Maryland Next Gen NCLEX Test Bank Project

Maryland Next Gen NCLEX Test Bank Project September 1, 2022

Case Study Topic:Postpartum HemorrhageAuthor

:

Christine Schlaerth, PhD, CNM, WHNP-BC Carroll Community College Case Summary A client in the 4th stage of labor has a postpartum hemorrhage following a cesarean birth.Uterotonics and fluids are given, and the client begins to recover once the fundus is firm and bleeding has ceased.Objectives

• Recognize trends and changes in client conditions/vital signs and intervene as needed
• Provide care for clients experiencing complications of pregnancy/labor and or delivery
• Evaluate and document client responses to emergency interventions

Case Study LinkCase Study QR Code

https://umaryland.az1.qualtrics.com/jfe/form/SV

_ethSrOLGR20HDZs Trend QR CodeTrend Link

https://umaryland.az1.qualtrics.com/jfe/form/

SV_02IHwhHpiblxzb8 Case References 1.Agency for Healthcare Research and Quality (2017). Sample Scenario for Postpartum Hemorrhage In Situ Simulation. Retrieved from: https://www.ahrq.gov/hai/tools/perinatal- care/modules/situ/simulation-postpart-hemorrhage.html 2.Bristol, T.J., Herrman, J.W, and Stephenson, W. (2019). Postpartum hemorrhage. In NurseThink

for Students: NCLEX-RN Conceptual Review Guide (pp. 46). NurseTim, Inc.

CJCST Version 2.1 designed by Desirée Hensel, 2022. Permission granted to use and modify template for educational purposes. This study source was downloaded by 100000809894292 from CourseHero.com on 05-29-2023 18:19:09 GMT -05:00 https://www.coursehero.com/file/197282168/postpartum-hemmorhagedocx/ 1 / 2

Case Study Question 1 of 6 A client in the 4th stage of labor is being cared for following a cesarean birth.Click to highlight the findings that require immediate follow-up.Flowsheet Time161516301645 Temp37.1 C / 98.8 F

P 88100115

RR202122

B/P124/70103/7685/45

Pulse oximeter 97% on RA 94% on RA 89% on RA

• 27yo Gravida 2 now Para 2 delivered 3590 gram(7lb 9oz) term infant via cesarean at 1545.

Quantitative blood loss 850 mL. Client stable in PACU with oxytocin 30units/500mL LR IV @ 250mL/hr.

• Client states, “I feel dizzy” and appears pale. Additional blood loss 400 mL.

Fundus boggy, midline, and 3cm above umbilicus.Key Flowsheet Time161516301645 Temp37.1 C / 98.8 F

P 88100115

RR202122

B/P124/70103/7685/45

Pulse oximeter 97% on RA 94% on RA 89% on RA

• 27yo Gravida 2 now Para 2 delivered 3590 gram(7lb 9oz) term infant via cesarean at 1545.

Quantitative blood loss 850 mL. Client stable in PACU with oxytocin 30units/500mL LR IV @ 250mL/hr.

• Client states, “I feel dizzy” and appears pale. Additional blood loss 400 mL.

Fundus boggy, midline, and 3cm above umbilicus.

Scoring Rule: +/-

Rationale: The concerning findings are the client stating she feels dizzy, appearing pale, additional blood loss and the bogginess and position of the uterus. Concerning vital signs are pulse, BP and pulse oximeter. The quantitative blood loss after the cesarean is within normal limits (up to 1000 mL for cesarean delivery). More than 1000 mL in 24 hours qualifies as postpartum hemorrhage after cesarean.Additional 400 mL puts the client at a total loss of 1300 mL. Infant weight is WNL.CJCST Version 2.1 designed by Desirée Hensel, 2022. Permission granted to use and modify template for educational purposes. This study source was downloaded by 100000809894292 from CourseHero.com on 05-29-2023 18:19:09 GMT -05:00 https://www.coursehero.com/file/197282168/postpartum-hemmorhagedocx/

• / 2