Question

In: Nursing

Becky is a 33 year old woman. She is a G4 P3. She had a spontaneous...

Becky is a 33 year old woman. She is a G4 P3. She had a spontaneous vaginal delivery of a 4100 live female 4 hours ago following a precipitous delivery. Post-delivery, she received 10u of Pitocin IM. Her perineum is intact and she is feeling good. She breastfed her infant after delivery for 20 minutes without any issues.

In the postpartum unit her fundus is firm at the umbilicus, her lochia is small to moderate. V.S. are stable. She rings her call bell and states "I feel dizzy and lightheaded". Upon entering the room, Becky is pale and there is a pool of blood on the floor.

  • What are 4 interventions that the nurse should do?
  • What are the risk factors for postpartum hemorrhage?
  • What medical management should be initiated?
  • Develop one nursing diagnosis and 3 nursing interventions for a patient experiencing a postpartum hemorrhage.

Solutions

Expert Solution

4 nursing interventions:

  • check the vital signs of the mother, blood pressure, pulse etc.
  • Place the woman in a side-lying position for checking the blood loss
  • if the blood loss more than 500ml- insert 2 large-bore catheters
  • provide oxygen by mask
  • alert medical
  • staff immediately
  • bimanual uterine massage.
  • prepare for blood transfusion and prevent shock
  • oxytocin administration if needed

risk factors of PPH:

  • placenta previa
  • abruption placenta
  • multiple pregnancies
  • prolonged labor
  • pre-eclampsia
  • infection
  • macrosomia
  • history of PPH

medical management:

  • IV volume replacement, replace the estimated amount of fluid.
  • infuse colloid solution, example- haemacel
  • normal saline as fast as possible
  • give a manual uterine massage or compress
  • infuse Syntocin 30 IU/500 ml normal saline over 2-4hr
  • inject Syntometrine 1 ampule IV or IM
  • chek for vitals, hemorrhage, pulse, etc for every 15minutes

nursing diagnosis:

deficient fluid volume related to excessive blood loss after birth as evidenced by decrease blood pressure/changes in mental status

3 interventions:

  • assess the type and amount of blood loss
  • monitor vital signs
  • measure 24 hour I/O chart
  • maintain NPO status
  • Start 1 or 2 IV infusion(s) of isotonic or electrolyte fluids with an 18-gauge catheter or via a central venous line.
  • administer oxygen
  • administer medications as prescribed.

Nightingale answered 9 months ago
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