Maternity Case 5: Fatime Sanogo (Exam 2)
When performing the postpartum exam, the nurse finds the pt funds above the umbilicus and deviated to the right. What does the nurse know might be the cause of this finding? a) This is a normal finding in some women b) Retained placental tissue c) A full bladder d) Constipation
c) A full bladder c displaces the uterus upward and laterally, and the uterus is unable to contract effectively. The expected position of the uterus is midline. b will interfere w/ contraction of the uterus but will not displace is. d doesn't impact uterine tone or position.
The nurse reviews Ms. Sanogo's chart. Which factors place this pt at a higher risk for a postpartum hemorrhage? a) Induction of labor with oxytocin (Pitocin) b) Positive sickle cell trait c) Baby weighed 9 lb (4082 g) d) Second degree laceration e) Prolonged second stage of labor
a) Induction of labor with oxytocin (Pitocin) c) Baby weighed 9 lb (4082 g) d) Second degree laceration e) Prolonged second stage of labor
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? a) 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. b) Let me check your uterus. You can stay sitting up and I will feel for your uterus to see if it is contracted c) That is a lot of blood. Let me get some gloves and clean you up. d) Let me call the provider to check your bleeding. Do you feel like you need to go to the bathroom?
a) 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 pt at risk for postpartum hemorrhage? (SATA) a) Macrosomia b) Maternal Fever c) Preterm Birth d) Rapid labor e) Oxytocin
a) Macrosomia b) Maternal Fever d) Rapid labor e) Oxytocin d, a and e use during labor all place additional stress on the uterine muscle and may lead to muscle fatigue and failure of the muscle ate effectively contract post-birth. Maternal fever indicating intrauterine infection may also impair the effectiveness of the uterine muscle to contract and control bleeding from the placental site. c is not a risk factor for postpartum hemorrhage.
The nurse monitoring Ms. Sanogo notices a large amount of vaginal bleeding. What would be the nurse's first action? a) Massage the fundus b) Call the provider c) Increase the rate of IV drug infusion d) Take blood pressure and pulse rate
a) Massage the fundus In attempt to stimulate uterine contraction and decrease the bleeding.
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? (SATA) a) Monitor bleeding b) Check fundus c) Take BP and HR d) Measure Temp e) Evaluate SpO2
a) Monitor bleeding b) Check fundus c) Take BP and HR e) Evaluate SpO2
While assessing the pt funds, 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? a) Retained tissue b) Atony c) Hematoma formation d) Laceration
a) Retained tissue The presence of retained placental tissue prevents contraction of the uterine muscle and occlusion of vessels at the placental site. With uterine atony, the uterus doest firm up with massage. With d there is excessive bleeding in the presence of a firm uterus. A c is not related to the tone of the uterus.
A complication of postpartum hemorrhage is hemorrhagic shock. Which of the following signs would alert the nurse to the development of hemorrhagic shock? a) Tachycardia, hypotension, and decreased urine output b) Bradycardia, hypertensions, and low platelets c) Bradycardia, hypotension, and decreasing SpO2 d) Tachycardia, hypertension, and decreasing hct levels
a) Tachycardia, hypotension, and decreased urine output a are signs of pro tissue perfusion and the body attempt to compensate to maintain vital functions. They're consistent with the development of hemorrhagic shock. Bradycardia, decreased hct levels, and low platelets are late signs of the body response to the blood loss and the consequences of hypovolemic shock.
Why should the pt LOC be assessed during management of postpartum hemorrhage? a) To evaluate cerebral perfusion b) To evaluate pt competence to make medical decisions c) To evaluate cognitive abilities d) To evaluate pt understanding of the situation
a) To evaluate cerebral perfusion LOC will provide data about the adequacy of cerebral perfusion. With loss of blood volume, perfusion of vital organs, such as the brain, is at risk. The pt cognitive abilities, understanding of the situation, and competence to make medical decisions are not parameters to assess cerebral perfusion.
The nurse calls the provider about Ms. Sanogo's bleeding. Which of the following items need to be included in the SBAR communication? (SATA) a) speaks limited english b) Blood loss of 800 mL in 25 mins c) Pulse tachycardia and weak d) Pain scale : 5/10 e) Bonding well with infant
b) Blood loss of 800 mL in 25 mins c) Pulse tachycardia and weak d) Pain scale : 5/10
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? a) Electrolyte panel b) CBC c) Glucose levels d) Fibrinogen and platelet counts e) Type and cross-match
b) CBC e) Type and cross-match
Which of the following are contraindications to the admin. of miso-rostov (Cytotec) for a tx of a postpartum hemorrhage? (SATA) a) Gastric ulcers b) Hep C c) EBL >1500 mL (50.7 oz) d) Asthma e) Grand multiparity
b) Hep C d) Asthma Presence of pulmonary or hepatic disease is a contraindication for the use of prostaglandin meds.
If Ms. Sanogo develops sx of hemorrhagic shock, what would be the priority interventions by the nurse? (SATA) a) Transfuse platelets b) Maintain adequate tissue perfusion c) Transfer the pt to the ICU d) Control blood loss e) Admin abx
b) Maintain adequate tissue perfusion d) Control blood loss
Following the admin of miso-rostov (Cytotec) for management of postpartum hemorrhage, which of the following is the priority nursing assessment? a) BP b) Uterine tone c) Urine output d) Pain scale rating
b) Uterine tone Continuous contraction of the uterus is the goal of postpartum hemorrhage interventions, and miso-rostov is used to stimulate uterine contraction. Therefore, assessing uterine tone is the priority assessment to evaluate the effectiveness of this med.
Which of the following is consistent w/ the definition of a major obstetric hemorrhage? a) Blood loss of 2000 mL (67.6 oz) after a cesarean birth b) Blood loss of 500-1000 mL (16.9-33.8 oz) c) Blood loss requiring transfusion if more than 5 units of blood d) Blood loss requiring transfusions of 2 units of blood
c) Blood loss requiring transfusion if more than 5 units of blood Blood loss of more than 2500 mL (84.5 oz) or blood loss requiring more than 5 units of transfused blood. Postpartum hemorrhage is defines as blood loss of 500 mL after vaginal birth or 1000 mL after c-section, but a more objective definition of postpartum hemorrhage would be any amount of bleeding that places the mother in hemodynamic jeopardy.
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? a) DIC b) CHF c) Hypotensive syndrome d) Hemorrhagic shock
c) Hypotensive syndrome
A pt is hemorrhagic after giving birth. When inspected, an area of the placenta was frayed. The provider suspects that placental fragments are retained within the uterus. What si the expected tx for this condition? a) Oxytocin (Pitocin) admin followed by carboprost tromethamine (Hemabate) admin b) Uterine inversion followed by miso-rostov (yYtotec) admin c) Uterine massage followed by methylergonovine maleate (Methergine) admin d) Evacuation of the uterus followed by oxytocin (Pitocin) admin
d) Evacuation of the uterus followed by oxytocin (Pitocin) admin Evacuation of the retained tissue from the uterus is the first step. This is usually done manually by the provider. Then oxytocin is administered to help maintain uterine contraction. a and c will stimulate contraction of the uterus while the placental fragments are still inside. Uterine inversion is a medical complication, not an intervention.
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? a) Inspect the perineum for hematoma formation b) Test the urine for protein, glucose, ketones c) Evaluate VS d) Palpate the funds
d) Palpate the funds
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? a) There is too much bleeding from the site where the placenta was attached in the uterus. We are giving her meds to help the blood clot and thereby decrease the bleeding. b) There is a laceration in the birth canal. We are giving her meds to decrease the bleeding and then the doctor will suture her later. c) The doctors are trying to save her life. They will speak with you later. Please wait int he waiting room for them to come get you. d) The uterus is not contracting properly. We are giving her meds to help the uterus contract and thereby control the bleeding.
d) The uterus is not contracting properly. We are giving her meds to help the uterus contract and thereby control the bleeding.
During the first 30-45 mins of a postpartum hemorrhage, which of the following is the best parameter to estimate the amount of blood loss? a) Increasing HR b) Change in the pt BP c) Lack of urine output d) Visual quantification of the amount of bleeding
d) Visual quantification of the amount of bleeding Due to the increased blood volume of pregnancy, VS & urine output don't reflect bleeding until approximately 1800 mL (60.9 oz) of blood has been lost. Therefore, early estimates of the degree of blood loss are based on observation or on weighing pads to quantify blood loss.