A nurse is caring for a client who has unrelieved episiotomy pain 8 hours following delivery. Which of the following actions should the nurse take? (Select onE.:
Place a soft pillow under the client's buttocks.
Prepare a warm sitz batH.
Position a heating lamp toward the episiotomy.
Apply an ice pack to the perineum.
The Correct Answer is D
Choice A: Placing a soft pillow under the client's buttocks is not an effective action, as it can increase the pressure and the swelling on the perineal area and worsen the pain. The nurse should avoid placing anything under the client's buttocks and encourage the client to lie on the side or sit on a firm surfacE.
Choice B: Preparing a warm sitz bath is not an appropriate action, as it can increase the blood flow and the inflammation on the perineal area and worsen the pain. The nurse should avoid using heat on the perineum for the first 24 hours after delivery and use cold therapy insteaD.
Choice C: Positioning a heating lamp toward the episiotomy is not an appropriate action, as it can cause burns and infections on the perineal area and worsen the pain. The nurse should avoid using heat on the perineum for the first 24 hours after delivery and use cold therapy insteaD.
Choice D: Applying an ice pack to the perineum is an effective action, as it can reduce the blood flow and the inflammation on the perineal area and relieve the pain. The nurse should apply an ice pack wrapped in a towel or a disposable cold pack to the perineum for 10 to 20 minutes every 2 to 4 hours for the first 24 hours after delivery.
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Related Questions
Correct Answer is B
Explanation
Correct Answer is B
Explanation
Choice A: At least you are young and can have another child is not a therapeutic response, as it minimizes the patient's grief and implies that the baby is replaceablE. The nurse should acknowledge the patient's loss and avoid making assumptions or judgments.
Choice B: I am so sorry for your loss. My heart hurts for you. Can you tell me a little bit about your baby? is a therapeutic response, as it expresses empathy and compassion and invites the patient to share their feelings and memories. The nurse should listen actively and respectfully and use the baby's name if the patient has given onE.
Choice C: There was probably something wrong and God has a way of taking care of these things is not a therapeutic response, as it rationalizes the patient's loss and imposes the nurse's religious beliefs. The nurse should respect the patient's spirituality and avoid making statements that may cause guilt or anger.
Choice D: Don't cry, be strong for your family is not a therapeutic response, as it discourages the patient from expressing their emotions and places unrealistic expectations on them. The nurse should support the patient's coping and encourage them to seek help from their family and friends.
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