Fatime Sanogo vSim

When performing the postpartum examination, the nurse find the patient's fundus above the umbilicus and deviated to the right. What does the nurse know might be the cause of this finding?

A full bladder

A complication of postpartum hemorrhage is hemorrhagic shock. Which of the following signs would alert the nurse to the development of hemorrhagic shock?

Tachycardia, hypotension, and decreased urine output.

Ms. Sanogo's husband asks, "Whats happening? What are you doing to help Fatime?" Which of the following is the best response by the nurse?

The uterus is not contracting properly. We are giving her meds to help the uterus contract and thereby control the bleeding.

The nurse is caring for a pt experiencing postpartum hemorrhage. After the nurse catheterizes the pt, the catheter drain 300 mL (10.1 oz) of clear yellow urine. Once the pt bladder is empty, what would the nurse do next?

Palpate the funds

A patient is hemorrhaging after giving birth. When inspected, an area of the placenta was frayed. The provider suspects that placental fragments are retained within the uterus. What is the expected treatment for this condition?

Evacuation of the uterus followed by oxytocin (Pitocin) administration

The nurse calls the provider about Ms. Sanogo's bleeding. Which of the following items need to be included in the SBAR communication?

Blood loss of 800 mL in 25 mins Pulse tachycardia and weak Pain scale : 5/10

Which of the following is consistent with the definition of a major obstetric hemorrhage?

Blood loss requiring transfusion of more than 5 units of blood.

Ms. Sanogo has lost a significant amount of blood. The provider wants to be ready for a blood transfusion if needed. Which of the following blood samples does the nurse need to draw and send to the lab at this time?

CBC Type and cross-match

Over a 10-min period, the nurse observes the following changes in Ms. Sanogo's VS: HR90 BP 100/60 SpO2 96% -> HR120 BP 90/50 SpO2 92%. Based on this data, the nurse is concerned that the pt is developing which condition?

Hemorrhagic shock

Which of the following contraindications to the administration of misoprostol (Cytotec) for treatment of a postpartum hemorrhage? (Select all that apply)

Hepatitis C Asthma Pulmonary or hepatic disease is a contraindication for the use of prostaglandin medications.

The nurse reviews Ms. Sanogo's chart. Which factors place this pt at a higher risk for a postpartum hemorrhage?

Induction of labor with oxytocin (Pitocin) Baby weighed 9 lb (4082 g) Second degree laceration Prolonged second stage of labor

vSim

Introduce Yourself Wash Hands ID patient NIBP, Temp, Pulse Ox, Breath assessment Check Pupils Assess IV Administer 2mg butorphanol tartrate IV Check for blood, lochia and fluid on the bed Change/weigh the bed pads Assist patient into trendelenburg position Assess bladder status Assess perineum Palpate the fundus Educate the patient Fundal massage Call Provider Verify Dose and Administer 500ml/h oxytocin IV Administer 500ml LR over 30min. Assess IV site Give patient non-rebreather mask 10L Perform a straight cath Assess breathing again Call Provider Take CBC + Type and Screen blood sample Administer 800mcg misoprostol rectally Administer 5mg morphine IV Check pupils Phone provider End Scenario>Return to nurses station

When the nurse enters the room, Ms. Sanogo is in bed with the HOB elevated about 45 degrees. Ms. Sanogo says to the nurse, "Lot of blood.... is this OK?" What is the most appropriate response by the nurse?

Let me check your uterus and see what is happening. First I need to lower the HOB and have you lay flat while I do the exam

Which of the following factors places a patient at risk for post partum hemorrhage?(Select all that apply)

Macrosomia Rapid Labor Maternal fever Oxytocin use during labor

If Ms. Sanogo develops sx of hemorrhagic shock, what would be the priority interventions by the nurse?

Maintain adequate tissue perfusion Control blood loss

The nurse monitoring Ms. Sanogo notices a large amount of vaginal bleeding. What would be the nurse's first action?

Massage the fundus

After Ms. Sanogo's IV infusion of oxytocin has been started, what assessments need to be performed every 15 minutes for the next house or until her condition has stabilized?

Monitor bleeding Check fundus Take BP and HR Evaluate SpO2

While assessing the patient's fundus, the nurse notes that with massage the uterus becomes firm, but then it relaxes again and the bleeding increases. Which of the following causes of excessive bleeding does the nurse suspect?

Retained tissue.

Why should the patient's level of consciousness be assessed during management of postpartum hemorrhage?

To evaluate cerebral perfusion.

Following the administration of misoprostol (Cytotec) for management of postpartum hemorrhage, which of the following is the priority nursing assessment?

Uterine tone

During the first 30 to 45 minutes of a postpartum hemorrhage, which of the following is the best parameter to estimate the amount of blood loss?

Visual quantification of the amount of bleeding.