What assessment data increases the risk of postpartum infection?

Correct Answer: A

Rationale: In the context of postpartum complications, understanding the risk factors for postpartum infection is crucial for providing optimal care to postpartum women. Option A, precipitous labor, is the correct answer because it can lead to increased tissue trauma, which creates a favorable environment for bacterial growth and infection. In precipitous labor, the rapid delivery can cause lacerations or tears in the birth canal, increasing the risk of infection. Option B, urinary retention, does not directly increase the risk of postpartum infection. While urinary retention can lead to urinary tract infections if left untreated, it is not a direct risk factor for postpartum infections. Option C, breastfeeding, is not a primary risk factor for postpartum infection. Breastfeeding is beneficial for the mother and baby, providing numerous health benefits, and does not inherently increase the risk of postpartum infection. Option D, intact perineum, does not increase the risk of postpartum infection. An intact perineum means that there are no lacerations or tears, reducing the risk of infection compared to having perineal trauma. Educationally, understanding the risk factors for postpartum infections helps healthcare providers identify high-risk patients, implement preventive measures, and provide appropriate treatment promptly. By knowing which assessment data points increase the risk of postpartum infection, healthcare providers can offer individualized care and improve outcomes for postpartum women.

Correct Answer: A

Rationale: In the context of postpartum endometritis, which is an infection of the uterine lining following childbirth, the correct nursing intervention included in the plan of care is to monitor for signs of sepsis (Option A). This is crucial because endometritis can lead to sepsis, a life-threatening condition characterized by a systemic response to infection. By closely monitoring for signs of sepsis such as elevated heart rate, fever, hypotension, and altered mental status, the nurse can promptly intervene and prevent the progression to septic shock. Option B, discouraging breast-feeding, is incorrect as breast-feeding is encouraged in postpartum care due to its numerous benefits for both the mother and the newborn, unless contraindicated by specific medications used in the treatment of endometritis. Option C, avoiding fundal assessment, is also incorrect as routine fundal assessment is essential in monitoring postpartum uterine involution and detecting any abnormal findings that may indicate complications such as retained placental fragments or excessive bleeding. Option D, increasing family visiting hours, is not a priority intervention in the case of postpartum endometritis. While family support is important in the postpartum period, the immediate focus should be on the patient's clinical condition and preventing complications like sepsis. In an educational context, understanding the rationale behind the correct intervention of monitoring for signs of sepsis highlights the importance of early recognition and intervention in preventing life-threatening complications in postpartum patients. Nurses must be diligent in assessing and monitoring patients for signs of deterioration, especially in the context of postpartum infections, to provide safe and effective care.

Correct Answer: B

Rationale: In postpartum hemorrhage (PPH), a late (secondary) PPH typically occurs between 24 hours and up to 6 weeks after delivery. The correct answer, B) is caused by subinvolution of the uterus, is characteristic of late PPH. Subinvolution refers to the delayed return of the uterus to its normal non-pregnant size, leading to persistent bleeding. Option A) is incorrect because PPH that occurs within the first 24 hours is considered an early PPH. Option C) is incorrect as PPH can occur after both vaginal and cesarean births. Option D) is incorrect as Methergine is a common medication used to treat PPH, including cases of subinvolution. Educationally, understanding the timing and causes of different types of PPH is crucial for healthcare providers working in obstetrics. Recognizing the characteristics of late PPH, such as subinvolution, helps in prompt identification and appropriate management to prevent serious complications like hemorrhagic shock.

Correct Answer: C

Rationale: In the context of postpartum complications, uterine atony refers to the inability of the uterus to contract effectively after childbirth, leading to excessive postpartum bleeding. Multiple gestation (Option C) is a known risk factor for uterine atony because the uterus becomes overstretched due to the presence of more than one fetus, making it harder for the uterus to contract effectively post-delivery. Primipara (Option B), a woman giving birth for the first time, is not a direct risk factor for uterine atony. Small for gestational age (Option A) and intrauterine growth restriction (Option D) refer to fetal size and growth issues, which are not directly related to the uterine muscle's ability to contract effectively. Educationally, understanding risk factors for postpartum complications like uterine atony is crucial for healthcare providers involved in obstetric care. Recognizing these risk factors allows for timely interventions to prevent or manage complications, ultimately improving maternal outcomes and reducing morbidity and mortality rates associated with childbirth.

Correct Answer: D

Rationale: In this scenario, the correct intervention for the nurse to perform next is option D, which is to massage the fundus and assess the lochia. This intervention is crucial in managing a boggy uterus, as massage helps the uterus to contract, preventing excessive bleeding and promoting involution. Assessing the lochia provides information about the amount and character of postpartum bleeding, which is essential in monitoring the patient's condition. Option A, calling for help, is not the immediate priority in this situation. The nurse should first take action to address the issue at hand before seeking additional assistance. Starting an IV bolus (option B) may be necessary if the patient is experiencing hypovolemic shock due to excessive bleeding, but addressing the boggy uterus is the primary intervention. Getting the person out of bed to walk to the restroom (option C) is contraindicated in this situation as it does not address the immediate concern of a boggy uterus and full bladder, which can lead to further complications if not managed promptly. In an educational context, understanding the importance of prompt assessment and intervention in postpartum complications is crucial for nurses caring for postpartum patients. Recognizing signs of uterine atony and knowing the appropriate interventions can prevent serious complications such as postpartum hemorrhage. This scenario highlights the critical thinking skills and clinical judgment required in postpartum care.