Vsim Week #4
Why should the patient's level of consciousness be assessed during management of postpartum hemorrhage?
To evaluate cerebral perfusion
The nurse reviews Ms. Sanogo's chart. Name the factors that place her at higher risk for postpartum hemorrhage?
-Baby weighed 9lb -Second degree laceration -Prolonged second stage of labor -Induction of labor with oxytocin
After Ms. Sanogo's IV infusion of oxytocin (Pitocin) has started, what assessments need to be performed every 15 minutes for the next hour or until her condition has stabilized?
-Check fundus -Monitor bleeding -Take blood pressure and HR -Evaluate Sp02
If Ms. Sanogo develops symptoms of hemorrhagic shock, what would be the priority interventions by the nurse?
-Maintain adequate tissue perfusion -Control blood loss
Which of the following factors places a patient at risk for postpartum hemorrhage?
-Rapid labor -Macrosomia -Maternal Fever -Oxytocin use during labor
Ms. Sanogo has lost a significant amount of blood. The provider wants to be ready for a blood transfusion if needed. What blood samples does the nurse need to draw and send to the lab at this time?
-Type and cross-match -CBC
When performing the postpartum examination, the nurse finds 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
What is consistent with the definition of postpartum hemorrhage?
Blood loss of 500mL after vaginal birth or 1,00mL after cesarean birth
What is consistent with the definition of major obstetric hemorrhage?
Blood loss of more than 2,500mL or blood loss requiring more than 5 units of transfused blood.
A patient is hemorrhaging after giving birth. When inspected, an area of 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 administration
Over a 10-minute period, the nurse observes the following change in Ms. Sanogo's vital signs: HR 90 bpm, BP 100/60 mm Hg, Sp02 96% HR 120 bpm, BP 90/50, SpO2 92% Based on this data, the nurse is concerned that the patient is developing what condition?
Hemorrhagic shock
Which of the following are contraindications to the administration of misoprostol (Cytotec) for treatment of a postpartum hemorrhage?
Hepatitis and Asthma
When the nurse enters the room, Ms. Sanogo is in bed with the head 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 head of the bed and have you lay flat while I do the examination.
The nurse monitoring Ms. Sanogo notices a large amount of vaginal bleeding. What would be the nurse's first action?
Massage the fundus
The nurse is caring for a patient experiencing postpartum hemorrhage. After the nurse catheterizes the patient, the catheter drains 300ml of clear yellow urine. Once the patient's bladder is emptied, what would the nurse do next?
Palpate the fundus
The nurse calls the provider about Ms. Sanogo's bleeding. Which of the following items need to be included in the SBAR?
Pulse tachycardic or weak Blood loss of 800mL Pain scale: 5/10
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. What could be the cause of excessive bleeding?
Retained tissue
A complication of postpartum hemorrhage is hemorrhagic shock. What are the signs of hemorrhagic shock?
Tachychardia, hypotension, and decreased urine output.
What is uterine atony?
The uterus does not firm up after massage
Following the administration of misoprostol (cytotec) for management of postpartum hemorrage, which of the following is the priority nursing assessment?
Uterine Tone
During the first 30-45 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
