Bleeding and vaginal discharge (lochia) may last for 2 to 4 weeks and can come and go for about 2 months. Vaginal soreness, including pain, discomfort, and numbness, is common after vaginal birth. Soreness may be worse if you had a perineal tear or episiotomy. order of discharge (of a bankruptcy) คำสั่งศาลให้ยกเลิก แห่ง, Thai definition: ที่สำหรับบรรทุกของลงหรือขนของขึ้นจากเรือหรืออากาศยาน, lochia; post-natal vaginal discharge. 20 rows · Define lochial discharge. lochial discharge synonyms, lochial discharge pronunciation, .
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D If a client becomes eclamptic, the nurse should stay with him or her and call for help. Insertion of an oral airway during seizure activity is no longer the standard of care. Oxygen would be administered after the convulsion has ended. A woman presents to the emergency department complaining of bleeding and cramping.
The initial nursing history is significant for a last menstrual period 6 weeks ago. On sterile speculum examination, the primary care provider finds that the cervix is closed. The anticipated plan of care for this woman would be based on a probable diagnosis of which type of spontaneous abortion?
Incomplete c. Threatened b. Inevitable d. C A woman with a threatened abortion presents with spotting, mild cramps, and no cervical dilation. A woman with an incomplete abortion would present with heavy bleeding, mild-to-severe cramping, and cervical dilation. An inevitable abortion presents with the same symptoms as an incomplete abortion: heavy bleeding, mild-to-severe cramping, and cervical dilation.
A woman with a septic abortion presents with malodorous bleeding and typically a dilated cervix. In caring for an immediate postpartum client, you note petechiae and oozing from her IV site. You would monitor her closely for the clotting disorder: a. Disseminated intravascular coagulation DIC b. Amniotic fluid embolism AFE c. Hemorrhage d. HELLP syndrome. Physical examination reveals unusual bleeding. Excessive bleeding may occur from the site of a slight trauma such as venipuncture sites.
Hemorrhage occurs for a variety of reasons in the postpartum client. These symptoms are associated with DIC. Hemorrhage would be a finding associated with DIC and is not a clotting disorder in and of itself.
Nurses should be aware that chronic hypertension: a. Is defined as hypertension that begins during pregnancy and lasts for the duration of pregnancy.
Is considered severe when the systolic blood pressure BP is greater than mm Hg or the diastolic BP is greater than 90 mm Hg. Is general hypertension plus proteinuria.
Can occur independently of or simultaneously with gestational hypertension. D Hypertension is present before pregnancy or diagnosed before 20 weeks of gestation and persists longer than 6 weeks postpartum.
It becomes severe with a diastolic BP of mm Hg or higher. Proteinuria is an excessive concentration of protein in the urine. It is a complication of hypertension, not a defining characteristic. The nurse caring for pregnant women must be aware that the most common medical complication of pregnancy is: a. Hemorrhagic complications. Hyperemesis gravidarum. A Preeclampsia and eclampsia are two noted deadly forms of hypertension. A large percentage of pregnant women have nausea and vomiting, but a relatively few have the severe form called hyperemesis gravidarum.
Hemorrhagic complications are the second most common medical complication of pregnancy; hypertension is the most common.
Hypertension is the most common medical complication of pregnancy. Magnesium sulfate is given to women with preeclampsia and eclampsia to: a. Improve patellar reflexes and increase respiratory efficiency. Shorten the duration of labor. Prevent and treat convulsions. Prevent a boggy uterus and lessen lochial flow.
C Magnesium sulfate is the drug of choice to prevent convulsions, although it can generate other problems. Loss of patellar reflexes and respiratory depression are signs of magnesium toxicity. Magnesium sulfate can increase the duration of labor. Women are at risk for a boggy uterus and heavy lochial flow as a result of magnesium sulfate therapy.
Your client has been on magnesium sulfate for 20 hours for treatment of preeclampsia. She just delivered a viable infant girl 30 minutes ago. Absence of uterine bleeding in the postpartum period b. A fundus firm below the level of the umbilicus c.
Scant lochia flow d. A boggy uterus with heavy lochia flow. D Because of the tocolytic effects of magnesium sulfate, this client most likely would have a boggy uterus with increased amounts of bleeding and a heavy lochia flow in the postpartum period. Your client is being induced because of her worsening preeclampsia. She is also receiving magnesium sulfate. It appears that her labor has not become active despite several hours of oxytocin administration.
It may increase the duration of your labor. A Because magnesium sulfate is a tocolytic agent, its use may increase the duration of labor. The amount of oxytocin needed to stimulate labor may be more than that needed for the woman who is not receiving magnesium sulfate.
The behavior of the fetus has no bearing on the length of labor. In caring for the woman with disseminated intravascular coagulation DIC , what order should the nurse anticipate? Administration of blood b. Preparation of the client for invasive hemodynamic monitoring c. Restriction of intravascular fluids d. Administration of steroids. A Primary medical management in all cases of DIC involves correction of the underlying cause, volume replacement, blood component therapy, optimization of oxygenation and perfusion status, and continued reassessment of laboratory parameters.
Central monitoring would not be ordered initially in a client with DIC because this can contribute to more areas of bleeding. Management of DIC would include volume replacement, not volume restriction.
Steroids are not indicated for the management of DIC. In planning care for women with preeclampsia, nurses should be aware that: a.
Induction of labor is likely, as near term as possible. If at home, the woman should be confined to her bed, even with mild preeclampsia.
A special diet low in protein and salt should be initiated. Vaginal birth is still an option, even in severe cases. A Induction of labor is likely, as near term as possible; however, at less than 37 weeks of gestation, immediate delivery may not be in the best interest of the fetus. Strict bed rest is becoming controversial for mild cases; some women in the hospital are even allowed to move around.
Diet and fluid recommendations are much the same as for healthy pregnant women, although some authorities have suggested a diet high in protein. Women with severe preeclampsia should expect a cesarean delivery. Is a mild form of preeclampsia. Can be diagnosed by a nurse alert to its symptoms.
Is characterized by hemolysis, elevated liver enzymes, and low platelets. Is associated with preterm labor but not perinatal mortality. HELLP syndrome is a variant of severe preeclampsia. HELLP syndrome is difficult to identify because the symptoms often are not obvious. It must be diagnosed in the laboratory.
Preterm labor is greatly increased and so is perinatal mortality. A primigravida is being monitored in her prenatal clinic for preeclampsia. What finding should concern her nurse? Weight gain of 0. Pitting pedal edema at the end of the day. Preeclampsia may be manifested as a rapid weight gain of more than 2 kg in 1 week. Edema occurs in many normal pregnancies and in women with preeclampsia. Therefore the presence of edema is no longer considered diagnostic of preeclampsia.
The labor of a pregnant woman with preeclampsia is going to be induced. The nurse notifies the physician because the laboratory results are indicative of: a. Idiopathic thrombocytopenia. C HELLP syndrome is a laboratory diagnosis for a variant of severe preeclampsia that involves hepatic dysfunction characterized by hemolysis H , elevated liver enzymes EL , and low platelets LP. Eclampsia is determined by the presence of seizures.
Idiopathic thrombocytopenia is the presence of low platelets of unknown cause and is not associated with preeclampsia. A pregnant woman has been receiving a magnesium sulfate infusion for treatment of severe preeclampsia for 24 hours. On assessment the nurse finds the following vital signs: temperature of Calls for a stat magnesium sulfate level.
Administers oxygen. Discontinues the magnesium sulfate infusion. Prepares to administer hydralazine. ANS: C The client is displaying clinical signs and symptoms of magnesium toxicity. Magnesium should be discontinued immediately. In addition, calcium gluconate, the antidote for magnesium, may be administered.
Hydralazine is an antihypertensive commonly used to treat hypertension in severe preeclampsia. A woman with severe preeclampsia has been receiving magnesium sulfate by intravenous infusion for 8 hours. The nurse assesses the woman and documents the following findings: temperature of The nurse calls the physician, anticipating an order for: a.
Magnesium sulfate bolus. Calcium gluconate. A Hydralazine is an antihypertensive commonly used to treat hypertension in severe preeclampsia. An additional bolus of magnesium sulfate may be ordered for increasing signs of central nervous system irritability related to severe preeclampsia e. Diazepam sometimes is used to stop or shorten eclamptic seizures.
Calcium gluconate is used as the antidote for magnesium sulfate toxicity. The client is not currently displaying any signs or symptoms of magnesium toxicity. A woman at 39 weeks of gestation with a history of preeclampsia is admitted to the labor and birth unit.
She suddenly experiences increased contraction frequency of every 1 to 2 minutes; dark red vaginal bleeding; and a tense, painful abdomen. The nurse suspects the onset of: a. Eclamptic seizure. Rupture of the uterus. Placental abruption. D Uterine tenderness in the presence of increasing tone may be the earliest finding of premature separation of the placenta abruptio placentae or placental abruption.
Women with hypertension are at increased risk for an abruption. Eclamptic seizures are evidenced by the presence of generalized tonic-clonic convulsions. Uterine rupture presents as hypotonic uterine activity, signs of hypovolemia and in many cases the absence of pain.
Placenta previa presents with bright red, painless vaginal bleeding. A woman with severe preeclampsia is receiving a magnesium sulfate infusion. The nurse becomes concerned after assessment when the woman exhibits: a. A sleepy, sedated affect. Deep tendon reflexes of 2 d.
Absent ankle clonus. Because magnesium sulfate is a central nervous system depressant, the client will most likely become sedated when the infusion is initiated.
Deep tendon reflexes of 2 and absent ankle clonus are normal findings. What nursing diagnosis would be the most appropriate for a woman experiencing severe preeclampsia? Risk for injury to the fetus related to uteroplacental insufficiency b. Risk for eclampsia c. Risk for deficient fluid volume related to increased sodium retention secondary to administration of MgSO4 d. Risk for increased cardiac output related to use of antihypertensive drugs. A Risk for injury to the fetus related to uteroplacental insufficiency is the most appropriate nursing diagnosis for this client scenario.
Other diagnoses include risk to fetus related to preterm birth and abruptio placentae. Eclampsia is a medical, not a nursing, diagnosis.
What should I know about newborn care and development? Health Tools Health Tools help you make wise health decisions or take action to improve your health. Actionsets are designed to help people take an active role in managing a health condition. Recovery At Home During the days and weeks after the delivery of your baby postpartum period , your body will change as it returns to its nonpregnant condition.
Physical changes after childbirth The changes in your body may include sore muscles and bleeding. Contractions called afterpains shrink the uterus for several days after childbirth. Shrinking of the uterus to its prepregnancy size may take 6 to 8 weeks. Sore muscles especially in the arms, neck, or jaw are common after childbirth. This is because of the hard work of labor. The soreness should go away in a few days. Bleeding and vaginal discharge lochia may last for 2 to 4 weeks and can come and go for about 2 months.
Vaginal soreness, including pain, discomfort, and numbness, is common after vaginal birth. Soreness may be worse if you had a perineal tear or episiotomy. If you had a cesarean C-section , you may have pain in your lower belly and may need pain medicine for 1 to 2 weeks. This can cause discomfort and swelling.
Care after vaginal birth Most women need some time after delivery to return to their normal activities. Use pads instead of tampons for the bloody flow that may last as long as 2 weeks. Ease cramps or afterpains with ibuprofen such as Advil. If the doctor gave you a prescription medicine for pain, take it as prescribed. If you have swelling or pain around the opening of your vagina, try using ice.
You can put ice or a cold pack on the area for 10 to 20 minutes at a time. Put a thin cloth between the ice and your skin. Cleanse yourself with a gentle squeeze of warm water from a bottle instead of wiping with toilet paper.
Try sitting in a few inches of warm water sitz bath 3 times a day and after bowel movements. Ease the soreness of hemorrhoids and the area between your vagina and rectum with ice compresses or witch hazel pads.
Ease constipation by drinking lots of fluid and eating high-fiber foods. Ask your doctor about over-the-counter stool softeners. What to avoid Give your body a chance to heal. Wait until you are healed about 4 to 6 weeks before you have sexual intercourse.
Your doctor will tell you when it is okay to have sex. Try not to travel with your baby for 5 or 6 weeks. If you take a long car trip, make frequent stops to walk around and stretch.
Do not rinse inside your vagina with fluids douche. Care after a C-section If you had a C-section, you will need to take it easy while the incision heals. Avoid strenuous activities, such as bicycle riding, jogging, weight lifting, and aerobic exercise, for 6 weeks or until your doctor says it is okay.
Until your doctor says it is okay, don't lift anything heavier than your baby. You may have some vaginal bleeding. Wear pads.
Do not use tampons until your doctor says it is okay. Hold a pillow over your incision when you cough or take deep breaths. This will support your belly and decrease your pain. You may shower as usual. Pat the incision dry when you are done. Coping With Emotions Having a new baby is exciting. Expect changes in your relationship If you have a partner and this is your first baby, your focus may have shifted from being part of a couple to being parents.
Watch out for depression " Baby blues " are common for the first 1 to 2 weeks after birth. Get support from others If you're feeling tired or overwhelmed, talk to your partner, friends, and family about your feelings. You also might want to: Go for walks with your baby.
Find a class for new mothers and new babies that has an exercise time. Try yoga, meditation, massage, or other ways to cope with stress. For more information, see the topic Stress Management. Common Problems Some women have problems—such as constipation, hemorrhoids, and sore breasts—that last for a while after childbirth.
Constipation and hemorrhoids Home treatment measures are usually all that is needed to relieve mild discomfort from hemorrhoids or constipation. To prevent or ease symptoms of constipation: Eat a high-fiber diet with lots of fruits, vegetables, and whole grains. Drink plenty of fluids, especially water and fruit juices. Try a stool softener, such as Colace. Do not strain push hard during a bowel movement. Get more exercise, such as walking, every day. To treat the itching or pain of hemorrhoids: Keep the anus clean by wiping carefully after each bowel movement.
Gently wipe from the front to the back. Baby wipes or hemorrhoid pads are usually more gentle than toilet paper. If you use toilet paper, use only soft, undyed, unscented toilet paper. Take warm soaks in a tub or a sitz bath. Warm water can help shrink or soothe hemorrhoids. Add baking soda to the water to relieve itching. Use cold packs. Do not sit for long periods, especially on hard chairs.
Drink plenty of fluids and use stool softeners, if needed. Don't strain push hard during a bowel movement. Vaginal and perineal problems Soreness in the vagina and the area between it and the anus perineum is common after delivery. To reduce pain and heal: Try using ice. Pelvic bone problems Recovery from pelvic bone problems , such as separated pubic bones or a fractured tailbone coccyx , can take several months.
Breast problems Breast engorgement is common between the third and fourth days after delivery, when the breasts begin to fill with milk. Postpartum Checkup Your doctor will want to see you for a checkup 2 to 6 weeks after delivery. Keep a list of questions to bring to your postpartum visit. Your questions might be about: Changes in your breasts, such as lumps or soreness.
When to expect your menstrual period to start again. What form of birth control is best for you. Weight you have put on during the pregnancy.
Exercise options. What foods and drinks are best for you, especially if you are breastfeeding. Problems you might be having with breastfeeding. When you can have sex. Some women may want to talk about lubricants for the vagina. Any feelings of sadness or restlessness that you are having. Health and Nutrition It is easy to get too tired and overwhelmed during the first weeks after childbirth.
Getting rest Like pregnancy, the newborn period can be a time of excitement, joy, and exhaustion. Rest every day.
Try to nap when your baby naps. Stay flexible so you can eat at odd hours and sleep when you need to. Ask for help with housework, cooking, and shopping.
Remind yourself that your job is to care for your baby. Sexuality, fertility, and birth control Your body needs time to heal after childbirth. If you don't breastfeed, your menstrual periods may begin within a month or two after delivery. If you breastfeed full-time, your periods will probably not resume for a few months.
The average among women who breastfeed exclusively is 8 months. But breastfeeding is not a dependable method of birth control. For more information, see Breastfeeding as Birth Control. Healthy eating Eating a variety of healthy food is important to help you keep your energy and lose extra weight you gained during your pregnancy. Eat a variety of foods to help you get all the nutrients you need. Your body needs protein, carbohydrate, and fats for energy.
Eat a diet high in fiber. Include foods such as whole-grain breads and cereals, raw vegetables, raw and dried fruits, and beans. Drink plenty of fluids, especially water. Eat small snacks throughout the day to keep up your energy. A woman with severe preeclampsia on magnesium sulfate whose labor is being induced c.
A multiparous woman G 3 P 2 0 0 2 with an 8-hour labor d. A primigravida in spontaneous labor with preterm twins. Magnesium acts as a smooth muscle relaxant, thereby contributing to uterine relaxation and atony. Although many causes and risk factors are associated with PPH, the primiparous woman being prepared for an emergency c-section, the multiparous woman with 8-hour labor, and the primigravida in spontaneous labor do not pose risk factors or causes of early PPH.
During the initial acute distress phase of grieving, parents still must make unexpected and unwanted decisions about funeral arrangements and even naming the baby. Take over as much as possible to relieve the pressure. Encourage grandparents to take over. Make sure the parents themselves approve the final decisions. Let them alone to work things out. Nurses can offer support and guidance and leave room for the same from grandparents.
However, in the end nurses should strive to let the parents make the final decisions. The perinatal nurse caring for the postpartum woman understands that late postpartum hemorrhage PPH is most likely caused by: a. Subinvolution of the placental site. Cervical lacerations. Defective vascularity of the decidua.
Coagulation disorders. Late PPH is not typically a result of defective vascularity of the decidua, cervical lacerations, or coagulation disorders. When caring for a postpartum woman experiencing hemorrhagic shock, the nurse recognizes that the most objective and least invasive assessment of adequate organ perfusion and oxygenation is: a. Absence of cyanosis in the buccal mucosa. Cool, dry skin. Diminished restlessness. ANS: D Hemorrhage may result in hemorrhagic shock.
Shock is an emergency situation in which the perfusion of body organs may become severely compromised and death may occur. The presence of adequate urinary output indicates adequate tissue perfusion. The assessment of the buccal mucosa for cyanosis can be subjective in nature.
The presence of cool, pale, clammy skin would be an indicative finding associated with hemorrhagic shock. Hemorrhagic shock is associated with lethargy, not restlessness. Do you think that caused my baby to die? Paint is associated with elevated pediatric lead levels. What else are you thinking about? It demonstrates caring and compassion and allows the mother to vent her thoughts and feelings, which is therapeutic in the process of grieving.
In addition, trying to give bereaved parents answers when no clear answers exist or trying to squelch their guilt feeling does not help the process of grief.
Trying to give bereaved parents answers when no clear answers exist does not help the grief process. One of the most important goals of the nurse is to validate the experience and feelings of the parents by encouraging them to tell their stories and listening with care. The nurse should encourage the mother to express her ideas.
A newborn in the neonatal intensive care unit NICU is dying as a result of a massive infection. To stand beside him quietly. ANS: B The grief phase can be very difficult, especially for fathers. Parents should be encouraged to share their feelings as the initial steps in the grieving process.
Shifting the focus is not in the best interest of the parent. Nursing actions may help the parents actualize the loss of their infant through sharing and verbalization of feelings of grief. A family is visiting two surviving triplets. The third triplet died 2 days ago. What action would indicate that the family had begun to grieve for the dead infant? They refer to the two live infants as twins.
They bring in play clothes for all three infants. They refer to the dead infant in the past tense. ANS: D Accepting that the infant is dead in the past tense of the word demonstrates acceptance of the reality and that the family has begun to grieve. The most appropriate statement that the nurse can make to bereaved parents is: a. Although such a response may seem supportive at the time, it can stifle the further expression of emotion. With shortened hospital stays, new mothers are often discharged before they begin to experience symptoms of the baby blues or postpartum depression.
As part of the discharge teaching, the nurse can prepare the mother for this adjustment to her new role by instructing her regarding self-care activities to help prevent postpartum depression. The most accurate statement as related to these activities is to: a. Stay home and avoid outside activities to ensure adequate rest. Be certain that you are the only caregiver for your baby to facilitate infant attachment. Keep feelings of sadness and adjustment to your new role to yourself.
Realize that this is a common occurrence that affects many women. ANS: D Should the new mother experience symptoms of the baby blues, it is important that she be aware that this is nothing to be ashamed of. Although it is important for the mother to obtain enough rest, she should not distance herself from family and friends. Her spouse or partner can communicate the best visiting times so the new mother can obtain adequate rest.
It is also important that she not isolate herself at home during this time of role adjustment. If depression occurs, the symptoms can often interfere with mothering functions and this support will be essential. The new mother should share her feelings with someone else.
Should symptoms continue, a referral to a professional therapist may be necessary. Prenatal depression c. Low socioeconomic status b. Single-mother status d. Unplanned or unwanted pregnancy. Single-mother status and low socioeconomic status are small-relation predictors, as is an unwanted pregnancy. The first and most important nursing intervention when a nurse observes profuse postpartum bleeding is to: a. Administer the standing order for an oxytocic.
Palpate the uterus and massage it if it is boggy. Assess maternal blood pressure and pulse for signs of hypovolemic shock. ANS: C The initial management of excessive postpartum bleeding is firm massage of the uterine fundus. Though calling the health care provider, administering an oxytocic, and assessing maternal BP are appropriate interventions, the primary intervention should be to assess the uterus.
Uterine atony is the leading cause of postpartum hemorrhage PPH. One of the first symptoms of puerperal infection to assess for in the postpartum woman is: a. Fatigue continuing for longer than 1 week.
Pain with voiding. Profuse vaginal bleeding with ambulation. ANS: D Postpartum or puerperal infection is any clinical infection of the genital canal that occurs within 28 days after miscarriage, induced abortion, or childbirth.
Fatigue would be a late finding associated with infection. Pain with voiding may indicate a urinary tract infection, but it is not typically one of the earlier symptoms of infection. Profuse lochia may be associated with endometritis, but it is not the first symptom associated with infection.
To provide adequate postpartum care, the nurse should be aware that postpartum depression PPD without psychotic features: a. Means that the woman is experiencing the baby blues. In addition she has a visit with a counselor or psychologist. Is more common among older, Caucasian women because they have higher expectations. Is distinguished by irritability, severe anxiety, and panic attacks.
Will disappear on its own without outside help. PPD, even without psychotic features, is more serious and persistent than postpartum baby blues. It is more common among younger mothers and African-American mothers. Most women need professional help to get through PPD, including pharmacologic intervention.
To provide adequate postpartum care, the nurse should be aware that postpartum depression PPD with psychotic features: a. Is more likely to occur in women with more than two children.
Is rarely delusional and then usually about someone trying to harm her the mother. Although serious, is not likely to need psychiatric hospitalization.
ANS: D Manic mood swings are possible. PPD is more likely to occur in first-time mothers. PPD with psychosis is a psychiatric emergency that requires hospitalization. When a woman is diagnosed with postpartum depression PPD with psychotic features, one of the main concerns is that she may: a. Have outbursts of anger. Harm her infant. Neglect her hygiene.
Lose interest in her husband. Although outbursts of anger, hygiene neglect, and loss of interest in her husband are attributable to PPD, the major concern would be the potential to harm herself or her infant. The perinatal nurse assisting with establishing lactation is aware that acute mastitis can be minimized by: a. Washing the nipples and breasts with mild soap and water once a day.
Using proper breastfeeding techniques. Wearing a nipple shield for the first few days of breastfeeding. Wearing a supportive bra 24 hours a day.
ANS: B Almost all instances of acute mastitis can be avoided by proper breastfeeding technique to prevent cracked nipples. Washing the nipples and breasts daily is no longer indicated. In fact, this can cause tissue dryness and irritation, which can lead to tissue breakdown and infection. Wearing a nipple shield does not prevent mastitis. Wearing a supportive bra 24 hours a day may contribute to mastitis, especially if an underwire bra is worn, because it may put pressure on the upper, outer area of the breast, contributing to blocked ducts and mastitis.
Nurses need to know the basic definitions and incidence data about postpartum hemorrhage PPH. For instance: a. PPH is easy to recognize early; after all, the woman is bleeding. Traditionally it takes more than ml of blood after vaginal birth and ml after cesarean birth to define the condition as PPH.
If anything, nurses and doctors tend to overestimate the amount of blood loss. Traditionally PPH has been classified as early or late with respect to birth. Unfortunately PPH can occur with little warning and often is recognized only after the mother has profound symptoms. Traditionally a ml blood loss after a vaginal birth and a ml blood loss after a cesarean birth constitute PPH.
A woman who has recently given birth complains of pain and tenderness in her leg.