Question

In: Nursing

Post Partum Case Study Client Profile Roquanda is a 24-year-old G4P300. Her oldest child is 31/2...

Post Partum Case Study


Client Profile

Roquanda is a 24-year-old G4P300. Her oldest child is 31/2 years old. She delivered a 9-pound 12-ounce baby boy following an 18-hour Pitocin-augmented labor with epidural anesthesia this morning. Her second stage was two hours. She was given a medio lateral episiotomy, and the baby’s head was delivered by vacuum extractor after she experienced difficulty pushing. Her estimated blood loss (EBL) was 400 ml right after delivery. Immediately after delivery her VS were BP 110/70, temperature 98, pulse 68, and respirations 20. She plans to bottle-feed.

Case Study

Roquanda delivered two hours ago, and has just been transferred to the postpartum floor with an IV of lactated ringers, which is to be discontinued when it is finished. Upon assessing her, the postpartum nurse notes that Roquanda is trickling blood from the vagina and has soaked a pad about 30 to 40 minutes after she changes it. He vital signs are BP 90/68, pulse 100, and respiration 28. She appears restless.

Questions

1-   Name three common sources of postpartum hemorrhage. Compare and contrast them according to the signs and symptoms, precipitating factors, and treatment for each.

2-   What is the normal expected blood loss for a vaginal delivery?

3-   Was Roquanda’s blood loss normal?

4-   What factors increase the initial blood loss in delivery?

5-   List four history factors that increase Roquanda’s risk for postpartum hemorrhage.

6-   List four labor and delivery factors that increased her risk.

7-   Assess her vital signs. Are these normal for post partum?

8-   If not, what is the significance of them?

9-   List at least six other signs of shock related to hypovolemia.

10   -List at least two consequences of postpartum hemorrhage.


11-Why is Roquanda at an even higher risk for problems related to post partum hemorrhage?

12- When would you expect Roquanda’s hematocrit to be checked? If she had a post partum hemorrhage, how would you expect it to be reflected in the hematocrit?

13- Roquanda’s hematocrit is low, and the certified nurse midwife prescribes iron supplements. The nurse is discharging her on her third postpartum day. What information about taking iron supplements needs to be included in teaching Roquanda?

Solutions

Expert Solution

Ans) 1) The Four T's mnemonic can be used to identify and address the four most common causes of postpartum hemorrhage (uterine atony [Tone]; laceration, hematoma, inversion, rupture [Trauma]; retained tissue or invasive placenta [Tissue]; and coagulopathy [Thrombin]).

- Symptoms:
Loss of lots of blood after childbirth, increased heart rate, feeling faint upon standing, increased breath rate.
Causes:
Poor contraction of the uterus, not all the placenta removed, tear of the uterus, poor blood clotting.
Risk factors:
Anemia, Asian ethnicity, more than one baby, obesity, age older than 40 years.
Prevention:
Oxytocin, misoprostol
Treatment:
Intravenous fluids, non-pneumatic anti-shock garment, blood transfusions, ergotamine, tranexamic acid.
Prognosis: 3% risk of death (developing world)
Frequency: 8.7 million (global)/ 1.2% of births (developing world)
Deaths: 83,100

2) The average amount of blood loss after the birth of a single baby in vaginal delivery is about 500 ml (or about a half of a quart). The average amount of blood loss for a cesarean birth is approximately 1,000 ml (or one quart). Most postpartum hemorrhage occurs right after delivery, but it can occur later as well.

3) Roquanda’s blood loss is normal as her estimated blood loss (EBL) was 400 ml right after delivery & normal average blood loss is 500ml.

4) Conditions that may increase the risk of PPH include:
Placental abruption- This is the early detachment of the placenta from the uterus.
Placenta previa.
Overdistended uterus.
Multiple-baby pregnancy.
High blood pressure disorders of pregnancy.
Having many previous births.
Prolonged labor.
Infection.


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