Ob Rotation 4

LYCEUM NORTHWESTERN UNIVERSITY
College of Nursing
Dagupan City
OB WARD
RLE for Care of Clients with Postpartum Hemorrhage
Susan Brown, 28-yrs.old, G2P2, no known allergies, O+, GBS (-), rubella immune. She arrived
on the unit at 5:30 am in active labor. Spontaneous rupture of membrane at 6:10 am and she had
a precipitous vaginal delivery at 6:42am. Gave birth to a male, 9lb.2oz. ( 4173 gm.), with an
Apgar score of 9/9. EBL – 250 with 2 degree laceration repaired with local and has an icepack.
nd
With an 18-gauge IV access, saline lock in left hand. She received an IVF of D5LR 500 ml with
30 unit Pitocin after delivery. Fundus is firm, midline, at the umbilicus. She voided 150cc. about
30 mins. ago, refused pain medication.
Vital signs taken and recorded as: T=98.8 F, P = 102, BP = 110/70, RR = 18,
0
SpO2 = 98 on room air. She breast-fed after delivery with good latch for 30-mins.
1. What is the normal location of the fundus 2hrs. post vaginal delivery?
Answer: Firm and even with the umbilicus
2. What assessments are vital for the nurse to perform on the postpartum client?
Answer: Vital signs, breast, fundus involution, lochia color and amount
perineum, urine in bladder, legs, incisions, and postpartum hemorrhage
3. What factors increase a woman’s risk for postpartum hemorrhage?
Answer: Risk factors for postpartum hemorrhage include a prolonged third

stage of labor, multiple delivery, episiotomy, fetal macrosomia, and history of
postpartum hemorrhage. However, postpartum hemorrhage also occurs in
women with no risk factors, so that physicians must be prepared to manage this
condition at every delivery.
4. Why is nursing assessment vital to caring for the postpartum woman?
Answer: Birth can be such a simple thing for a woman because the body was
naturally made to delivery, but sometimes things can take a twist and whenever
do assess the mother it can prevent a lot of complications that may arise.
Something as simple as making sure the bladder doesn’t get full can help with
the involution of the uterus.
5. What are other causes of postpartum bleeding?
Answer: Off hand, the bladder can cause hemorrhage if it is full because it
messes with the contraction and the process of the uterus firming up, it can
cause it to become boggy. A retained placenta, remnants of placental tissue, or
retained amniotic membranes or blood clots, increases the risk of excessive
bleeding. A large can also cause the uterus to overstretch and can put more
strain on the uterus to shrink
6. How is postpartum bleeding treated? What is the nursing intervention to be

given to a postpartum patient as a nurse?
Answer: Give a woman oxytocin to help with contractions and shrink the
uterus. If the uterus is unable to contract, the physician might prescribe
oxytocin to maintain the tone of the uterus, Administration of carboprost
thromethamine. This is a prostaglandin derivative that could help in promoting
sustained uterine contractions. Blood transfusion. Cross matching and blood
typing is necessary to replace the blood loss. Administration of oxygen if the
patient is experiencing respiratory distress, administration of oxygen at 4L/min
via face mask could be prescribed by physician.
7. Why is Pitocin be given to the patient?

Because, after delivery is to help the uterus stop bleeding by squeezing down
on the raw blood vessels exposed as the placenta is released.
What is it indicated for? Oxytocin
Make a drug study on Pitocin following the format given below.
8. Formulate a comprehensive nursing care plan using the format below.

LYCEUM-NORTHWESTERN UNIVERSITY
COLLEGE OF NURSING
Related Learning Experience Plan

First Semester 2021-2022
Course Title: CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEMS (ACUTE AND
CHRONIC)- NCM 109
NURSING CARE PLAN

Assessment Planning Implementation Rationale Evaluation

Subjective: Independent:
After 8 hours After 8 hours
I’m still for nursing Monitor amount of To measure of nursing
bleeding interventions bleeding by the amount of intervention
heavily after the patient will weighing all pads. blood loss. the patient
weeks giving demonstrate was able to
birth as adequate Frequently Early demonstrate
verbalized by perfusion and monitor vital recognition of adequate
patient stable vital signs. possible perfusion and
signs, adverse effects stable vital
allow for sign.
prompt
Objective: intervention. Goals was
met.
Restlessness, Massage the To help expel
confusion, uterus. clots of blood
irritability and it is also
used to check
VS: T=98.8 the tone of the
degrees F. uterus and
P=102, ensure that it is
BP=110/70, clamping down
RR= 18, to prevent
SpO2= 98 excessive
bleeding.
Encourages
Nursing Place the mother venous return
diagnosis: in Trendelenberg to facilitate
position. circulation and
Risk for prevent further
ineffective
bleeding.
tissue
perfusion
related to Promotes
hemorrhage relaxation and
Provide comfort may enhance
measure like back patient’s
rubs, deep coping abilities
breathing. Instruct by refocusing
in relaxation or attention.
visualization
exercise. Provide
diversional
activities.
Dependent: To supply
adequate
Administer oxygen oxygen to the
as indicated. fetus and the
mother and
prevents
further
complication.
To promote
contraction
Administer and prevents
medication as further
indicated (pitocin) bleeding.
LYCEUM-NORTHWESTERN UNIVERSITY
COLLEGE OF NURSING
Related Learning Experience Plan

First Semester 2021-2022
Course Title: CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEMS (ACUTE AND
CHRONIC)- NCM 109

Drug Study:
Name of Classification: Indications: Side Effects: Nursing

the drug: Implications:
Functional: Stimulation of Hypertension,
Generic: Oxytocic uterine dysrhythmias, Assess vital
Oxytocin contractions tachysystole, signs for
Chemical: during third stage uterine and baseline
Brand: Ergot Alkaloid of labor and hyperstimulations data.
Pitocin, control of
Syntocinon Mechanism of postpartum Tachysystole is 6 Monitor
Action: bleeding or or more uterine frequency
Dosage: hemorrhage. contractions in a duration,
Directly affects 20-min window. strength of
10 units neuroreceptor Contraindications: (Hyperstimulation contractions.
/ml; nasal site to is defined as
solution 40 stimulate Hypersensitivity to uterine Monitor for
units/ml contraction of oxytocin. contractions sign of uterine
the uterus lasting at least 2 rupture, which
Adjust during labor Cephalopelvic min or 5 or more include FHR
dosage especially disproportion. contractions in decelerations,
based on toward the 10-min window.) sudden
uterine end of expel Fetal intolerance increased
response. the baby. It of labor pain, loss of
also contracts uterine
myoepithelial Anticipated non Adverse Effects: contractions,
cells in the vaginal delivery hemorrhage,
breast, Hypertonicity may and rapidly
causing milk occur with tearing developing
to be of uterus, hypovolemic
expressed increased shock.
from the bleeding,
alveoli into the abruption Maintain
ducts so that placenta fetal careful I and
the baby can bradycardia low O; be alert to
potential
obtain it by Apgar score at 5 water
suckling. min. intoxication.
Check for
Prolonged IV blood loss.
infusion of
oxytocin with Report
excessive fluid changes in
volume has vital signs and
caused severe FHR,
water intoxication specifically
with seizures, late
coma and death. decelerations
and any
vaginal
bleeding.

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LYCEUM NORTHWESTERN UNIVERSITY

Answer: Firm and even with the umbilicus

3. What factors increase a woman’s risk for postpartum hemorrhage?

Answer: Risk factors for postpartum hemorrhage include a prolonged third

4. Why is nursing assessment vital to caring for the postpartum woman?

6. How is postpartum bleeding treated? What is the nursing intervention to be

7. Why is Pitocin be given to the patient?

Make a drug study on Pitocin following the format given below.

8. Formulate a comprehensive nursing care plan using the format below.

Related Learning Experience Plan

NURSING CARE PLAN

Related Learning Experience Plan

Name of Classification: Indications: Side Effects: Nursing

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