Which documentation on a woman's chart after postpartum day 14 indicates a normal involution process?

Fundus below the symphysis and not palpable

Moderate, bright red lochia.

Breasts warm, firm and tender

Laceration slightly red and puffy

Answer and Explanation

The Correct Answer is A

A) Fundus below the symphysis and not palpable:
The process of involution refers to the shrinking and returning of the uterus to its normal size and position after delivery. By postpartum day 14, the uterus should be largely involuted, with the fundus no longer palpable above the pubic symphysis. This is a normal finding, as the uterus typically shrinks to its pre-pregnancy size over this period. The fundus should be at or below the symphysis pubis and should not be palpable after about two weeks postpartum, indicating that the involution process is proceeding as expected.

B) Moderate, bright red lochia:
While bright red lochia (also known as lochia rubra) is common during the first few days postpartum, by postpartum day 14, lochia should have transitioned to a serosa (pinkish or brownish) or alba (white or yellowish) appearance. Bright red lochia on day 14 would suggest a possible issue, such as retained placental fragments or uterine atony, and would require further evaluation.

C) Breasts warm, firm and tender:
Breast tenderness and firmness can be normal in the early postpartum period, especially as milk comes in. However, by postpartum day 14, if the breasts remain tender and warm, this could indicate mastitis or engorgement that hasn't been resolved. While some tenderness may still occur, it should have decreased by this point. If tenderness persists, further assessment would be needed.

D) Laceration slightly red and puffy:
Postpartum lacerations or episiotomy sites should begin to heal within the first few days, but slight redness and swelling might still be present at two weeks. However, puffiness or continued redness after 14 days may indicate poor healing, infection, or other complications, which requires further evaluation and intervention. Normal healing should show a decrease in redness and swelling by this time.

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Correct Answer is A

Explanation

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.

A. A rubella injection is advised B. A blood transfusion is advised C. The nurse should contact the provider for an antibiotic order an D. RhoGAM injection should be administered within 72 hours

Correct Answer is A

Explanation

A) A rubella injection is advised:
Since the rubella titer is non-immune, the woman is not protected against rubella, which is important to address during the postpartum period. The rubella vaccine is typically given to women who are non-immune to rubella after childbirth, but it is contraindicated during pregnancy because it is a live vaccine. The best action in this case would be to administer the rubella vaccine to the postpartum woman before discharge, with instructions to avoid becoming pregnant for at least 28 days after vaccination to prevent harm to a future fetus.

B) A blood transfusion is advised:
The hematocrit of 30% indicates that the woman has mild anemia, but it does not require immediate intervention like a blood transfusion. Normal hematocrit levels for postpartum women typically range between 32% and 42%. A transfusion would be indicated if the hematocrit were much lower (usually below 20-25%) or if there were symptoms of significant blood loss, which are not indicated in this case.

C) The nurse should contact the provider for an antibiotic order:
There is no indication from the provided laboratory results or the scenario that the woman requires antibiotics. Group B Streptococcus (GBS) was negative, which eliminates the need for prophylactic antibiotics. There is no mention of any infection risk requiring an antibiotic prescription, and since her GBS result is negative, antibiotics are not warranted.

D) RhoGAM injection should be administered within 72 hours:
RhoGAM (Rh immunoglobulin) is typically administered to a woman with Rh-negative blood who has given birth to an Rh-positive baby to prevent Rh sensitization in future pregnancies. In this case, the woman has an Rh-positive blood type (A+), so she does not need RhoGAM. RhoGAM would only be necessary if the woman had an Rh-negative blood type, which she does not.

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Which documentation on a woman's chart after postpartum day 14 indicates a normal involution process?

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Explanation

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Correct Answer is A

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