A nurse is assessing a postpartum client during a follow-up visit.

Exhibits

The nurse is teaching the client about postpartum depression. The nurse should encourage the client to

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and

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to help prevent postpartum depression.

The correct answer is choice A. Provide the client with a cool sitz bath.

Choice A rationale:

Providing a cool sitz bath helps reduce swelling and provides pain relief for the perineum, which is crucial for a client with a fourth-degree laceration. Cool sitz baths are recommended in the initial postpartum period to soothe the area and promote healing.

After a vaginal delivery, most women experience swelling of the perineum and consequent pain. This is intensified if the woman has had an episiotomy or a laceration. Routine care of this area includes ice applied to the perineum to reduce the swelling and to help with pain relief. Conventional treatment is to use ice for the first 24 hours after delivery and then switch to warm sitz baths. However, little evidence supports this method over other methods of postpartum perineum treatment. Pain medications are helpful both systemically as nonsteroidal anti-inflammatory drugs (NSAIDs) or narcotics and as local anesthetic spray to the perineum.

Hemorrhoids are another postpartum issue likely to affect women who have vaginal deliveries. Symptomatic relief is the best treatment during this immediate postpartum period because hemorrhoids often resolve as the perineum recovers. This can be achieved by the use of corticosteroid creams, witch hazel compresses, and local anesthetics in addition to a bowel regimen that avoids constipation.

Tampon use can be resumed when the patient is comfortable inserting the tampon and can maintain it without discomfort. This often takes longer for the woman who has had an episiotomy or a laceration than for one who has not. The vagina and perineum should first be fully healed, which takes several weeks. Tampons must be changed frequently to prevent infection.

Choice B rationale:

Administering methylergonovine 0.2 mg IM is typically used to manage postpartum hemorrhage by contracting the uterus. It is not directly related to the care of a perineal laceration.

Choice C rationale:

Applying a moist, warm compress to the perineum is generally not recommended in the immediate postpartum period for a fourth-degree laceration. Warm compresses might be used later, but initially, cool treatments are preferred to reduce swelling.

Choice D rationale:

Applying povidone-iodine to the perineum after voiding is not a standard practice for managing a fourth-degree laceration. It is more important to keep the area clean and dry, and povidone-iodine can be irritating to the sensitive tissue.

A. Initiate oxytocin via continuous IV infusion: Oxytocin stimulates uterine contractions, which would increase pressure on the umbilical cord, further compromising fetal oxygenation. This action is contraindicated in the presence of a prolapsed cord.

B. Place the client in the left-lateral position: Although the left-lateral position improves uteroplacental perfusion, it does not relieve pressure on the prolapsed cord. Instead, the nurse should position the client in a knee-chest or Trendelenburg position to reduce cord compression.

C. Request that the provider insert an intrauterine pressure catheter: Intrauterine pressure catheters are contraindicated in cases of umbilical cord prolapse as they can worsen cord compression and fetal hypoxia.

D. Exert continuous upward pressure on the presenting part: This action helps relieve pressure on the umbilical cord, improving blood flow and oxygen supply to the fetus. The nurse should maintain this position while simultaneously calling for immediate assistance and preparing the client for an emergency cesarean delivery.