Question

I. Read chapters 18, 19, 20, 21 from your Text Book

II. NCLEX Review questions for chapters 18, 19, 20, 21 from Evolve Resources

III. Case Study : Postpartum Hemorrhage

Janelle is a 40-year-old G6P5. She gave birth to a 9-pound healthy male infant via normal spontaneous vaginal delivery 3 hours ago. She has no medical problems. Her pregnancy history was normal. Her labor course was normal, although her membranes were ruptured for 24 hours before delivery. She had no lacerations at delivery. Her body mass index (BMI) is 36. Her vital signs are T 99.6º F; P 118 bpm; BP 120/70 mm Hg; R 20 breaths/min. She has an intravenous (IV) infusion of lactated Ringer (LR) solution 1000 with 20 units of oxytocin.

What risk factors does Janelle have for postpartum hemorrhage?

The nurse performs an assessment of Janelle with the following additional findings: her uterine fundus is palpable 4 cm above the umbilicus and deviated to the right side; it is not firm; a large amount of vaginal bleeding and clots are noted saturating the obstetric pad. What is the nursing priority in this situation?

What causes other than uterine atony could be contributing to this postpartum hemorrhage?

The physician evaluates Janelle and finds no lacerations and orders carboprost tromethamine 250 mcg IM (intramuscularly). Why is this drug ordered?

What are the common side effects with the use of Hemabate ?

Answer 1

1.Risk factors:(in the given case)

.Multiple pregnancy, that is G6P5

.Obesity, bmi is 36,which is considered as obese.

.Older age

.Birth weight( is negligible factor , still, if birth weight is more than 4.5 kg then that becomes a Risk factor for pph, here the birth weight is 4kg)

2.the nursing priority should be the measures to prevent postpartum hemorrhage, because the assessment shows that there is atony of uterus, the uterus is not well contracted, which is a serious condition that results in pph.

3.other contributing factors

Conditions that may increase the risk for postpartum hemorrhage include the following:

Placental abruption. The early detachment of the placenta from the uterus.

Placenta previa. The placenta covers or is near the cervical opening.

Overdistended uterus. Excessive enlargement of the uterus due to too much amniotic fluid or a large baby, especially with birthweight over 4,000 grams (8.8 pounds).(present in this given case)

Multiple pregnancy. More than one placenta and overdistention of the uterus.(present in this given case)

Gestational hypertension or preeclampsia. High blood pressure of pregnancy.

Having many previous births(present in this given case)

Prolonged labor

Infection

Obesity(present in this given case)

Medications to induce labor

Medications to stop contractions (for preterm labor)

Use of forceps or vacuum-assisted delivery

General anesthesia

Postpartum hemorrhage may also be due to other factors including the following:

Tear in the cervix or vaginal tissues

Tear in a uterine blood vessel

Bleeding into a concealed tissue area or space in the pelvis which develops into a hematoma, usually in the vulva or vaginal area

Blood clotting disorders, such as disseminated intravascular coagulation

Placenta accreta. The placenta is abnormally attached to the inside of the uterus (a condition that occurs in one in 2,500 births and is more common if the placenta is attached over a prior cesarean scar).

Placenta increta. The placental tissues invade the muscle of the uterus.

Placenta percreta. The placental tissues go all the way into the uterine muscle and may break through (rupture).

4.carboprost tromethamine is an effective drug used to stop excessive bleeding after delivery/to stop pph.

5. side effects of hemabate are:

Nausea

Vomiting

Diarrhea

Fever

Flushing

It also may cause:

Endometritis

Retained placental fragments

Excessive uterine bleeding

Hypersensitivity