A nurse is assisting a postpartum woman to get up for the first time after an unmedicated vaginal birth. What action by the nurse is best?
A.
Apply a properly fitting gait belt before assisting the woman.
B.
Determine if the woman has normal sensation to her lower extremities.
C.
Instruct the woman to sit on the edge of the bed prior to standing.
D.
Take the patient's blood pressure lying down and then in a standing position.
ANS: C
Orthostatic hypotension can occur in the postpartum woman. The nurse should instruct the woman to change positions slowly and sit on the edge of the bed prior to standing up. A gait belt is not necessary. Checking for lower extremity sensation would be important after spinal or epidural anesthetic. Obtaining orthostatic blood pressures is not necessary unless this is an ongoing problem.
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