A nurse is giving discharge instructions to a new mother. What is the most important instruction to address the prevention of postpartum infection?

Wash your hands before and after you use the bathroom and change your sanitary pad

Do not take tub baths for eight weeks

Use tampons instead of pads as they are better at inhibiting bacterial growth

Douche with a mild antiseptic twice a day for two weeks, starting at day three

Answer and Explanation

The Correct Answer is A

A) Wash your hands before and after you use the bathroom and change your sanitary pad:
The most important instruction for preventing postpartum infection is proper hand hygiene. The risk of infection in the postpartum period is high, especially because the perineum and cervix are healing after delivery. By washing hands before and after using the bathroom or changing sanitary pads, the mother reduces the risk of introducing harmful bacteria into the vaginal area. Proper hand hygiene helps minimize the risk of urinary tract infections (UTIs), wound infections, and endometritis, which are all common postpartum complications.

B) Do not take tub baths for eight weeks:
While it is true that taking tub baths can potentially introduce bacteria into the vaginal area, particularly if the perineum is healing from a tear or episiotomy, this is a secondary concern. The priority is hand hygiene, which directly prevents infection by limiting bacterial exposure. The recommendation to avoid tub baths is generally valid for the first 6 weeks, but it is less critical than hand washing.

C) Use tampons instead of pads as they are better at inhibiting bacterial growth:
Using tampons is not recommended in the postpartum period because they can increase the risk of toxic shock syndrome and can irritate the vaginal area or interfere with uterine healing. Pads are preferred to absorb lochia (postpartum discharge) and are safer for vaginal healing. Tampons do not inhibit bacterial growth more effectively than pads, and the use of tampons can actually increase the risk of infection, so this option is incorrect.

D) Douche with a mild antiseptic twice a day for two weeks, starting at day three:
Douching is not recommended during the postpartum period. It can disrupt the natural vaginal flora, increase the risk of infections like vaginitis, and delay the healing process. The vagina has its own natural defense mechanisms, and douching with antiseptics is unnecessary and can do more harm than good. Instead, the focus should be on keeping the area clean and dry and practicing proper hand hygiene.

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Correct Answer is A

Explanation

A. The woman has a laceration:
The orders for perineal ice packs, sitz baths, and a stool softener suggest that the woman may have sustained perineal trauma, such as a laceration, during childbirth. Ice packs are used initially to reduce swelling and discomfort, while a sitz bath helps with healing and soothing of the perineal area. Stool softeners are prescribed to prevent straining during bowel movements, which could worsen the discomfort of a laceration. These interventions are commonly recommended for women who experience perineal lacerations during vaginal delivery.

B. The woman had her fourth baby:
While the fact that this is the woman’s fourth pregnancy may influence her overall recovery, it is not directly correlated with the orders for ice packs, sitz baths, and stool softeners. Women who have had multiple children may be at a higher risk for perineal trauma due to the stretching of tissues, but this specific care plan is more likely related to a perineal injury, not the number of previous births.

C. The woman received epidural anesthesia:
Epidural anesthesia may be used to manage pain during labor, but it does not directly necessitate the use of ice packs, sitz baths, or stool softeners. While epidurals can sometimes lead to difficulty with bladder or bowel control, they do not typically cause perineal lacerations or require these specific interventions unless there is another issue, such as a laceration, that needs attention.

D. The woman had a vacuum-assisted birth:
Vacuum-assisted births can cause perineal trauma, including lacerations or hematomas, but the order for perineal care (ice packs, sitz baths, stool softeners) is not exclusively linked to vacuum assistance. The woman may have had a laceration during a vacuum-assisted delivery, but it is the laceration itself, rather than the use of the vacuum, that most directly correlates with these interventions. Therefore, the priority care focus is still on addressing the potential for perineal laceration.

A. Assess the woman's fundus and massage it if boggy B. Assess the woman's pulse and BP for signs of hypovolemic shock C. Call the woman's primary healthcare provider D. Begin an IV infusion of Ringer's lactate solution and administer oxytocin

Correct Answer is A

Explanation

A) Assess the woman's fundus and massage it if boggy:
A saturated pad within 15 minutes after delivery suggests a hemorrhage, and the first priority in this situation is to assess the fundus. If the fundus is boggy (soft and not contracted), it is a sign of uterine atony, which is the most common cause of postpartum hemorrhage. Massaging the fundus helps stimulate uterine contraction, which can help stop the bleeding.

B) Assess the woman's pulse and BP for signs of hypovolemic shock:
While it is important to monitor vital signs for signs of hypovolemic shock (e.g., increased heart rate, decreased blood pressure, and pale skin), this action would not be the first priority in managing a postpartum hemorrhage. The immediate focus should be on stopping the bleeding by addressing uterine atony. Hypovolemic shock assessment is important, but it comes after the initial steps of managing hemorrhage.

C) Call the woman's primary healthcare provider:
Calling the provider may be necessary if the bleeding does not stop after initial interventions. However, it should not be the first action. The nurse should first assess the uterus and attempt to stop the bleeding by massaging the fundus before calling the provider.

D) Begin an IV infusion of Ringer's lactate solution and administer oxytocin:
Starting an IV infusion and administering oxytocin may be part of the treatment for postpartum hemorrhage, but the first action should be to assess and manage the fundus. Oxytocin can help contract the uterus, but massaging the fundus is the immediate intervention. Intravenous fluids and medications should be initiated once the uterus is assessed and massaged, especially if bleeding persists.

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A nurse is giving discharge instructions to a new mother. What is the most important instruction to address the prevention of postpartum infection?

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Naxlex Comprehensive Predictor Exams

A woman gave birth vaginally to a 9-lb, 12-ounce girl yesterday. Her primary health care provider has written orders for perineal ice packs, use of sitz bath TID, and a stool softener. What information is most closely correlated with these orders?

Correct Answer is A

Explanation

While assessing a patient who gave birth 5 hours ago, the nurse finds that the woman has completely saturated: pad within 15 minutes. What is the nurse's first action?

Correct Answer is A

Explanation

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