A nurse is caring for a patient who just stabilized after she had a postpartum hemorrhage with a QBL of 1300 ml. Which of the following are priorities for her care?
Encourage bottle feeding.
Give aspirin for pain.
Perform frequent fundal assessments.
Check a CBC in 6 hours.
Correct Answer : C,D
Choice A rationale
Bottle feeding does not impact recovery from postpartum hemorrhage. Breastfeeding promotes oxytocin release, aiding uterine contractions to minimize bleeding risk, unlike bottle feeding, which has no therapeutic impact.
Choice B rationale
Aspirin is contraindicated postpartum as it increases bleeding risk due to its antiplatelet effects. Analgesic alternatives like acetaminophen are preferred for pain relief in hemorrhage recovery settings.
Choice C rationale
Frequent fundal assessments monitor for uterine atony, a leading hemorrhage cause. Ensuring the uterus remains firm and contracted is critical in preventing recurrent excessive blood loss postpartum.
Choice D rationale
A CBC after six hours checks hemoglobin, hematocrit, and platelet levels, identifying ongoing bleeding or anemia. Timely lab evaluation ensures appropriate interventions like transfusions or iron supplementation.
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Correct Answer is D
Explanation
Choice A rationale
Manually removing the placenta can introduce infection and cause uterine injury, which are not preventive measures for postpartum hemorrhage but treatments for retained placenta requiring sterile conditions and medical indication.
Choice B rationale
Administering antibiotics does not directly prevent postpartum hemorrhage, as it focuses on managing infections like endometritis. Hemorrhage prevention is better addressed by uterine tone management and avoiding excessive bleeding.
Choice C rationale
Applying pressure to the umbilical cord can lead to uterine inversion, worsening hemorrhage. Controlled cord traction during active management of the third stage is safer and reduces hemorrhage risk effectively.
Choice D rationale
Frequent urination prevents bladder distension, which enhances uterine contraction. A contracted uterus reduces hemorrhage risk by compressing blood vessels. Distended bladder inhibits proper uterine contraction, increasing hemorrhage likelihood.
Correct Answer is C
Explanation
Choice A rationale
Feeling tired and wanting to sleep longer postpartum is common due to disrupted sleep from infant care, but it doesn't specifically indicate postpartum depression, which involves significant mood and emotional changes.
Choice B rationale
Occasional headaches postpartum can result from hormonal changes or stress, resolving with analgesics like Tylenol, and are not indicative of postpartum depression without associated mood disturbances like sadness or crying episodes.
Choice C rationale
Persistent crying and daily sadness are hallmark signs of postpartum depression, linked to hormonal imbalances, disrupted serotonin regulation, and social or emotional factors affecting maternal mental health postpartum.
Choice D rationale
Restlessness may be attributed to anxiety, but it alone doesn't conclusively diagnose postpartum depression, which involves deeper and more pervasive mood changes such as sadness or emotional withdrawal.
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