After completing post anesthesia recovery assessments, the registered nurse (RN) asks the practical nurse (PN) to transfer four clients, each two hours post-birth, to the postpartum unit. Which client should the PN ask the RN to reassess prior to transfer?
A A primigravida whose perineal pain has worsened one hour after being medicated.
B A multigravida whose peri-pad is 1/4 saturated with lochia rubra after one hour.
C A multigravida complaining of strong afterbirth pains when breastfeeding.
D A primigravida who passed a small clot when she sat up on the edge of the bed
The Correct Answer and Explanation is:
Correct Answer: A. A primigravida whose perineal pain has worsened one hour after being medicated.
Explanation:
In this scenario, the practical nurse (PN) is tasked with transferring four postpartum clients to the postpartum unit. While all the clients require routine monitoring, the primigravida (first-time mother) whose perineal pain has worsened one hour after receiving pain medication is the client who needs to be reassessed by the registered nurse (RN) before transfer. Here’s why:
1. Worsening Perineal Pain
- Worsening perineal pain after receiving pain medication is a red flag and may indicate complications such as a hematoma, infection, or excessive swelling at the perineal site. A hematoma is a localized collection of blood, usually from trauma during delivery, that can grow rapidly and cause significant pain.
- A primigravida, being a first-time mother, might not be familiar with normal postpartum pain and could be less able to distinguish between normal discomfort and severe pain caused by a complication. Therefore, it is important that the RN reassess the situation to rule out any serious underlying conditions that might delay or complicate the transfer.
2. Other Clients’ Conditions
- B. A multigravida whose peri-pad is 1/4 saturated with lochia rubra after one hour: This is considered a normal finding in the postpartum period. Lochia rubra, which consists of blood and uterine lining, is expected within the first few hours to days after birth. The amount described here is not excessive and does not indicate a need for immediate reassessment.
- C. A multigravida complaining of strong afterbirth pains when breastfeeding: Afterbirth pains, especially during breastfeeding, are common in multigravida women. Breastfeeding stimulates the release of oxytocin, which helps the uterus contract, causing cramping. This is a normal process and does not require urgent reassessment.
- D. A primigravida who passed a small clot when she sat up on the edge of the bed: Passing small clots in the postpartum period can be normal as long as they are not accompanied by excessive bleeding. The description here suggests that the clot was small and likely does not warrant immediate concern.
3. Safety and Risk Considerations
- The client in Option A represents the highest potential for a serious complication. Untreated hematomas or infections can lead to significant morbidity, and it is essential to address worsening pain that is not controlled by medication. Early identification and intervention by the RN can prevent further complications, ensuring the client’s safe transfer to the postpartum unit.
In conclusion, the PN should prioritize asking the RN to reassess the primigravida with worsening perineal pain before transfer to ensure patient safety and appropriate management.