Postpartum Care (20 Questions)

1.1 Mrs. Jolicoeur, 35 years old, gave birth at 38 weeks of gestation to her second child under epidural anesthesia at 11:25 following a difficult labor. She sustained a third-degree perineal tear and was transferred to the postpartum unit at 13:00.

At the 16:00 report, the nurse informs you that the client’s first void was 100 mL at 14:30; at that time, the uterine fundus (UF) was at 0/0, midline, and firm. The lochia is dark red and soaks one sanitary pad per hour. The client’s vital signs at 15:30 were as follows: BP 110/60 mmHg, P 72/min (regular), R 20/min (regular, normal depth), and T 37.3°C. Her first time out of bed was well tolerated.

During your rounds at 16:25, you note that Mrs. Jolicoeur’s uterine fundus is now at 1/0 and has deviated to the right. The client complains of "severe cramp-like" pain in her lower abdomen.

Question:
Based on your assessment of Mrs. Jolicoeur’s clinical situation, what problem do you suspect? *
1.2 Question:
What is your next priority intervention for Mrs. Jolicoeur? *
1.3 Question:
Which two (2) signs and symptoms indicate that your interventions have resolved Mrs. Jolicoeur’s problem? *
2.1 At 17:00, Mrs. Élise Dufresne, a 33-year-old postpartum client who delivered her second child at 38 weeks of gestationvia vaginal birth with epidural, reports moderate perineal edema and rates her pain as 4/10. She sustained a third-degree perineal tear and was transferred to the postpartum unit earlier in the day. To manage her discomfort, she has been given Acetaminophen (Tylenol) 325 mg, 2 tablets and Naproxen (Naprosyn) 250 mg, 1 tablet. While the medications provide some relief, Mrs. Dufresne expresses concern about taking too many analgesics and asks if there are alternative ways to manage her pain more naturally.

Question:
What is the best recommendation the nurse can give to Mrs. Dufresne to help her manage pain while minimizing the use of analgesics? *
2.2 Mrs. Dufresne has anemia, and her doctor has prescribed an iron supplement to take until her next follow-up appointment. She wants to follow the medical prescription while continuing to consume dairy products.

Question:
What recommendation should the nurse give her? *
2.3 The following findings have already entered in Mrs. Dufresne’s therapeutic nursing plan (TNP).

Priority problem:
1 – Vaginal delivery at 38 weeks
2 – 3rd-degree perineal tear

Question:
What new finding must you enter in the TNP to reflect the evolution of Mrs. Dufresne’ clinical profile in connection with the clinical follow-up of her health situation? *
3.1 At 5:30 AM, Mrs. Lajoie, a 32-year-old primipara, gave birth vaginally, without anesthesia, to a healthy 3.4 kg boy after 8 hours of labor. During her first breastfeeding session, she asks you: "Apart from the fact that it doesn't hurt, how will I know if my baby has latched on properly?"

Question:
What should you tell her? *
3.2 Twenty-four hours after giving birth, Mrs. Lajoie is getting ready to go home. While you are giving her the discharge information, she asks you:
"Apart from the fact that my baby is gaining weight, how will I know if he is getting enough milk after my milk comes in?"

Question:
Which of the following is the best response? *
4.1 While preparing her newborn for discharge, Mrs. Blunt tells you: "I’ve heard about Sudden Infant Death Syndrome. I know I should always put my baby to sleep on his back to help prevent it. Is there anything else I should do to reduce the risk?"

Question:
What other recommendation should you give Mrs. Blunt to help prevent SIDS? *
4.2 Two days after returning home with her newborn, Mrs. Blunt calls you. She is worried and says:

"I don't understand—my baby is so quiet, he's yellow, he sleeps more than usual, and he's been nursing poorly since yesterday. His behavior has really changed since we came home."

Question:
What will you recommend Mrs. Lajoie do to help resolve her baby's signs of jaundice? *
5. You are caring for Mme Boucher, a 32-year-old G3P3 who delivered a 4.2 kg male infant vaginally 2 hours ago. She had a prolonged labor augmented with Oxytocin. The physician’s standing order states: "Monitor vital signs q15min x 1h, then q1h x 4h. Notify MD if soaking >1 pad/hour." While assessing Mme Boucher, you note she appears pale and clammy. Her lochia rubra is heavy with large clots, and she has saturated two pads in the last 30 minutes. Her blood pressure is 90/58 mmHg, and her pulse is 118 bpm.

Question:
What is your immediate priority nursing intervention? *
6. Mme Lefebvre, a primipara (first-time mother), delivered 6 hours ago with an epidural which has since worn off. She has an IV of Lactated Ringer’s running at 125 mL/hr. The medical order indicates: "Discontinue IV once patient is tolerating oral fluids and has voided." During your assessment, you note that her fundus is palpable 2 cm above the umbilicus and deviated to the right side. Her lochia flow has increased from scant to moderate.

Question:
Based on these findings, what is the most appropriate nursing action? *
7. Mme Dubé, 28 years old, is being prepared for discharge 48 hours after a vaginal delivery. Her pregnancy was uncomplicated. The physician has written discharge orders. However, Mme Dubé complains of a new, pounding frontal headache and says, "My vision is a little blurry." You note she has 2+ pitting edema in her lower extremities.

Question:
Before processing the discharge, which assessment is critical to perform? *
8. Mme Roy, 35 years old, underwent an emergency Cesarean section 24 hours ago. She has a BMI of 35 and has been reluctant to mobilize due to pain. The medical order includes: "Analgesics PRN and encourage early ambulation." Mme Roy calls you to the bedside complaining of a sharp, persistent pain in her left calf. Upon inspection, the left calf is warm, red, and slightly swollen compared to the right.

Question:
Which nursing intervention is contraindicated in this situation? *
9. Mme Caron, who is Rh-negative (A-), delivered a healthy baby girl 36 hours ago. The baby’s cord blood results confirm the baby is Rh-positive (O+). The Direct Coombs test on the mother is negative. The physician has ordered: "Administer WinRho (Rho(D) Immune Globulin) 300 mcg IM if indicated."

Question:
How do you explain the purpose of this medication to Mme Caron? *
10. Mme Lapointe delivered a 4.5 kg infant via forceps-assisted vaginal delivery 2 hours ago. She has an ice pack on her perineum. The physician’s order is for "Ibuprofen 400mg PO q4h PRN for pain." Despite receiving the medication and having the ice pack, Mme Lapointe reports severe, excruciating pressure in her rectal area and rates her pain as 10/10. You assess the fundus, which is firm and midline, and lochia is moderate.

Question:
What complication should the nurse suspect? *
11. Mme Tremblay is 3 days postpartum. She calls you into the room crying. When you ask what is wrong, she says, "I don't know. I love my baby and he is feeding well, but I just feel so overwhelmed and sad for no reason. I feel like I'm going crazy." Her history reveals no prior mental health issues.

Question:
What is the most appropriate nursing response? *
12. Mme Fortin had a Cesarean section under spinal anesthesia 12 hours ago. She received intrathecal morphine (Duramorph). The standing orders state: "Monitor respiratory rate and sedation level q1h for 24 hours. Naloxone 0.4mg IV PRN for RR < 10." Upon entering the room, you find Mme Fortin difficult to arouse. Her respiratory rate is 8 breaths/minute and shallow. Oxygen saturation is 88%.

Question:
What is your priority action sequence? *
13. Mme Poirier calls the clinic 2 weeks postpartum. She is exclusively breastfeeding. She reports feeling like she has the flu, with a fever of 39°C, chills, and body aches. She states, "My right breast is very red, hot, and painful in one specific area." The physician prescribes an antibiotic.

Question:
In addition to taking the medication, what instruction is essential to prevent complications like an abscess? *
14. Mme Gagnon is 4 days postpartum following a Cesarean section after prolonged rupture of membranes (24 hours). She is readmitted with a temperature of 38.5°C. She complains of lower abdominal tenderness and "bad smelling" vaginal discharge. The physician orders: "CBC, Blood Cultures, Cervical Culture, Start IV Ampicillin/Gentamicin."

Question:
Which assessment finding would most strongly confirm a diagnosis of Endometritis rather than a urinary tract infection (UTI)? *