Clara Guidry Scenario 3
Following indwelling urinary catheter placement, and upon reassessment, bladder is non-distended, fundus is 1 cm. below the umbilicus, beginning to firm up with massage, but bleeding remains excessive with large clots continuing. Patient remains pale and is anxious. SELECT THE FIRST TWO NURSING ACTIONS IN THE ORDER THAT THEY SHOULD BE IMPLEMENTED:
1Reassess vital signs.Indicates physiologic response to fluid resuscitation and uterotonic meds, BP must be assessed prior methergine administration.
2Set plain Lactated Ringers to Bolus rate on IV pump.Next the nurse must address fluid resuscitation to treat hypovolemia and fluid loss. 3Administer Methergine 0.2 mg IM per healthcare provider order.Methergine causes a sustained firm contraction of the uterus, clamping off blood vessels at the placental site, decreasing excessive bleeding.
4Assist healthcare provider with exam to assess for cervical or vaginal lacerations/hematoma or retained placental pieces.Unrecognized cervical/vaginal lacerations from a rapid second stage labor and large fetus can be the cause of excessive vaginal bleeding, especially with a firm fundus.
5Anticipate laboratory studies: CBC, blood typing and crossmatch, coagulation studies.Laboratory studies reveal degree of hemorrhage, coagulopathies which can cause hemorrhage and aid in patient management.