Question

Chapter 15: Postpartum Adaptations

1.     You are caring for Linda, who has just delivered her first baby. You are responsible for assessing Linda’s condition during recovery and for doing patient teaching when the opportunity arises. (Learning Objectives 2 and 3)

While she is recovering, you keep checking her fundal height. Linda asks you how her uterus will go back to the way it was before she had the baby. How would you explain this physiologic process? What could impede the process?

Linda wants to know how long she should expect to bleed. What would you tell her?

The next day Linda appears very passive and you have overheard her telling everyone who will listen about her labor experience. What phase of adjustment is Linda going through? What other stages should she go through while adjusting to her new role?

Chapter 16: Nursing Management During the Postpartum Period

1. You are caring for Bonnie, age 42, who has just undergone a cesarean birth for her first baby. You are responsible for monitoring her condition during recovery and for teaching her how to take care of herself and her baby. (Learning Objectives 2, 3, 4, 5, and 7)

1A. You note that Bonnie has a positive Homans’ sign in the left leg. What are the risk factors for thromboembolic disorders, and how will you determine if she has a DVT? If Bonnie has a DVT, what else is she at risk for?

1B. Bonnie is ready for discharge and asks you about bleeding, perineal care, and what she should eat while breast-feeding. What are you going to teach her?

1C. Bonnie, the baby, and Bonnie’s husband are following up for newborn care. What nursing interventions should be included to promote parental role adaptation and parent–newborn attachment?

2. You have just received report on the following patient. Hannah G1P1 gave birth vaginally two days ago to a baby girl. She had a midline episiotomy and has protruding hemorrhoids. Hannah is rubella negative and has A– blood type and her daughter is O+. Hannah is breast-feeding her daughter. Hannah is expected to be discharged to home later this afternoon. (Learning Objectives 6 and 8)

2A. Describe the nursing management for Hannah and her family during the postpartum time period.

2B. Hannah and Justin are preparing for discharge. What areas of health education are needed for discharge planning, home care, and follow-up visits for Hannah and her baby girl?

Answer 1

1 I would tell to Linda that she is now in postpartum period and it is the period when the reproductive tract returns to the normal ,non pregnant state.it starts immediately after delivery and is usually completed by week 6 following delivery.Clients who breast feed may experience a more rapid involution because of the release of oxytocin during breast feeding.the weight of the uterus decreases from 2lb to 2oz in 6 weeks.the endometrium regenerates.the fundus steadily descends into the pelvis .fundal height decreases about 1 finger breadth ie 1cm per day.By 10 days postpartum ,the uterus cannot be palpated abdominally.Afterpains decrease in frequency after the first few day.

2 Rubra is bright discharge that occurs from delivery day to day 3.Serosa is brownish pink discharge that occurs from days 4 to 10.Alba is white discharge that occurs from days 11 to 14.the discharge should smell like normal menstrual flo.Discharge decreases daily in amount.It may increase with ambulation.Cervical involution occurs and the muscle begins to regenerate after 1 week.

Chapter 16

1After Caesarian Section

• Bonnies vital signs are monitored.
• Assess pain level.
• Assess the height,consistency and location of the fundus
• Monitor colour amount and odour of lochi.
• Assess breast for engorgemnt.
• Assess the incision or dressing of client
• Monitor bowel status.
• Monitor intake output.
• Encourage frequent voiding and Monitor intake and output.
• Assess the extremeties for thrombophlebitis.

Teaching how to take care of herself and baby.

• Demonstrate newborn skills necessary
• provide the opportunity for the client to bathe the newborn infant.
• Instruct in feeding technique.
• Instruct the client to avoid heavy lifting for atleast 3 weeks.
• Instruct the client to plan atleast one rest period per day.
• Instruct the client that contraception should begin after delivery
• Instruct the client in the importance of follow-up ,which should be scheduled at 4-6 weeks.
• Instruct the client to to report any signs of chills,fever ,increased lohia or depressed feelings
• Discuss calorie intake with Bonnie.
• Put the infant to the mothers breast as soon as the mothers and infants conditions are stable.
• Assess LATCH technique and encourage the infant to nurse on each breast for 15 to 20 minutes.

1 A Thrombophlebitis is a clot which forms in a vessel wall as a result of inflammation of the vessel wall.Increased blood-clotting factors in the postpartum period place the client at risk.Early ambulation in the post operative period after caesarian section is a preventive measure.There are several assessments to determine the type of thrombophlebitis.

• Superficial-palpable thrombus that feels bumpy and hard.
• Tenderness and pain in affected extremities.
• Warm and pinkish redcolour over the thrombus area.
• Femoral-malaise,chills and fever,possible positive homans sign,diminished peripheral pulses,shiny whiteskin over affected area,pain ,stiffness and swelling of affected leg.
• Pelvic- Severe chills,dramatic body temperature changes,pulmonary embolism.

She has an increased chance of develping pulmonary embolism.

1 b

• Instruct Bonnie to use general hygiene and wash the breasts once daily.
• The client should not use soap on the breasts because it tends to remove natural oils and increase the chance of cracked nipples.
• THe bra should be well supported and well fitting.
• Breasts may leak between feedings.
• Calories should be increased by 200 to 500 cal/day and the diet should include additional fluids ,prenatal vitamins should be taken as prescribed.
• Gas producing foods and caffeine should be avoided.
• Hormonal contraceotives may causea decrease in the milk supply and are best avoided during the first 6 weeks after birth.