The nurse is caring for a client who had been administered an anesthetic block during
labor. For which risks should the nurse watch in the client? Select all that apply. -
ANSWER>>incomplete emptying of bladder
bladder distention
urinary retention
Many women have difficulty with feeling the sensation to void after giving birth if they
have received an anesthetic block during labor, which inhibits neural functioning of the
bladder. This client will be at risk for incomplete emptying, bladder distention, difficulty
voiding, and urinary retention. Ambulation difficulty and perineal lacerations are due to
episiotomy.
The nurse is used to working on the postpartum floor taking care of women who have
had normal vaginal births. Today, however, the nurse has been assigned to help care
for women who are less than 24 hours post cesarean birth. The nurse realizes that
some areas will not be assessed. What would the nurse leave out of the client
assessments? - ANSWER>>perineum
Usually a woman who experiences cesarean birth does not have an episiotomy,
although rarely this may be the case.
Healthy bonding behaviors are important to note when the nurse is assessing the new
family. What would the nurse consider a warning sign that the mother and infant were
not attaching as they should? - ANSWER>>Mother states she wanted a boy this time,
not another girl.
It is important to differentiate between a new parent who is nervous and anxious about
her new role and one who is rejecting her parenting role. Warning signals of poor
attachment include turning away from the newborn, refusing or neglecting to provide
care, and disengagement from the newborn.
Which maternal reaction is the most concerning? - ANSWER>>She neglects to engage
with or provide care for the baby and shows little interest in it.
A mother not bonding with the infant or showing disinterest is a cause for concern and
requires a referral or notification of the primary health care provider. Some mothers
hesitate to take their newborn and express disappointment in the way the baby looks,
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