A nurse is monitoring the amount of lochia drainage in a client who is 2 hours postpartum and notes that the client has a saturated a perineal pad in 1 hour. The nurse reports the amount of lochial flow as:
Heavy lochial discharge is a saturated menstrual pad in 1 hour.
The following are interventions to make the fundus contract postpartally EXCEPT
Massaging the fundus of the uterus should not be vigorous and should only be done until the uterus feels firm and contracted. If the massage is vigorous and prolonged, the uterus will relax due to over stimulation.
According to Rubin’s theory of maternal role adaptation, the mother will go through 3 stages during the postpartum perioD. These stages are:
Rubin’s theory states that the 3 stages that a mother goes through for maternal adaptation are: taking-in, taking-hold and letting-go. In the taking-in stage, the mother is more passive and dependent on others for care. In taking-hold, the mother begins to assume a more active role in the care of the child and in letting-go, the mother has become adapted to her maternal role.
The following are nursing measures to stimulate lactation EXCEPT
To stimulate lactation, a warm compress is applied to the breast. A cold application will cause vasoconstriction thus reducing the blood supply consequently the production of milk.
When the uterus is firm and contracted after delivery but there is vaginal bleeding, the nurse should suspect
When the uterus is firm and contracted it means that the bleeding is not in the uterus but other parts of the passageway such as the cervix or the vagina.
Which of the following is an abnormal vital sign in postpartum?
All the vital signs given in the choices are within normal range except an increase of 15mm Hg in the diastolic which is a possible sign of hypertension in pregnancy.
The uterine fundus right after delivery of placenta is palpable at
Immediately after the delivery of the placenta, the fundus of the uterus is expected to be at the level of the umbilicus because the contents of the pregnancy have already been expelled. The fundus is expected to recede by 1 fingerbreadths (1cm) every day until it becomes no longer palpable above the symphysis pubis.
In a woman who is not breastfeeding, menstruation usually occurs after how many weeks?
When the mother does not breastfeed, the normal menstruation resumes about 6-8 weeks after delivery. This is due to the fact that after delivery, the hormones estrogen and progesterone gradually decrease thus triggering negative feedback to the anterior pituitary to release the Follicle-Stimulating Hormone (FSH) which in turn stimulates the ovary to again mature a Graafian follicle and the menstrual cycle post pregnancy resumes.
The neonate of a mother with diabetes mellitus is prone to developing hypoglycemia because:
pancreas is normally secreting insulin If the mother is diabetic, the fetus while in utero has a high supply of glucose. When the baby is born and is now separate from the mother, it no longer receives a high dose of glucose from the mother. In the first few hours after delivery, the neonate usually does not feed yet thus this can lead to hypoglycemia.
The following are nursing interventions to relieve episiotomy wound pain EXCEPT
Perineal care is primarily done for personal hygiene regardless of whether there is pain or not; episiotomy wound or not.
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