The nurse is caring for 4 patients on the postpartum unit.
Which of her patients is at greatest risk for the development of thromboembolic disease?

Choice A rationale

A personal or family history of depression and/or anxiety is a significant risk factor for developing postpartum depression. The biological and psychological factors that predispose an individual to these conditions, such as hormonal fluctuations and brain chemistry imbalances, can be exacerbated by the hormonal changes and stresses of the postpartum period. A history of these conditions indicates a pre-existing vulnerability to mood disorders.

Choice B rationale

Having a third baby is not an inherent risk factor for postpartum depression. In fact, some studies suggest that multiparous women may have a lower risk than first-time mothers, as they may have more experience and social support. However, it is the overall context, such as a history of depression, lack of social support, or a stressful life event, that contributes to the risk, not the number of children alone.

Choice C rationale

A lack of social support is a major risk factor for postpartum depression. Moving far from family, who are often a primary source of emotional and practical support, creates a sense of isolation. When combined with a husband who works long hours, the mother is left to manage the significant demands of a newborn with minimal assistance, increasing stress and feelings of loneliness, which are all key contributors to postpartum depression.

Choice D rationale

While some studies indicate that primiparous (first-time) mothers may be at a slightly higher risk of postpartum depression due to the novelty of the experience and the steep learning curve, it is not a definite risk factor in itself. The risk is more closely tied to pre-existing conditions and external stressors, such as a history of mood disorders and lack of social support. This is her first baby is a less influential factor compared to a history of anxiety/depression and a lack of social support

The use of oil of peppermint has been shown in some studies to have an antispasmodic effect on the smooth muscles of the urethra, potentially relaxing the external sphincter and promoting spontaneous urination. The aromatic compounds can also stimulate the parasympathetic nervous system. However, its efficacy is not universally guaranteed.

Choice B rationale

Inserting a sterile catheter is the most invasive but a highly effective last resort intervention when a woman is unable to urinate spontaneously and has a full bladder post-delivery. A full bladder can displace the uterus and prevent proper uterine contractions, increasing the risk of postpartum hemorrhage. Catheterization is a direct method to relieve bladder distension and its associated complications.

Choice C rationale

Analgesics are primarily used for pain relief and do not directly address the mechanical or neurological issues causing urinary retention. While pain can contribute to difficulty urinating, prescribing analgesics is an indirect approach and is not the most effective or immediate solution for an over-filled bladder causing uterine atony.

Choice D rationale

Pouring water over the perineum can be an effective non-invasive technique to stimulate the micturition reflex. The sensation of the water on the external genitalia triggers a parasympathetic response, which can lead to relaxation of the urethral sphincter and promote the urge to void. This is a common nursing intervention used before more invasive measures.