Question

History/ Information Past medical history: Patient is apparently healthy woman who has been married for two years. She denies surgery or previous health problems except for occasional episodes of asthma that resolve with albuterol inhaler as needed. Her last inhaler use was 2 weeks ago. She denies smoking, recreational drug use or alcohol use. No known drug allergies. Familiar history: Mother: hypertension at age 40; hysterectomy at age 42 and diabetes at age 45 Father: myocardial infarction at age 58 Labor and Delivery This patient is a 35-year-old female gravida 1, para 0. She is 37 weeks and pregnant with twins. Her blood type is A negative. She has a history of occasional episodes of asthma and has used the inhaler three times this pregnancy. The patient was diagnosed with preeclampsia at 30 weeks gestation and is scheduled for an augmentation of labor. The patient had blood pressure reading reaching 150/95 and a trace urine protein noted. A urinary catheter was inserted following the epidural anesthesia and removed prior to the second stage of labor. The patient delivered twins (Twin A-boy and Twin B- girl) vaginally after 16 hours of labor, both cephalic presentations. Twin A weighed 7 pounds 3 ounces and Twin B weighed 7 pounds 6 ounces. She had an episiotomy with a third degree extension that was repaired. No other lacerations were indicated on the delivery record. Estimated blood loss was 700ml. There was unusual bleeding or blood clots noted upon fundal massage. Postpartum Assessment After 2 hours the patient was transferred to the postpartum unit with husband and twins at bedside. The patient is oriented to the room and a new perineal pad is applied to the patient during the initial assessment. After one hour the patient press the call light and states she feels blood dripping down her leg. Upon assessment you note a boggy uterus deviated to the right side, her pad is saturated, and there is a constant flow of blood. You perform a fundal massage and the uterus is firm after 2 minutes. You apply a new pad and inform the patient that you will return in 15 minutes. After 15 minutes you return to the patient room to assess her bleeding. The pad is saturated again, fundus is boggy, abdomen is distended and you notice blood clots. The palms of her hands are sweaty , she’s complaining of abdomen pain and feeling dehydrated. The patient and the husband are concern about her condition.

Questions:

1. What is your plan of action of this patient?

2. How would you explain this situation to the patient and her husband?

3. Would you consider calling the physician and why?

4. Would orders do you anticipate the physician to order and why?

5. What would be the primary nursing diagnosis?

Answer 1

1.start i.v line of normal saline fastly and give in 15 mi utes to prevent dehydration and shock as she has severe bleeding.add oxytocin 20IU into normal saline according to doctors order.

2.I would tell them that she experiences post partum haemorrhoge .it can occur due to several reasons.so,she may need to shift to the ICU to get emergency care.This situation can be controlled by medicines.Tell the bystander to arrange blood donor to handle emergency.give psychological support to the patient .Inform the family that if the condition verses,her uterus will be removed to save the life of patient.

3.Patient has severe stomach pain and she is going to shock due to excessive bleeding .so,it is ne essary to call the doctor to manage the patient.

4. I would suggest to start misprost 1000mcg trough rectum,carboprost 0.25mg and methergin 0.2 mg should be given I/M to control bleeding immediately as it can contract the uterus.

5.Priority nursing diagnosis will be deficent fuid volume related to excessive bleeding after delivery

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