Question

Upon examination of a postpartal client's perineum, the nurse notes a large hematoma. The client does not report any pain, and lochia is dark red and moderate in amount. Which factor would most likely contribute to the nurse not discovering the perineal hematoma prior to the examination?

A. Lack of communication from the client.
B. The client's discomfort with the examination.
C. The nurse's failure to ask about pain.
D. Absence of signs and symptoms.

Answer 1

The absence of pain and symptoms led to the delayed detection of the perineal hematoma. Since dark red lochia is expected postpartum, it did not raise initial concern, potentially masking hematoma presence. Prompt recognition and treatment are crucial for postpartum recovery.

Step-by-step explanation:

The most likely factor contributing to the nurse not discovering the perineal hematoma before the examination could be the absence of signs and symptoms. The client not reporting any pain can mask the presence of a hematoma. Additionally, a moderate amount of dark red lochia, which is expected in the immediate postpartum period, might not raise concern initially. The presence of a significant hematoma without pain is unusual, but it is possible if the hematoma is not pressing on nerves or if the mother is experiencing a high level of endorphins post-delivery, which can serve as natural painkillers.

Recognizing a perineal hematoma promptly is critical since it can lead to complications if not addressed. The perineum can experience significant stretching or tearing during vaginal birth, and hematomas can form as a result of blood vessels breaking and bleeding into the surrounding tissue. Timely intervention is key to avoid further complications such as increased pain, infection, or healing issues.