Question

1. Lynn delivers a baby girl, 7 lb. 12 oz. vaginally at 6 pm. After one hour your assessment findings reveal: pulse 98, resp. 24, B/P 95/60, temp 99.5, fundus is palpated at U-2, firm & midline; lochia is rubra, heavy and bright red. Perineum is intact without swelling, discoloration or drainage. IV of LR with 20 Units of Pitocin is infusing in the right arm @ 125 mL/hr. She has been assisted to the bathroom to void and is back in bed breastfeeding the baby. She complains of menstrual-like cramps. Describe the problems she is most likely experiencing and the nursing actions you will take. Discuss the rationale for each action.

Answer 1

After pains or intermittent uterine contractions,are normal occurance during postpartum period .

LOCHIA is shedding of endometrium after delivery [, for the first three days after delivery lochia is dark red in colour ,a few small blood clots ,no larger than a plum are normal ]

Symptoms of postpartum hemorrhage

1 UNCONTROLLED BLEEDING [bleeding more than 500 ml in normal vaginal delivery ]

2 DECREASED BLOOD PRESSURE

3 INCREASED HEART RATE

4 DECREASE IN RED BLOOD CELL COUNT

5 SWELLING AND PAIN IN THE VAGINAL AREA

6 TENSE AND RIGID UTERUS

NURSING ASSESSMENT

assess the amount of bleeding

assess maternal vital signs [in normal condition vitals should be higher than 100/60 blood pressure and pulse 60-100]

assess for signs of shock

assess the conditions of uterus

NURSING INTERVENTION AND RATIONAL

save all pads used during bleeding and weight them to determine the amount of blood loss

place the women in sidelying position to make sure that no blood is pooling underneath her

assess lochia frequently to determine if the amount discharged is stll within the normal limits

assess vital signs especially blood pressure