Author Question: A woman had a cesarean birth after a prolonged trial of labor. When assessing the patient, the nurse ... (Read 42 times)

Alygatorr01285 · **on:** Jun 28, 2018

A woman had a cesarean birth after a prolonged trial of labor. When assessing the patient, the nurse notes the patient is lethargic, has a pulse of 130 beats/minute, and states: I'm glad I have so little lochia; I'm too tired to change my pad.

What action by the nurse is most appropriate?
A.
Assess the amount of lochia on the peri-pad.
B.
Cluster the nursing care given to allow uninterrupted sleep.
C.
Have the woman get up and attempt to void.
D.
Take a full set of vital signs and call the provider.

Question 2

A woman is being taken to the operating room later in the day for incision and drainage of a large perineal hematoma. What action by the nurse is most important to meet the patient's psychosocial needs?

A.
Administer a preoperative sedative to calm her.
B.
Allow the woman to make choices when possible.
C.
Introduce the patient to the nursery staff.
D.
Reassure the patient that hematomas heal quickly.

smrerig · **Reply #1 on:** Jun 28, 2018

Answer to Question 1

ANS: D
Signs of puerperal infection include tachycardia, malaise, uterine tenderness, and subinvolution. Lochia can be heavy and foul smelling or scant and odorless, depending on the offending organism. The nurse should take a full set of vital signs, perform a complete assessment, and notify the health-care provider.

Answer to Question 2

ANS: B
Patients with postpartum complications often feel a lack of control. Allowing the woman to make choices whenever possible helps her regain her sense of control. Giving a sedative is merely masking the problem. Reassuring the woman may be important to do but is not the best response. Introducing the patient to the nursery staff would be a good action if that staff will be caring for the baby while the patient is in the operating room, but it is not the best option.