Your patient is 12 hours postpartum. You ask her in your assessment when the last time she urinated was. She tells you it has been 4 hours. You advise her that she needs to urinate every 2 hours even if she does not feel the urge to go You know this is good advice because of which of the following? (Select All that Apply)

The urethra, bladder and urinary meatus is edematous

She has decreased sensitivity to fluid pressures after a vaginal birth

At 12 hours postpartum she will begin diuresing

There is no cause for concern as long as the patient urinates once shift

A full bladder can lead to postpartum hemorrhage

Answer and Explanation

Correct Answer : A,B,C,E

A) The urethra, bladder, and urinary meatus are edematous:
Postpartum women often experience edema in the urethra, bladder, and urinary meatus due to the pressure exerted during delivery. This swelling can make it difficult for the woman to feel the urge to urinate, even when her bladder is full. Encouraging her to urinate every 2 hours helps prevent overdistension of the bladder, which can lead to urinary retention and other complications.

B) She has decreased sensitivity to fluid pressures after a vaginal birth:
After childbirth, especially a vaginal birth, the pelvic floor and surrounding tissues can be numb or less sensitive due to trauma, swelling, and the effects of anesthesia. This decreased sensitivity makes it harder for the woman to sense when she needs to urinate. Encouraging regular voiding even without the urge helps to prevent urinary retention, which is common in the immediate postpartum period.

C) At 12 hours postpartum, she will begin diuresing:
Diuresis, the process of excreting excess fluid retained during pregnancy, typically begins within 12 hours postpartum. This increased urine output can make it even more important for the mother to void regularly to prevent urinary retention. If the bladder is not emptied regularly, it can lead to discomfort and increase the risk of complications like bladder distention or infection.

D) There is no cause for concern as long as the patient urinates once per shift:
This is not true. A postpartum woman should void more frequently than once per shift (which is about every 8 hours). Urinating only once every shift can lead to urinary retention, bladder overdistension, and possible infection. The recommendation to urinate every 2 hours helps ensure proper bladder emptying and reduces the risk of complications.

E) A full bladder can lead to postpartum hemorrhage:
A full bladder can indeed contribute to postpartum hemorrhage (PPH). An overdistended bladder can displace the uterus, preventing it from contracting effectively after delivery. This can increase the risk of excessive bleeding. Regular voiding helps prevent bladder distention and supports uterine contraction, thereby reducing the risk of hemorrhage.

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Correct Answer is A

Explanation

A) A rubella injection is advised:
Since the rubella titer is non-immune, the woman is not protected against rubella, which is important to address during the postpartum period. The rubella vaccine is typically given to women who are non-immune to rubella after childbirth, but it is contraindicated during pregnancy because it is a live vaccine. The best action in this case would be to administer the rubella vaccine to the postpartum woman before discharge, with instructions to avoid becoming pregnant for at least 28 days after vaccination to prevent harm to a future fetus.

B) A blood transfusion is advised:
The hematocrit of 30% indicates that the woman has mild anemia, but it does not require immediate intervention like a blood transfusion. Normal hematocrit levels for postpartum women typically range between 32% and 42%. A transfusion would be indicated if the hematocrit were much lower (usually below 20-25%) or if there were symptoms of significant blood loss, which are not indicated in this case.

C) The nurse should contact the provider for an antibiotic order:
There is no indication from the provided laboratory results or the scenario that the woman requires antibiotics. Group B Streptococcus (GBS) was negative, which eliminates the need for prophylactic antibiotics. There is no mention of any infection risk requiring an antibiotic prescription, and since her GBS result is negative, antibiotics are not warranted.

D) RhoGAM injection should be administered within 72 hours:
RhoGAM (Rh immunoglobulin) is typically administered to a woman with Rh-negative blood who has given birth to an Rh-positive baby to prevent Rh sensitization in future pregnancies. In this case, the woman has an Rh-positive blood type (A+), so she does not need RhoGAM. RhoGAM would only be necessary if the woman had an Rh-negative blood type, which she does not.

A. Put baby to breast for non -nutritive sucking to calm baby B. Give the baby pacifier C. Put the baby in the nursery so mom can get some rest D. Supplement with formula

Correct Answer is A

Explanation

A) Put baby to breast for non-nutritive sucking to calm baby:
Non-nutritive sucking (sucking without feeding) is a natural way for babies to self-soothe. It can help calm a fussy infant and also promote bonding between mother and baby. This action also stimulates milk production in the mother. It's a safe and effective way to comfort the baby without introducing unnecessary interventions. Non-nutritive sucking can help regulate the baby's sucking reflexes and provide comfort until the next feeding.

B) Give the baby pacifier:
While pacifiers can help some babies self-soothe, they can interfere with breastfeeding, especially in the early days. Introducing a pacifier too soon may confuse the baby’s natural sucking pattern and affect the latch, which can impact breastfeeding success. It’s typically recommended to wait until breastfeeding is well-established, around 3-4 weeks, before introducing a pacifier.

C) Put the baby in the nursery so mom can get some rest:
While maternal rest is important, removing the baby from the mother's care in the early postpartum period may interfere with the breastfeeding process. Breastfeeding on demand is crucial for establishing a good milk supply, and keeping the baby close for frequent feedings (and comfort) will help with this. Encouraging rest is important, but it shouldn't come at the expense of bonding and feeding.

D) Supplement with formula:
There is no indication that the baby is not getting enough nutrition at this point. Fussy behavior between feedings is common in newborns and can be due to various factors such as the baby's need for comfort, a growth spurt, or a short interval between feedings. Supplementing with formula is not necessary unless there is a clear indication of inadequate milk supply or other medical concerns, which isn’t evident in this situation.

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The laboratory results for a postpartum woman are as follows: blood type: A + rubella: non-immune hematocrit: 30% GBS: negative How would the nurse best interpret these data?

Correct Answer is A

Explanation

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Correct Answer is A

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