis is much more effective.

The patient at 3 days postpartum has come to the maternity clinic with complaints of urinary urgency and dysuria. Which statement is most important for the nurse to make? A) "Void into this sterile cup without touching the inside of the cup." B) "Be sure to wipe from back to front after you have a bowel movement." C) "Call the clinic if you develop nausea and vomiting or constipation." D) "Decrease your fluid intake for a few days, but eat a lot of vegetables."

A) "Void into this sterile cup without touching the inside of the cup." A clean-catch urine sample will need to be obtained for urinalysis to determine if the patient has developed a urinary tract infection. Patients should be taught to wipe from front to back after bowel movements in order to prevent contamination of the urethra and bladder with normal bowel flora. A lower urinary tract infection can progress into pyelonephritis, the signs of which are fever and flank pain. Constipation is not associated with urinary tract infections. Patients should increase their fluid intake but decrease their consumption of carbonated beverages. Cranberries, or cranberry juice, are helpful, as they acidify the urine. Vegetables do not help clear or prevent urinary tract infections.

The charge nurse is reviewing the plan of care for maternal patients currently admitted for postpartum care. During the course of her chart review, which intervention requires immediate consideration for revision? A) Daily prothrombin time (PT) measurements for coagulation assessment in a woman receiving heparin for treatment of thrombophlebitis. B) Use of the REEDA scale for assessment every 8 hours in the care of a patient diagnosed with puerperal infection. C) Misoprostol (Cytotec) administration to a patient who demonstrates uterine atony and bleeding after receiving oxytocic medications. D) Inserting a straight catheter to drain the overdistended bladder of a woman during the early postpartum period of her care.

A) Daily prothrombin time (PT) measurements for coagulation assessment in a woman receiving heparin for treatment of thrombophlebitis. Prothrombin time (PT) evaluates the anticoagulation effects of Coumadin; the effects of heparin are assessed by way of activated partial thromboplastin time (aPTT). The nurse should inspect the woman's perineum every 8 to 12 hours for signs of early infection. The REEDA scale helps the nurse remember to consider redness, edema, ecchymosis, discharge, and approximation Misoprostol (Cytotec) administration to a patient who demonstrates uterine atony and bleeding after receiving oxytocic medications Inserting a straight catheter to drain the overdistended bladder of a woman during the early postpartum period of her care.

A patient is experiencing excessive bleeding immediately after the birth of her newborn. After speeding up the IV fluids containing oxytocin, with no noticeable decrease in the bleeding, the nurse should anticipate the physician requesting which medications? (Select all that apply) A) Methergine B) Stadol C) Misoprostol D) Betamethasone

A) Methergine C) Misoprostol Methergine is a drug of choice for postpartum hemorrhage. Misoprostol is commonly administered rectally for postpartum hemorrhage Stadol is an analgesic and Bethamethasone is a glucocorticoid used for preterm labor in an attempt to decrease respiratory distress in preterm infant

A nurse suspects that a postpartum patient has mastitis. The following assessment provides what data to support this assessment? (Select all that apply) A) Shooting pain in her nipple during breastfeeding. B) Late onset of nipple pain C) Pink, flaking, pruritic skin of the affected nipple. D) Nipple soreness when the infant latches on.

A) Shooting pain in her nipple during breastfeeding. B) Late onset of nipple pain C) Pink, flaking, pruritic skin of the affected nipple. Mastitis is characterized by late-onset nipple pain, followed by shooting pain during and between feedings. The skin of the affected breast becomes pink, flaking, and pruritic Nipple soreness, engorgement, and the letdown reflex are not symptoms of Mastitis.

The postpartum client who is being discharged from the hospital experienced severe postpartum depression after her last birth. What should the nurse include in the plan of​ follow-up care for this​ client?

An appointment with a mental health counselor

The client delivered vaginally 2 hours ago after receiving an epidural analgesia. She has a slight tingling sensation in both lower​ extremities, but normal movement. She sustained a​ second-degree perineal laceration. Her perineum is edematous and ecchymotic. What should the nurse include in the plan of care for this​ client?

Assist the client to the bathroom in 2 hours to void.

A postpartal client recovering from deep vein thrombosis is being discharged. What areas of teaching on​ self-care and anticipatory guidance should the nurse discuss with the​ client?

Avoid crossing the legs. Avoid prolonged standing or sitting. Take frequent walks.

The postpartum patient has developed thrombophlebitis in her right leg. Which finding requires immediate intervention? The patient: A) Develops pain and swelling in her left lower leg B) Appears anxious, and describes pressure in her chest. C) Becomes upset that she can't go home yet.

B) Appears anxious, and describes pressure in her chest. Anxiety and sudden onset of chest pain or pressure might indicate pulmonary embolus, which is a life-threatening complication of thrombophlebitis. This is the most abnormal finding, and requires immediate intervention.

Which method of initial assessment would best indicate whether a patient has a urinary complication? A) Urine pH B) Calculation of urine output C) Urine-specific gravity D) Calculation of intake

B) Calculation of urine output Calculation of output would provide a better assessment of complete emptying of the bladder, because overdistention can cause trauma to the bladder, displace the uterus, and cause infection. Urine pH and urine-specific gravity can be used to identify certain conditions, but would not be part of the initial assessment. Monitoring intake is an intervention that may help prevent urinary complications but calculating the intake itself would not indicate a complication.

The nurse is assisting a multiparous woman to the bathroom for the first time since her delivery 3 hours ago. When the patient stands up, blood runs down her legs and pools on the floor. The patient turns pale and feels weak. The first action of the nurse is to: A) Assist the patient to empty her bladder B) Help the patient back to bed to check her fundus. B) Assess her blood pressure and pulse. C) Begin an IV of Lactated Ringer's infusion.

B) Help the patient back to bed to check her fundus. Massaging the fundus is the top priority because of the excessive blood loss. If the fundus is boggy, fundal massage may stimulate toning of the uterus and prevent further blood loss.

The nurse is calling postpartum patients. Which patient should be seen immediately? The patient at 4 weeks postpartum who: A) Describes feeling sad all the time. B) Reports hearing voices talking about the baby. C) States she has no appetite and wants to sleep all day. D) Says she needs a refill on her sertraline (Zoloft) next week.

B) Reports hearing voices talking about the baby. This is an indication the patient is experiencing postpartum psychosis, and is the highest priority, because the voices might tell her to harm her baby.

The nurse is revising the care plan of a 26-year-old woman who has developed mastitis. Which nursing diagnosis is most appropriate for inclusion in this patient's updated plan of care? A) Ineffective Peripheral Tissue Perfusion related to obstructed venous return B) Risk for Trauma related to lack of information about appropriate breastfeeding practices. C) Deficient Knowledge related to self-care after discharge on anticoagulant therapy D) Acute Pain related to tissue hypoxia and edema secondary to vascular obstruction

B) Risk for Trauma related to lack of information about appropriate breastfeeding practices. In relation to the patient's mastitis, the most appropriate nursing diagnosis is Risk for Trauma related to lack of information about appropriate breastfeeding practices.

The maternal nurse educator is conducting a presentation for antepartum patients describing the identification and care of women diagnosed with postpartum psychiatric disorders. Which information should the maternal nurse educator include in her teaching content? A) Postpartum depression occurs in as many as 50% to 70% of mothers and is characterized by mild depression interspersed with happier feelings. B) Postpartum depression is typically mild and usually self-limiting, lasting up to 6 weeks. C) Even if she is asymptomatic, a woman with a history of postpartum depression should be referred to a mental health professional for counseling and biweekly visits postpartum. D) Women with postpartum depression have a history of exposure to an extremely traumatic personal event that involves actual or threatened death or serious injury and evokes intense fear, helplessness, or horror.

C) Even if she is asymptomatic, a woman with a history of postpartum depression should be referred to a mental health professional for counseling and biweekly visits postpartum. Women with a history of postpartum psychosis or depression or other risk factors should be referred to a mental health professional for counseling and biweekly visits between the second and sixth week postpartum for evaluation. As many as 50% to 70% of mothers develop adjustment reaction with depressed mood, which is also known as postpartum blues, or as maternal or baby blues. Unlike postpartum depression, this condition is characterized by mild depression interspersed with happier feelings. Post-traumatic stress disorder or PTSD (also called post-traumatic stress syndrome) is associated with exposure to an extremely traumatic event involving direct personal experience with actual or threatened death or serious injury, and evokes a reaction of intense fear, helplessness, or horror.

To prevent the spread of​ infection, the nurse teaches the postpartum client to do which of the​ following?

Change​ peri-pads frequently

Which relief measure would be most appropriate for a postpartum client with superficial​ thrombophlebitis?

Elevate the affected limb

A client is experiencing excessive bleeding immediately after the birth of her newborn. After speeding up the IV fluids containing​ oxytocin, with no noticeable decrease in the​ bleeding, the nurse should anticipate the physician requesting which​ medications?

Misoprostol Methergine

Which of the following is a risk factor for urinary retention after​ childbirth?

Not sufficiently recovering from the effects of anesthesia

The postpartum client states that she​ doesn't understand why she​ can't enjoy being with her baby. What would the nurse be concerned​ about?

Postpartum depression

The nurse understands that the classic symptom of endometritis in a postpartum client is which of the​ following?

Purulent, foul-smelling lochia

Which findings would indicate the presence of a perineal wound​ infection?

Redness Tender at the margins Hardened tissue Purulent drainage

A nurse suspects that a postpartum client has mastitis. Which data support this​ assessment?

Shooting pain between breastfeedings Late onset of nipple pain ​Pink, flaking, pruritic skin of the affected nipple

The nurse suspects that a client has developed a perineal hematoma. What assessment findings would the nurse have detected to lead to this​ conclusion?

Tense tissues with severe pain

A client had a cesarean birth 3 days ago. She has​ tenderness, localized​ heat, and redness of the left leg. She is afebrile. As a result of these​ symptoms, what would the nurse anticipate would be the next course of​ action?

That the client would be placed on bed rest

The postpartum client has developed thrombophlebitis in her right leg. Which finding requires immediate​ intervention?

The client appears​ anxious, and describes pressure in her chest.

The charge nurse is assessing several postpartum clients. Which client has the greatest risk for postpartum​ hemorrhage?

The client who had oxytocin augmentation of labor

The nurse is calling clients at 4 weeks postpartum. Which of the following clients should be seen​ immediately?

The client who reports hearing voices talking about the baby

A postpartum client with endometritis is being discharged home on antibiotic therapy. The new mother plans to breastfeed her baby. What should the​ nurse's discharge instruction​ include?

The​ baby's mouth should be examined for thrush.

The postpartum client who delivered 2 days ago has developed endometritis. Which entry would the nurse expect to find in this​ client's chart?

​"Cesarean birth after extended labor with ruptured​ membranes."

The postpartum multipara is breastfeeding her new baby. The client states that she developed mastitis with her first​ child, and asks whether there is something she can do to prevent mastitis this time. What would the best response of the nurse​ be?

​"Massage your breasts on a daily​ basis, and if you find a hardened​ area, massage it towards the​ nipple."

The client has experienced a postpartum hemorrhage at 6 hours postpartum. After controlling the​ hemorrhage, the​ client's partner asks what would cause a hemorrhage. How should the nurse​ respond?

​"Sometimes the uterus relaxes and excessive bleeding​ occurs."

The client delivered her second child​ yesterday, and is preparing to be discharged. She expresses concern to the nurse because she developed an upper urinary tract infection​ (UTI) after the birth of her first child. Which statement indicates that the client needs additional teaching about this​ issue?

​"Voiding 2 or 3 times per day will help prevent a​ recurrence."

The home health nurse is visiting a new mother whose baby was delivered by emergency cesarean after a car accident. The mother seems​ dazed, irritable, and unaware of her surroundings. She tells the nurse she has had trouble sleeping. What would the nurse suspect that the mother​ has?

​Post-traumatic stress disorder