On which of the postpartum days can the client expect lochia serosa?
-
Solution
Days 3 to 10 PP.
On the third and fourth PP days, the lochia becomes a pale pink or brown and contains old blood, serum, leukocytes, and tissue debris. This type of lochia usually lasts until PP day 10. Lochia rubra usually last for the first 3 to 4 days PP. Lochia alba, which contain leukocytes, decidua, epithelial cells, mucus, and bacteria, may continue for 2 to 6 weeks PP.
A client is complaining of painful contractions, or after pains, on postpartum day 2. Which of the following conditions could increase the severity of afterpains?
-
Solution
Multiple gestation.
Multiple gestation, breastfeeding, multiparity, and conditions that cause overdistention of the uterus will increase the intensity of after-pains.
Options A and B: Bottle-feeding and diabetes aren’t directly associated with increasing severity of afterpains unless the client has delivered a macrosomic infant.
Which of the following findings would be expected when assessing the postpartum client?
-
Solution
Fundus 1 cm above the umbilicus 1 hour postpartum.
Within the first 12 hours postpartum, the fundus usually is approximately 1 cm above the umbilicus. The fundus should be below the umbilicus by PP day 3. The fundus shouldn’t be palpated in the abdomen after day 10.
The nurse is about the give a Type 2 diabetic her insulin before breakfast on her first day postpartum. Which of the following answers best describes insulin requirements immediately postpartum?
-
Solution
Lower than before she became pregnant.
PP insulin requirements are usually significantly lower than pre pregnancy requirements. Occasionally, clients may require little to no insulin during the first 24 to 48 hours postpartum.
On completing a fundal assessment, the nurse notes the fundus is situated on the client’s left abdomen. Which of the following actions is appropriate?
-
Solution
Ask the client to empty her bladder.
A full bladder may displace the uterine fundus to the left or right side of the abdomen. Catheterization is unnecessary invasive if the woman can void on her own.
Which of the following interventions would be helpful to a breastfeeding mother who is experiencing engorged breasts?
-
Solution
Teaching how to express her breasts in a warm shower.
Teaching the client how to express her breasts in a warm shower aids with let-down and will give temporary relief. Ice can promote comfort by vasoconstriction, numbing, and discouraging further letdown of milk.
Which of the following factors might result in a decreased supply of breastmilk in a PP mother?
-
Solution
Supplemental feedings with formula.
Routine formula supplementation may interfere with establishing an adequate milk volume because decreased stimulation to the mother’s nipples affects hormonal levels and milk production.
Methergine or Pitocin are prescribed for a client with PP hemorrhage. Before administering the medication(s), the nurse contacts the health provider who prescribed the medication(s) in which of the following conditions is documented in the client’s medical history?
-
Solution
Peripheral vascular disease.
These medications are avoided in clients with significant cardiovascular disease, peripheral disease, hypertension, eclampsia, or preeclampsia. These conditions are worsened by the vasoconstriction effects of these medications.
Methergine or Pitocin is prescribed for a woman to treat PP hemorrhage. Before administration of these medications, the priority nursing assessment is to check the:
-
Solution
Blood pressure.
Methergine and pitocin are agents that are used to prevent or control postpartum hemorrhage by contracting the uterus. They cause continuous uterine contractions and may elevate blood pressure. A priority nursing intervention is to check blood pressure. The physician should be notified if hypertension is present.
A nurse is preparing a list of self-care instructions for a PP client who was diagnosed with mastitis. Select all instructions that would be included on the list.
-
Solution
Answers: B, D, and E.
Mastitis are an infection of the lactating breast. Client instructions include resting during the acute phase, maintaining a fluid intake of at least 3 L a day, and taking analgesics to relieve discomfort. Additional supportive measures include the use of moist heat or ice packs and wearing a supportive bra.
Option A: Antibiotics may be prescribed and are taken until the complete prescribed course is finished. They are not stopped when the soreness subsides.
Option C: Continued decompression of the breast by breastfeeding or pumping is important to empty the breast and prevent formation of an abscess.