Clara Guidry Scenario 4
Further assessment: no cervical or vaginal lacerations; coagulation studies are WNL, BP 84/56, P 114, R 24, SAO2 94%, fundus firms with massage but otherwise boggy, excessive bright red vaginal bleeding with large clots. Patient complains of feeling more light-headed and is paler. Other registered nurses are caring for the newborn and providing education and support to the husband. SELECT THE FIRST TWO NURSING ACTIONS IN THE ORDER THAT THEY SHOULD BE IMPLEMENTED:
1Administer Oxygen via nonrebreather face mask at 10-12L/min.Hypovolemia from blood loss and decreased perfusion decreases circulating oxygen levels to brain and other vital organs. Oxygen is a priority.
2Assist healthcare provider with administration of misoprostol (Cytotec) 1000 mcg rectally.Causes a sustained firm contraction of the uterus, clamping off blood vessels at the placental site, decreasing excessive bleeding. This medication may be given quickly via rectum while obtaining other IV line.
3Establish an additional IV line and anticipate additional crystalloids (Lactated Ringer's), colloids (albumin), blood and blood products.Fluid resuscitation and blood administration is critical to restoring blood volume and successful management of woman with postpartum hemorrhage.
4Continue to closely monitor vital signs, uterine fundus tone/level and vaginal bleeding.Indicates physiologic response to fluid and blood resuscitation, uterotonic meds and postpartum balloon with rapid installation components.
5Anticipate healthcare provider insertion of postpartum balloon and/or return to operating room.Balloon exerts inward to outward pressure against the uterine wall, resulting in a reduction in persistent capillary and venous bleeding from the endometrium and myometrium.