ch 21 OB NCLEX

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Two hours after giving birth, a primiparous woman becomes anxious and complains of intense perineal pain with a strong urge to have a bowel movement. Her fundus is firm, at the umbilicus, and midline. Her lochia is moderate rubra with no clots. The nurse would suspect:
bladder distention.
uterine atony.
constipation.
hematoma formation. Correct

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Bladder distention would result in an elevation of the fundus above the umbilicus and deviation to the right or left of midline. Uterine atony would result in a boggy fundus. Constipation is unlikely at this time. Increasing perineal pressure along with a firm fundus and moderate lochial flow are characteristic of hematoma formation.

Postpartum women experience an increased risk for urinary tract infection. A prevention measure the nurse could teach the postpartum woman would be to:
acidify the urine by drinking three glasses of orange juice each day.
maintain a fluid intake of 1 to 2 L/day.
empty her bladder every 4 hours throughout the day.
perform perineal care on a regular basis. Correct

Urine is acidified with cranberry juice. The woman should drink at least 3 L of fluid each day. The woman should empty her bladder every 2 hours to prevent stasis of urine. Keeping the perineum clean will help prevent a urinary tract infection.

The first and most important nursing intervention when a nurse observes profuse postpartum bleeding is to:
call the woman's primary health care provider
administer the standing order for an oxytocic
palpate the uterus and massage it if it is boggy Correct
assess maternal blood pressure and pulse for signs of hypovolemic shock

The most important nursing intervention is to stop the bleeding. Once the nurse has applied firm massage of the uterine fundus, the primary health care provider should be notified or the nurse can delegate this task to another staff member. This intervention is appropriate after assessment and immediate steps have been taken to control the bleeding. The initial management of excessive postpartum bleeding is firm massage of the uterine fundus. Vital signs will need to be ascertained after fundal massage has been applied.

Which postpartum conditions are considered medical emergencies that require immediate treatment?
Inversion of the uterus and hypovolemic shock Correct
Hypotonic uterus and coagulopathies
Subinvolution of the uterus and idiopathic thrombocytopenic purpura
Uterine atony and disseminated intravascular coagulation (DIC)

Inversion of the uterus and hypovolemic shock are considered medical emergencies. A hypotonic uterus can be managed with massage and oxytocin. Coagulopathies should be identified before delivery and treated accordingly. Although subinvolution of the uterus and ITP are serious conditions, they do not always require immediate treatment. ITP can be safely managed with corticosteroids or IV immunoglobulin. DIC and uterine atony are very serious obstetric complications; however, uterine inversion is a medical emergency requiring immediate intervention.

Which postpartum infection is most often contracted by first-time mothers who are breastfeeding?
Endometritis
Wound infections
Mastitis Correct
Urinary tract infections (UTIs)

Endometritis is the most common postpartum infection. Incidence is higher after a cesarean birth and not limited to first-time mothers. Wound infections are also a common postpartum complication. Sites of infection include both a cesarean incision and the episiotomy or repaired laceration. The gravidity of the mother and her feeding choice are not factors in the development of a wound infection. Mastitis is infection in a breast, usually confined to a milk duct. Most women who suffer this are first-timers who are breastfeeding. UTIs occur in 2% to 4% of all postpartum women. Risk factors include catheterizations, frequent vaginal examinations, and epidural anesthesia.

Despite popular belief, there is a rare type of hemophilia that affects women of childbearing age. von Willebrand disease is the most common of the hereditary bleeding disorders and can affect males and females alike. It results from a factor VIII deficiency and platelet dysfunction. Although factor VIII levels increase naturally during pregnancy, there is an increased risk for postpartum hemorrhage from birth until 4 weeks postpartum as levels of von Willebrand factor (vWf) and factor VIII decrease. The treatment that should be considered first for the client with von Willebrand disease who experiences a postpartum hemorrhage is:
cryoprecipitate
factor VIII and vWf
desmopressin Correct
Hemabate

Cryoprecipitate may be used; however, because of the risk of possible donor viruses, other modalities are considered safer. Treatment with plasma products, such as factor VIII and vWf, are an acceptable option for this client. Because of the repeated exposure to donor blood products and possible viruses, this is not the initial treatment of choice. Desmopressin is the primary treatment of choice. This hormone can be administered orally, nasally, and intravenously. This medication promotes the release of factor VIII and vWf from storage. Although the administration of this prostaglandin is known to promote contraction of the uterus during postpartum hemorrhage, it is not effective for the client who presents with a bleeding disorder.

Herbal remedies have been used with some success to control PPH after initial management. Some herbs have homeostatic actions, whereas others work as oxytocic agents to contract the uterus. What herbal remedy is a commonly used oxytocic agent?
Witch hazel
Lady's mantel
Blue cohosh Correct
Yarrow

Witch hazel is a homeostatic herb. Lady's mantle is a homeostatic remedy. Blue cohosh, cotton root bark, motherwort, and shepherd's purse are oxytocic agents that promote uterine contraction. Yarrow is not an oxytocic agent, it is a homeostatic.

The priority nursing intervention for a woman who suffered a perineal laceration is to:
apply a cold compress.
establish hemostasis. Correct
administer analgesia.
administer a stool softener.

Bleeding should be stopped first. After bleeding has been controlled, the care of the woman with lacerations of the perineum includes analgesia administration, hot or cold applications, and stool softeners. Stool softeners may be used to assist the woman in reestablishing bowel habits without straining and putting stress on the suture lines.

Thromboembolic conditions that are of concern during the postpartum period include (Select all that apply.)
Amniotic fluid embolism (AFE)
Superficial venous thrombosis Correct
Deep vein thrombosis Correct
Pulmonary embolism Correct
Disseminate intravascular coagulation (DIC)

An AFE occurs during the intrapartum period when amniotic fluid containing particles of debris enters the maternal circulation. Although AFE is rare, the mortality rate is as high as 80%. A superficial venous thrombosis includes involvement of the superficial saphenous venous system. With deep vein thrombosis the involvement varies but can extend from the foot to the iliofemoral region. A pulmonary embolism is a complication of deep vein thrombosis occurring when part of a blood clot dislodges and is carried to the pulmonary artery, where it occludes the vessel and obstructs blood flow to the lungs. DIC is an imbalance between the body's clotting and fibrinolytic systems. It's a pathologic form of clotting that consumes large amounts of clotting factors.

Nursing care management for mothers and fathers suffering grief from the loss of their baby includes: (Select all that apply.)
using therapeutic communication and caring techniques. Correct
listening as parents tell their story of loss and grief. Correct
avoiding asking any questions about the loss of parents.
giving advice from personal experiences.
insisting parents name the baby in order to be remembered.

The nurse should utilize therapeutic communication and caring techniques. The nurse should listen patiently while people tell their story of loss and grief. It may be necessary to ask questions that help people talk about their grief. The nurse should resist the temptation to give advice or use clichés in offering support. A caution about naming is important. Naming is an individual decision that should never be imposed on parents. Beliefs and individual needs vary greatly, sometimes based upon cultures and religious preferences as well.

ch 21 OB NCLEX

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