A nurse is caring for a 25-year-old postpartum female client who had a spontaneous vaginal birth at 39 weeks of gestation in the postpartum unit.
Medical History: The client is a Gravida 1, Para 1. She is currently breastfeeding.
Vital Signs:
- Blood Pressure: 120/80 mmHg
- Pulse: 80 bpm
- Respirations: 16/min
- Temperature: 36.8°C (98.2°F)
- Pulse Ox: 99%
Nurses Notes: The client reports feeling well overall. She is breastfeeding her newborn and has expressed concerns about her baby’s weight loss. The client’s breasts are full, warm, and slightly tender, indicating that her milk is coming in. She has been educated on breastfeeding and the expected changes in her baby's stool color. The client appears attentive and responsive to her baby’s needs. She is utilizing correct breastfeeding techniques and has been encouraged to continue feeding 8 to 12 times per day and on demand. The client has also been advised on the importance of monitoring her newborn's weight and intake.
Newborn Daily Weights:
- Birth weight: 3,515 gm (7 lb 12 oz)
- Weight after 24 hr: 3,410 gm (7 lb 8 oz) (3% weight loss)
- Weight after 48 hr: 3,345 gm (7 lb 4 oz) (5% weight loss)
Querry: Which of the following statements by the client indicates an understanding of the discharge teaching? Click to highlight the client statements that indicate an understanding of the discharge teaching.
"Because of my baby's weight loss, I need to supplement with formula after breastfeeding."
"I should make sure that my baby feeds 8 to 12 times per day, and on demand."
"I should cover my sore nipples with plastic-lined breast pads after every feeding."
"I can increase my milk supply by drinking more whole milk."
My baby's stools should turn from the dark greenish color meconium to a yellow color within the next day or two.
I should expect my breasts to feel full, warm, and slightly tender when my milk comes in
Correct Answer : B,E,F
Choice A rationale:
The statement suggests supplementing with formula due to the baby’s weight loss. However, a 5% weight loss in the first few days is normal for breastfed infants, and formula
supplementation is not necessary unless recommended by a healthcare provider. Early breastfeeding should be encouraged to increase milk supply and support newborn weight gain.
Choice B rationale:
This statement correctly indicates that newborns should feed 8 to 12 times per day and on demand to ensure adequate nutrition and promote milk production. Frequent breastfeeding
helps establish and maintain milk supply.
Choice C rationale:
Using plastic-lined breast pads can retain moisture and increase the risk of infection or irritation. Sore nipples can be managed with lanolin creams, air-drying, and proper latching
techniques during breastfeeding.
Choice D rationale:
Drinking more whole milk is a common misconception and does not directly increase a mother's milk supply. Milk production is influenced by frequent breastfeeding, proper hydration,
and balanced nutrition, not by specific types of foods or drinks.
Choice E rationale:
Newborn stools transition from dark greenish meconium to yellow, seedy stools within the first few days of life as breastfeeding becomes established. This indicates effective feeding
and milk intake.
Choice F rationale:
It is normal for a breastfeeding mother’s breasts to feel full, warm, and slightly tender as her milk comes in. This indicates that the milk supply is increasing and the body is responding
to the newborn’s feeding needs.
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Correct Answer is C
Explanation
Choice A rationale
Placenta formation begins shortly after implantation, but it continues to develop throughout the first trimester and into the early second trimester, making it less precise to attribute the
first 8 weeks solely to this process.
Choice B rationale
Fertilization occurs within the first week after ovulation, marking the beginning of pregnancy, but it is a singular event that happens prior to the developmental processes vulnerable to teratogens.
Choice C rationale
Organogenesis is the critical period during which the major organs and structures of the fetus form, typically occurring between the third and eighth weeks of gestation. This is the
time when the fetus is most susceptible to the effects of teratogens, which can cause congenital anomalies.
Choice D rationale
Implantation occurs approximately 6-10 days after fertilization, embedding the blastocyst into the uterine lining. While crucial, it is not the primary period when teratogenic effects are
most significant, as this happens during organogenesis.
Correct Answer is ["A","B","C","F"]
Explanation
Choice A rationale:
A postpartum temperature of 100.4°F (38.0°C) or higher may indicate an infection. Infections can occur after delivery, particularly if there was a manual extraction of the placenta, as in
this case. Close monitoring and further assessment are necessary to ensure the client does not develop sepsis or other complications.
Choice B rationale:
Fundal tone should be firm and well-contracted to prevent excessive bleeding postpartum. A boggy, midline fundus suggests that the uterus is not contracting effectively, increasing the
risk for postpartum hemorrhage. This requires immediate attention and intervention to ensure adequate uterine tone and control bleeding.
Choice C rationale:
Lochia should be monitored for quantity, color, and the presence of clots. Heavy lochia with small clots indicates that the client may be experiencing postpartum hemorrhage, which is a
significant concern. This can be related to uterine atony, retained placental fragments, or coagulopathies and warrants prompt evaluation and intervention.
Choice D rationale:
A respiratory rate of 17/min is within the normal adult range (12-20/min) and does not require follow-up. There are no signs of respiratory distress or abnormalities in this case, indicating
that the client's respiratory status is stable and does not necessitate further evaluation.
Choice E rationale:
A white blood cell count of 12,000/mm³ is within the expected range for postpartum women, where normal values can be elevated due to physiological stress and inflammation from
delivery. This level does not indicate infection or pathology and does not require follow-up in the context provided.
Choice F rationale:
Blood pressure of 144/92 mmHg is elevated and concerning, particularly in a postpartum client with a history of chronic hypertension and gestational diabetes. This could signal
postpartum preeclampsia or other hypertensive disorders, requiring careful monitoring and management to prevent complications like seizures, stroke, or organ damage.