What is the most appropriate initial action for the nurse to take when finding the fundal height higher than expected during the postpartum assessment?

A) Encourage the patient to empty her bladder

B) Increase the patient's fluid intake

C) Apply a warm compress to the abdomen

D) Notify the physician immediately

During the postpartum period, what is the primary concern when a nurse observes an increase in lochia flow with small clots present?

B) Retained placental fragments

What is the primary reason for performing a dilation and curettage (D&C) in a postpartum patient with retained placental tissue?

B) To remove retained placental fragments and prevent complications

A) To alleviate breast engorgement

B) To remove retained placental fragments and prevent complications

C) To speed up the involution process

D) To monitor the baby's health status

After a dilation and curettage (D&C) procedure, a nurse is assessing a postpartum patient. Which of the following findings would indicate a normal recovery?

B) Moderate lochia and firm fundus

A) Elevated heart rate and hypotension

B) Moderate lochia and firm fundus

C) Persistent severe cramping and heavy bleeding

D) Elevated temperature and tachycardia

Following a dilation and curettage (D&C) procedure, which assessment finding indicates that the intervention was successful in resolving retained placental tissue?

B) The lochia flow has decreased to a moderate level with no new clots.

A) The patient's blood pressure is 118/76 mmHg.

B) The lochia flow has decreased to a moderate level with no new clots.

C) The patient reports feeling slightly groggy but is alert and oriented.

D) The fundal height is firm and at the level of the umbilicus.

What is the most important reason for encouraging early ambulation in a postpartum patient?

B) To prevent deep vein thrombosis

A) To promote bonding with the newborn

B) To prevent deep vein thrombosis

C) To expedite the healing of the perineum

What is the primary reason for encouraging early ambulation in postpartum patients?

B) To prevent deep vein thrombosis

D) To enhance breast milk production

A postpartum nurse notices that a patient has developed a mild headache and slight increase in blood pressure. Which of the following is the most appropriate initial nursing action?

D) Perform a focused assessment for signs of postpartum preeclampsia

A) Reassure the patient and continue routine monitoring

B) Notify the healthcare provider immediately

C) Encourage the patient to rest and increase fluid intake

D) Perform a focused assessment for signs of postpartum preeclampsia

postpartum assessment - Nursing Case Study

Pathophysiology

• Primary mechanism: Uterine involution is the process where the uterus contracts and returns to its pre-pregnancy size. This is essential to prevent postpartum hemorrhage, a leading cause of maternal mortality. Effective contraction helps constrict blood vessels and reduces bleeding.

• Secondary mechanism: Hormonal shifts, particularly the dramatic drop in estrogen and progesterone, trigger milk production and emotional changes. These hormonal adjustments can contribute to minor complications like mood swings or postpartum blues, impacting maternal mental health.

• Key complication: Retained placental fragments can impede uterine involution and lead to excessive bleeding or infection. Early detection through postpartum assessment is crucial to prevent these complications and ensure maternal recovery.

Patient Profile

Demographics:

28-year-old female, stay-at-home mother

History:

• Key past medical history: Uncomplicated pregnancy and delivery

• Current medications: Prenatal vitamins

• Allergies: None known

Current Presentation:

• Chief complaint: Routine postpartum check-up

• Key symptoms: Mild fatigue, breast tenderness

• Vital signs: Temperature 98.6°F, Heart rate 76 bpm, Blood pressure 118/72 mmHg, Respiratory rate 16 breaths per minute, Oxygen saturation 99% on room air

Section 1

Initial Assessment Findings:

During the routine postpartum check-up, the nurse conducts a thorough assessment of the patient to ensure a smooth recovery process. The nurse begins by evaluating the patient's vital signs, which remain stable with a temperature of 98.6°F, heart rate of 76 bpm, blood pressure of 118/72 mmHg, respiratory rate of 16 breaths per minute, and oxygen saturation at 99% on room air. These values indicate that the patient is hemodynamically stable, with no immediate signs of distress.

The physical examination reveals that the uterus is firm and midline, a positive sign of effective uterine involution. However, the nurse notes that the patient's fundal height is slightly higher than expected for this stage of postpartum recovery. This finding prompts the nurse to inquire further about the patient's lochia, which is the vaginal discharge following childbirth. The patient reports moderate bleeding with a fleshy odor, but without any large clots or foul smell, suggesting the absence of infection. Despite these reassuring signs, the nurse remains vigilant for potential retained placental fragments given the higher fundal height, which could pose a risk for excessive bleeding if not addressed promptly.

The nurse also assesses the patient's breasts, noting mild tenderness and slight engorgement, common in the early postpartum period as milk production begins. The nurse educates the patient on proper breastfeeding techniques and the importance of regular feeding to relieve engorgement. Additionally, the nurse discusses emotional well-being, acknowledging the hormonal shifts and reassuring the patient that mild mood swings are normal. The patient is encouraged to reach out for support if these feelings intensify. The initial assessment provides a comprehensive overview of the patient's current status, guiding the care team in monitoring for any emerging complications while supporting the patient's recovery journey.

Section 2

As the postpartum recovery progresses, the nurse continues to monitor the patient's status closely. During a follow-up assessment, the nurse observes an increase in the patient's lochia flow, now described as heavy with a few small clots present. Concerned about the possibility of retained placental fragments, the nurse promptly informs the healthcare provider and orders an ultrasound to investigate further. The patient's vital signs remain stable; however, the nurse notes a slight increase in heart rate to 82 bpm, which, while still within normal limits, warrants careful monitoring given the change in lochia.

The ultrasound results reveal a small amount of retained placental tissue, which is likely contributing to the altered lochia pattern and fundal height discrepancy. The healthcare provider discusses with the patient the need for a minor procedure, such as a dilation and curettage (D&C), to remove the remnants and prevent further complications like excessive bleeding or infection. The patient is reassured by the nurse about the safety and routine nature of the procedure, and plans are made for it to be conducted within the day.

Meanwhile, the nurse continues to support the patient's overall well-being by encouraging hydration and rest, monitoring for any signs of increased bleeding or infection, and providing emotional support. The patient's breast tenderness and engorgement remain manageable with the use of warm compresses and frequent breastfeeding sessions. Through this vigilant care and clear communication, the patient feels informed and prepared for the next steps in her postpartum journey, with the expectation of returning to a smooth recovery following the resolution of this minor complication.

Section 3

As the day progresses, the nurse continues to monitor the patient closely, focusing on her response to the planned intervention and any changes in her condition. After the dilation and curettage (D&C) procedure is successfully completed, the patient is brought back to the postpartum unit for recovery. The nurse conducts a thorough post-procedure assessment, noting that the patient's vital signs remain stable: blood pressure is 118/76 mmHg, heart rate has decreased slightly to 78 bpm, and temperature is normal at 98.6°F (37°C). The patient reports feeling slightly groggy but is otherwise alert and oriented.

The nurse assesses the patient's lochia, finding that the flow has decreased to a moderate level with no new clots, which is an encouraging sign that the procedure effectively addressed the retained placental tissue. The fundal height is now appropriately firm and at the level of the umbilicus, confirming the resolution of the earlier discrepancy. The patient is experiencing mild uterine cramping, which the nurse explains is normal following the procedure and can be managed with prescribed pain relief as needed.

Throughout the day, the nurse emphasizes the importance of hydration and encourages the patient to continue breastfeeding frequently to promote uterine involution and manage breast engorgement. The patient feels reassured by the nurse's consistent presence and clear explanations, expressing relief that the complication was identified and managed promptly. With the patient's condition improving and no new complications arising, the nurse anticipates a smooth transition in the patient's postpartum care plan, focusing on ongoing recovery and discharge education.

Section 4

As the afternoon progresses, the nurse continues to monitor the patient’s recovery closely, focusing particularly on her response to interventions and any new changes in her condition. The patient is encouraged to ambulate as soon as she feels comfortable, as early mobilization is important for preventing complications such as deep vein thrombosis. With assistance, the patient is able to walk to the bathroom, reporting only mild dizziness, which resolves with rest and hydration.

The nurse performs an additional assessment, noting that the patient’s lochia remains moderate with a normal progression in color, indicating that postpartum bleeding is stabilizing. The patient's vital signs remain within normal limits, with blood pressure at 116/74 mmHg, heart rate steady at 76 bpm, and temperature maintaining at 98.7°F (37.1°C). The nurse also evaluates the patient's pain level, which the patient rates as a manageable 3 out of 10 on a standard pain scale, primarily due to uterine cramping. The previously administered analgesic appears to be effective, and the nurse offers a warm pack to provide additional comfort.

In the coming hours, the nurse plans to reinforce education on recognizing signs of potential complications, such as excessive bleeding or fever, and the importance of self-care measures at home. The patient is receptive to the information and expresses confidence in managing her postpartum recovery. With these foundations set, the nurse prepares to collaborate with the healthcare team to discuss the timing and criteria for the patient’s potential discharge, ensuring a safe and informed transition to home care.

Section 5

As the afternoon progresses, the nurse notices a slight change in the patient's condition during the routine postpartum assessment. While most parameters remain stable, the patient reports increased fatigue and a mild headache. Recognizing the importance of early detection and intervention, the nurse decides to perform a focused assessment to ensure these symptoms are not indicative of a developing complication.

Upon further evaluation, the nurse observes that the patient's blood pressure has slightly increased to 128/82 mmHg, while the heart rate remains steady at 78 bpm and temperature is unchanged at 98.7°F (37.1°C). Given these findings, the nurse considers the possibility of postpartum preeclampsia, a condition that can develop even after delivery. To rule out this concern, the nurse reviews the patient's recent laboratory results, noting that hemoglobin levels are stable at 11.5 g/dL and platelet count is within normal range at 250,000/mm³. However, a urinalysis performed earlier reveals trace amounts of protein, which warrants close monitoring.

In response to these findings, the nurse collaborates with the healthcare provider to determine the next steps, which may include ordering additional diagnostic tests to evaluate kidney function and monitor protein levels. The patient is educated on the significance of these assessments and the importance of reporting any worsening symptoms, such as severe headache or visual changes. The nurse also reinforces the plan for continued hydration and rest, alongside regular monitoring of vital signs. By maintaining a proactive approach, the nurse aims to ensure the patient's recovery remains on track and that any potential complications are addressed promptly.