Chapter 15, Postpartum Adaptations

• You are caring for Linda, who has just delivered her first baby. You are responsible for assessing Linda’s condition during recovery and for doing patient teaching when the opportunity arises. (Learning Objectives 1 and 2)
• Gretta and Sam just had their first child. Gretta is excited and talkative about her birth experience and wants to keep her baby with her constantly. She tells you his name is Joseph and they will call him “Joey” for short. Gretta is breast-feeding and is attentive to Joey’s needs. You observe that Sam does not initiate contact with the baby but when Gretta insists that he hold Joey, he picks him up slowly and awkwardly and stares at his face for a long period of time. When Joey cries, he immediately returns him to Gretta’s arms. (Learning Objective 7)

1. While she is recovering, you keep checking her fundal height. Linda asks you how her uterus will go back to the way it was before she had the baby. How would you explain this physiologic process? What could impede the process?
2. Linda wants to know how long she should expect to bleed. What would you tell her?
3. The next day Linda appears very passive and you have overheard her telling everyone who will listen about her labor experience. What phase of adjustment is Linda going through? What other stages should she go through while adjusting to her new role?

• Based on your observations of Sam’s interactions with Joey, where is Sam developmentally in the process of paternal attachment and bonding?
• What nursing interventions could you implement that would assist Sam in the transition to fatherhood?

Chapter 16, Nursing Management During the Postpartum Period

1. You are caring for Bonnie, age 42, who has just undergone a cesarean birth for her first baby. You are responsible for monitoring her condition during recovery and for teaching her how to take care of herself and her baby. (Learning Objectives 1, 2, 3, 4, and 7)

A. You note that Bonnie has a positive Homans’ sign in the left leg. What are the risk factors for thromboembolic disorders, and how will you determine if she has a DVT? If Bonnie has a DVT, what else is she at risk for?

B. Bonnie is ready for discharge and asks you about bleeding, perineal care, and what she should eat while breast-feeding. What are you going to teach her?

C. Bonnie, the baby, and Bonnie’s husband are following up for newborn care. What nursing interventions should be included to promote parental role adaptation and parent–newborn attachment?

2. You have just received report on the following patient. Hannah G1P1 gave birth vaginally 2 days ago to a baby girl. She had a midline episiotomy and has protruding hemorrhoids. Hannah is rubella negative and has A– blood type and her daughter is O+. Hannah is breast-feeding her daughter. Hannah is expected to be discharged to home later this afternoon. (Learning Objectives 5 and 7)

A. Describe the nursing management for Hannah and her family during the postpartum time period.

B. Hannah and Justin are preparing for discharge. What areas of health education are needed for discharge planning, home care, and follow-up visits for Hannah and her baby girl?

Chapter 22, Nursing Management of the Postpartum Woman at Risk

1. Amy calls the office 3 days after delivering a healthy baby girl and tells you she is passing small clots and feels like her bleeding is heavier than it should be. You advise Amy to come into the clinic to be checked. (Learning Objectives 1, 2, 3, and 6)

1. What are the “four T’s” that need to be assessed in a possible case of postpartum hemorrhage?
2. Amy also tearfully tells you that she is experiencing anxiety and feelings of being overwhelmed. What is she experiencing, and what education are you going to provide?

2. Alyssa, age 26, had a cesarean delivery 7 days ago and is breast-feeding her baby. She calls the office today and reports that she has a temperature of 102. (Learning Objective 5)

1. Given the limited information you have, describe the four most likely types of infection Alyssa may have contracted.
2. What additional questions do you want to ask her to try to ascertain the cause of her fever?
3. Describe the care required to treat each of these infections
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