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A nurse is assessing a postpartum client for signs of postpartum depression. Which of the following symptoms is most indicative of postpartum depression rather than normal postpartum adjustment?

A.

Feeling anxious about the baby's health and well-being, but still able to care for the baby effectively

B.

Experiencing occasional mood swings and irritability while adjusting to the new role of motherhood

C.

Feeling overwhelmed and having difficulty sleeping due to the demands of a newborn

D.

Persistent feelings of sadness, severe fatigue, and loss of interest in activities, including caring for the baby

Answer and Explanation

The Correct Answer is D

A. Feeling anxious about the baby's health and well-being, but still able to care for the baby effectively
Mild anxiety about the baby’s health is a common experience for new mothers and does not necessarily indicate PPD. It becomes concerning if anxiety becomes overwhelming or interferes with daily functioning.

B. Experiencing occasional mood swings and irritability while adjusting to the new role of motherhood
Mood swings and irritability are normal postpartum adjustments, often due to hormonal changes, sleep deprivation, and new responsibilities. These symptoms typically resolve within a few weeks.

C. Feeling overwhelmed and having difficulty sleeping due to the demands of a newborn
Feeling overwhelmed and sleep disturbances are common in the postpartum period due to frequent infant care needs. However, severe or persistent sleep disturbances, especially with loss of interest in daily activities, may indicate PPD.

D. Persistent feelings of sadness, severe fatigue, and loss of interest in activities, including caring for the baby
Postpartum depression is characterized by prolonged sadness, extreme fatigue, withdrawal, and difficulty bonding with the baby. These symptoms extend beyond normal postpartum blues (which typically resolve within two weeks) and require medical intervention, including therapy and possibly medication.


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Related Questions

Correct Answer is {"A":{"answers":"A"},"B":{"answers":"A"},"C":{"answers":"B"},"D":{"answers":"A"},"E":{"answers":"B"},"F":{"answers":"B"}}

Explanation

Priority concerns:

Liver function tests: The client has elevated ALT (75 U/L), AST (78 U/L), alkaline phosphatase (184 U/L), and LDH (250 U/L), which are consistent with liver involvement in preeclampsia with severe features. This suggests hepatic dysfunction and possible progression to HELLP syndrome.

Blood pressure: The client’s BP is 168/100 mmHg, which meets the criteria for severe preeclampsia (≥160/110 mmHg). Uncontrolled hypertension increases the risk of stroke, placental abruption, and progression to eclampsia.

Headache: The persistent headache could indicate severe preeclampsia with neurological involvement due to cerebral vasospasm and increased risk of stroke or seizure. A headache that does not resolve with usual measures is a warning sign, and magnesium sulfate should be considered for seizure prophylaxis.

Not a Priority Concern

Heartburn is a common symptom in pregnancy due to gastric reflux and increased progesterone levels, which relax the lower esophageal sphincter. While it can be uncomfortable, it is not immediately life-threatening.

Gestational age: The client is at 37 weeks’ gestation, which is considered early term but not preterm. While gestational age is important for delivery planning, it is not the most immediate concern compared to the client’s hypertensive crisis.

Cardiac assessment: The apical pulse is 77 bpm, regular, and lungs are clear, indicating that there is no immediate cardiac or respiratory compromise.

Correct Answer is {"A":{"answers":"C"},"B":{"answers":"A"},"C":{"answers":"B"},"D":{"answers":"B"},"E":{"answers":"C"}}

Explanation

Preeclampsia:

  • Blood pressure of 150/96 mmHg: A BP of ≥140/90 mmHg on two occasions at least 4 hours apart after 20 weeks of gestation in a previously normotensive client is diagnostic of preeclampsia.

Preeclampsia with Severe Features:

  • Blood pressure of 162/112 mmHg: Severe hypertension is ≥160/110 mmHg on two occasions at least 4 hours apart. This is a criterion for severe preeclampsia, requiring immediate intervention to prevent complications like eclampsia or stroke.

  • Elevated liver enzymes (ALT/AST > 2x the upper limit of normal) are indicative of severe preeclampsia due to hepatic involvement. This can progress to HELLP syndrome, increasing the risk of liver rupture and disseminated intravascular coagulation (DIC).

Neither:

  • Negative for protein on a urine dipstick: Preeclampsia is typically diagnosed with proteinuria (≥300 mg in 24 hours or protein/creatinine ratio ≥0.3). A negative urine dipstick means proteinuria is absent, making preeclampsia unlikely. However, preeclampsia can also be diagnosed without proteinuria if other systemic features (e.g., thrombocytopenia, renal dysfunction) are present.

  • Seizures in a client with preeclampsia indicate eclampsia, which is a medical emergency requiring magnesium sulfate to prevent further seizures. If the client had no preeclampsia, the seizures could be due to another cause (e.g., epilepsy, metabolic disturbance).

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