Labor
Mrs. R. was still in labor when I returned at 7p the following night. She had dilated to 10 and was ready to push.
She had a normal vaginal delivery with a second degree tear of the perineum. The NICU team was called to be on hand at delivery to assess the baby.
After the OB stitched up the tear, it became evident that the patient was having abnormal vaginal bleeding.
Management of Post Partum Hemorrhage:
Patient was still bleeding with no additional lacerations identified. She was immediately transferred to the OR where better lighting and instruments can be utilized. Once the patient arrived in the OR, was transferred to the stretcher and put into the stirrups, she was barely arousable. Her BP was around 60/40. However, no further bleeding was noted at this time. The OB massaged her fundus and visualized her cervix and found no other signs of bleeding. Estimated Blood Loss was 2,000 mL. Normal EBL for a vaginal delivery is 500 mL or less. The nurse called the lab to have 2 units of blood on standby and drew blood to assess her Hemoglobin and hematocrit levels. They were very similar to her admission levels, so the blood was held in reserve.
Nursing Diagnosis related to PPH:
Risk for deficient fluid volume related to excessive blood loss following delivery
Risk for impaired attachment related to congenital birth defect and the baby going to the NICU
Risk for unstable blood glucose level related to pregnancy.
Risk for constipation related to inactivity following delivery
Risk for falls related to instability following massive blood loss.
Mrs. R spent an extra 4 hours in Labor and Delivery for recovery, and her condition improved. She was transferred to mother/baby at 0100.
Mrs. R. was still in labor when I returned at 7p the following night. She had dilated to 10 and was ready to push.
She had a normal vaginal delivery with a second degree tear of the perineum. The NICU team was called to be on hand at delivery to assess the baby.
After the OB stitched up the tear, it became evident that the patient was having abnormal vaginal bleeding.
Management of Post Partum Hemorrhage:
- Pitocin infusion is hung as as soon as the placenta is delivered (for all patients)
- Cytotec 800 mcg is inserted per rectum
- Methergine injection is given IM
Patient was still bleeding with no additional lacerations identified. She was immediately transferred to the OR where better lighting and instruments can be utilized. Once the patient arrived in the OR, was transferred to the stretcher and put into the stirrups, she was barely arousable. Her BP was around 60/40. However, no further bleeding was noted at this time. The OB massaged her fundus and visualized her cervix and found no other signs of bleeding. Estimated Blood Loss was 2,000 mL. Normal EBL for a vaginal delivery is 500 mL or less. The nurse called the lab to have 2 units of blood on standby and drew blood to assess her Hemoglobin and hematocrit levels. They were very similar to her admission levels, so the blood was held in reserve.
Nursing Diagnosis related to PPH:
Risk for deficient fluid volume related to excessive blood loss following delivery
Risk for impaired attachment related to congenital birth defect and the baby going to the NICU
Risk for unstable blood glucose level related to pregnancy.
Risk for constipation related to inactivity following delivery
Risk for falls related to instability following massive blood loss.
Mrs. R spent an extra 4 hours in Labor and Delivery for recovery, and her condition improved. She was transferred to mother/baby at 0100.