Maternity Nursing Q 160
Following a precipitous delivery, examination of the client’s vagina reveals a fourth-degree laceration. Which of the following would be contraindicated when caring for this client?
A. Applying cold to limit edema during the first 12 to 24 hours.
B. Instructing the client to use two or more peri pads to cushion the area.
C. Instructing the client on the use of sitz baths if ordered.
D. Instructing the client about the importance of perineal (Kegel) exercises.
Correct Answer: B. Instructing the client to use two or more peri pads to cushion the area
Using two or more peripads would do little to reduce the pain or promote perineal healing. A fourth-degree perineal laceration is the injury to the perineum involving the anal sphincter complex and anorectal mucosa.
Option A: Ice packs can help reduce pain and swelling in the perineum. Use ice cubes in a clean, disposable glove. Wrapped in a damp cloth or place the ice pack inside a pad. Never apply directly on skin. Apply for 10-20 minutes. Repeat every 2-3 hours until pain and swelling decrease.
Option C: Hot sitz bath may help speed up the healing process. Use sitz baths a few times a day, 24 hours after giving birth. Sit in water that covers the vulvar area.
Option D: The muscles lie deep in the pelvis and support the pelvic organs and control the bladder and bowel function. The pelvic floor muscles attach to the pubic bone at the front, tail bone at the back, and from one sitting bone to the other sitting bone. It is important to retrain the muscles after a tear, to prevent problems such as incontinence.