Case Study 128 – Postpartum

Read the scenario and answer all questions


T.N. delivered a healthy male infant 2 hours ago. She had a midline episiotomy. This is her sixth pregnancy. Before this delivery, she was G6, T4, P0, A1, L4. She had an epidural block for her labor and delivery. She is now admitted to the postpartum unit.

  1. What is important to note in the initial assessment?
  2. You find a boggy fundus during your assessment. What corrective measures should be instituted?
  3. The patient complains of pain and discomfort in her perineal area. How will you respond?
  4. The nurse reviews the hospital security guidelines with T.N. The nurse points out that her baby has a special identification bracelet that matches a bracelet worn by T.N., and the nurse reviews other security procedures. Which statement by T.N. indicates a need for more teaching?
    1. “If I have a question about someone’s identity, I can ask my nurse about it.”
    2. “If someone comes to take my baby for an examination, that person will carry my baby to the examination room.”
    3. “Nurses on this unit all wear the same color uniform.”
    4. “Each staff member who takes my baby somewhere will have a picture identification badge.”
  5. An hour after admission, you recheck T.N.s perineal pad and find that there is a very small amount of lochia on the perineal pad. What will you do next? a. Ask T.N. to change her perineal pad
  6. Check her perineal pad again in 1 hour
c. Check the pad underneath T.N.’s buttocks
  1. Document the findings in T.N.’s medical record
  2. That evening, the nursing assistive personnel assesses T.N.’s vital signs. Which vital signs would be of concern at this time?

Vital Signs:

Temperature: 99.9°F
Blood pressure: 100/50
Pulse rate: 120 bpm

Respiratory rate:      16/min.

  1. What will you do next? Monitor VS, notify doctor is BP and pulse do not improve. Assess pt for bleeding or leaking. Assess for color, amount, consistency, and odor of the lochia. Check to see if blood has spread to other areas of the body. Check uterine fundus, if boggy, massage until firm.
  2. After your prompt intervention, you need to document what occurred. Write an example of a documentation entry describing this event.

Time: 1600  Pulse: 120 BP: 100/50

Large amount of lochia rubra noted with small clots underneath patients buttocks. Fundus was boggy until massaged firm. Patient encouraged to increase fluid intake. Patient voiding without difficulty. Assisted patient with perineal hygiene and provided a clean perineal pad which was placed under patient. Will continue to monitor.

  1. Two hours later, you perform another perineal pad check and observe a 2 in. stain on the pad. How would you document your findings in terms of the amount of lochia on the peripad? Light
  2. N.’s condition is stable, and you prepare to provide patient teaching. What patient teaching is vital after delivery?
  3. N. tells you she must go back to work in 6 weeks and is not sure she can continue breastfeeding. What options are available to her?

T.N. is discharged to home and plans to consult a lactation specialist before returning to work.

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