A nurse is caring for a client who is 5 hours postpartum following a successful vaginal birth of twins. The nurse should recognize that this client is at increased risk for which of the following postpartum complications?
Mastitis.
Uterine infection.
Uterine atony.
Retained placental fragments.
The Correct Answer is C
Choice A rationale
Mastitis is an infection of the breast tissue that results in breast pain, swelling, warmth, and redness. It is more common in breastfeeding women and typically occurs when bacteria enter the breast tissue through a cracked or sore nipple. While it is a postpartum complication, it is not specifically associated with the delivery of twins.
Choice B rationale
Uterine infection, also known as endometritis, is an infection of the uterine lining. It can occur after childbirth, especially if there were complications such as prolonged labor, multiple vaginal exams, or manual removal of the placenta. However, it is not specifically associated with the delivery of twins.
Choice C rationale
Uterine atony is the most common cause of postpartum hemorrhage. It occurs when the uterus fails to contract effectively after childbirth, leading to excessive bleeding. The risk of uterine atony is higher in cases of overdistension of the uterus, such as with multiple gestations (twins), polyhydramnios, or a large baby. Therefore, a client who has delivered twins is at increased risk for uterine atony.
Choice D rationale
Retained placental fragments occur when parts of the placenta remain in the uterus after childbirth. This can lead to postpartum hemorrhage and infection. While it is a potential complication, it is not specifically associated with the delivery of twins.
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Correct Answer is A
Explanation
Choice A rationale
Ensuring the newborn has a successful latch is crucial for preventing and treating sore and cracked nipples. A poor latch can cause nipple trauma and pain.
Choice B rationale
Increasing the length of time between feedings is not recommended as it can lead to engorgement and further complications. Frequent breastfeeding helps maintain milk supply and prevents issues like mastitis.
Choice C rationale
Applying mineral oil to the nipples is not recommended. Instead, using expressed breast milk or medical-grade lanolin can promote healing.
Choice D rationale
Keeping the nipples covered between breastfeeding sessions is not necessary and can sometimes exacerbate the problem. Allowing the nipples to air dry or using hydrogel pads can be more beneficial.
Correct Answer is ["A","D","E"]
Explanation
Choice A rationale
Washing hands before and after perineal care or voiding is essential to prevent infection. Proper hand hygiene reduces the risk of introducing bacteria to the perineal area, which is particularly vulnerable to infection postpartum.
Choice B rationale
Leaving the current pad on until it is fully saturated is not recommended. Changing pads frequently helps to maintain cleanliness and reduce the risk of infection. A saturated pad can harbor bacteria and increase the risk of infection.
Choice C rationale
Wiping the perineum thoroughly with a back-and-forth motion is not recommended. Instead, the perineum should be wiped from front to back to prevent the spread of bacteria from the rectal area to the perineal area, reducing the risk of infection.
Choice D rationale
Using a perineal squeeze bottle to cleanse the perineum is recommended. It helps to gently clean the area without causing irritation or discomfort. The warm water can also provide soothing relief to the perineal area.
Choice E rationale
Applying ice or cold packs to the perineum can help to reduce swelling and provide pain relief. The cold temperature constricts blood vessels, reducing inflammation and numbing the area to alleviate discomfort.