Maternity Nursing: Postpartum Q 41
Which of the following findings would be a source of concern if noted during the assessment of a woman who is 12 hours postpartum?
A. Postural hypotension
B. Temperature of 100.4°F
C. Bradycardia — pulse rate of 55 BPM
D. Pain in left calf with dorsiflexion of the left foot
Correct Answer: D. Pain in left calf with dorsiflexion of the left foot.
Pain in the left calf with dorsiflexion of the left foot indicates a positive Homan sign and is suggestive of thrombophlebitis and should be investigated further. The risk of developing blood clots (thrombophlebitis) is increased for about 6 to 8 weeks after delivery . Typically, blood clots occur in the deep veins of the legs or pelvis (a disorder called deep vein thrombosis). Sometimes one of these clots breaks loose and travels through the bloodstream into the lungs, where it lodges in a blood vessel in the lung, blocking blood flow. This blockage is called pulmonary embolism. Blood clots may also develop in the veins just under the skin in the legs. This disorder is called superficial venous thrombosis (superficial thrombophlebitis).
Option A: The postpartum period is the period after delivery of conceptus when maternal physiological and anatomical changes return to the nonpregnant state. The blood pressure could be elevated due to pain or excitement but is generally in the normal range. A significant decrease (> 20% below baseline) in blood pressure could be a sign of postpartum hemorrhage or septic shock. Conversely, high blood pressure could be a sign of pain or pre-eclampsia.
Option B: A temperature of 100.4°F in the first 24 hours is most likely indicative of dehydration which is easily corrected by increasing oral fluid intake. The temperature is slightly elevated up to 37.2C (99F) along with increased shivering, sweating, or diaphoresis in the first 24 hours and normalizes within 12 hours. The temperature rise is attributable to the systemic absorption of metabolites accumulated due to muscle contractions. There could be a transient temperature rise (by 0.5C) on the third or fourth day due to breast engorgement.
Option C: Bradycardia is expected to be related to circulatory changes after birth. There is generalized physical fatigue immediately after delivery. The pulse rate may be elevated a few hours after childbirth due to excitement or pain and usually normalizes on the second day. The postpartum period, also known as puerperium, starts following the expulsion of the placenta until complete physiological recovery of various organ systems. The postpartum period divides into three arbitrary phases, i.e., acute phase – the first 24 hours after delivery of the placenta, early – up to 7 days, and late – up to 6 weeks to 6 months. Each phase has its unique clinical considerations and challenges.