A nurse is assisting a client out of bed for the first time since delivery.The client becomes frightened when she passes a large amount of lochia.Which of the following responses should the nurse make?
Urinary tract infections are associated with increased lochia.
Lochia can pool in the vagina while you lie in bed.
You might have retained fragments of your placenta.
The amount of lochia increases during the postpartum period.
The Correct Answer is B
Choice A rationale
Urinary tract infections (UTIs) are not typically associated with increased lochia. UTIs usually present with symptoms such as burning during urination, frequent urination, and lower abdominal pain.
Choice B rationale
Lochia can pool in the vagina while lying in bed, leading to a larger amount being expelled upon standing. This is a normal occurrence and not a cause for concern.
Choice C rationale
Retained fragments of the placenta can cause heavy bleeding and infection, but the sudden expulsion of a large amount of lochia upon standing is more likely due to pooling rather than retained placenta.
Choice D rationale
The amount of lochia typically decreases over time during the postpartum period. An increase in lochia is not expected and should be evaluated for other causes.
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Correct Answer is B
Explanation
Choice A rationale
Fungal infections typically present with itching, redness, and a thick, white discharge resembling cottage cheese. The yellow-white vaginal drainage described is more consistent with lochia alba, the final stage of lochia, which is a normal postpartum discharge.
Choice B rationale
Lochia alba is the final stage of lochia, occurring around 10 to 14 days postpartum and lasting up to six weeks. It is characterized by a yellowish-white discharge, indicating the end of the postpartum bleeding process.
Choice C rationale
Retained placenta can cause prolonged bleeding and infection, but it is usually associated with heavy bleeding and not a yellow-white discharge. The presence of lochia alba suggests normal postpartum progression.
Choice D rationale
Bacterial infections often present with a foul-smelling discharge, pain, and fever. The yellow-white discharge described is more indicative of lochia alba, a normal postpartum occurrence.
Correct Answer is C
Explanation
Choice A rationale
A cervical or perineal laceration would typically result in continuous bleeding rather than a gush that stops. The uterus would also not be firm and midline if there were a significant laceration.
Choice B rationale
Abnormally excessive lochia rubra flow would be continuous and not stop after a gush. The uterus being firm and midline indicates that the bleeding is not excessive.
Choice C rationale
A normal postural discharge of lochia occurs when pooled blood in the vagina is expelled upon standing or changing position. This is common and expected in the postpartum period.
Choice D rationale
A vaginal hematoma would present with localized pain and swelling, and the bleeding would not stop suddenly. The uterus being firm and midline also indicates that a hematoma is unlikely.