CNA - Certified Nursing

CNA - Certified Nursing Assistant Postpartum Hemorrhage (PPH), Case Study.

Postpartum Hemorrhage

(PPH).

Primary Concept Perfusion Interrelated Concepts (In order of emphasis)

• Clotting
• Clinical Judgment
• Patient Education
• Communication
• Collaboration

© 2016 Keith Rischer/www.KeithRN.com

UNFOLDING Reasoning Case Study:

Postpartum Hemorrhage (PPH)

History of Present Problem:

Brenda Jackson is a 22-year-old African American, G-1, now T-1 P -0 A- 0 L-1 who is Group B strep positive and was treated with four doses of penicillin G. She had a vaginal delivery over an intact perineum after 19 hours of labor at 39 weeks gestation. She has been clinically stable and is about to be transferred to the postpartum unit after a two-hour recovery period. Oxytocin 20 units in 1000 mL of Lactated Ringer’s is infusing at a fixed rate of 125 mL/hr in a 20 g. peripheral IV in her left hand.Type and screen done on admission, Hgb 12.6/Hct 38.

Her last set of vital signs were:

∙ T: 99.4 F/37.4 C

∙ P: 95

∙ R: 18

∙ BP: 110/67.

She has gotten up to void once and had 50 mL of blood-tinged urine. Her fundus is firm at the umbilicus, and has a small amount of dark red lochia. She is physically exhausted and has been anxious since delivery because her labor and delivery were harder than she ever expected.

Personal/Social History:

Brenda is an advanced nursing student in her final year. She is single and remains in a relationship with her boyfriend, who is also the father of her baby. She lives at home with her parents, who are supportive.

What data from the histories are RELEVANT and have clinical

significance to the nurse? RELEVANT Data from Present Problem:

Clinical Significance: She is group B strep positive so she had

antibiotics before delivery. Her BP is a little low as well. She also got oxytocin after delivery.

RELEVANT Data from Social History: Clinical Significance: She is a nursing student in her final year. He boyfriend is there and supportive and she lives with her parents who are also supportive.

ELATIONSHIP of your patient’s past medical history (PMH) and current meds? (Which medication treats which condition? Draw lines to connect.) PMH: Home Meds: Pharm. Classification: Expected Outcome:

G1-T1-P0-A0-L1

Prenatal vitamin (PVI) 1 tab PO daily - prevent neural tube defects and help with nutrients

Ferrous gluconate 325 mg PO daily - use to treat and prevent iron deficiency anemia

Patient Care Begins:

Brenda arrived in her room ten minutes ago. You were delayed by another mother who required pain medication, but the nursing assistant collected the first set of vital signs posted below. You introduce yourself, orient her to the

room and unit, and begin your BUBBLE-HE assessment:

© 2016 Keith Rischer/www.KeithRN.com

Current VS: P-Q-R-S-T Pain Assessment (5

th

VS):

T: 99.9 F/37.6 C (oral)

Provoking/Palliative: Vaginal delivery

P: 105 (regular) Quality: Cramp R: 22 (regular) Region/Radiation: Lower abdomen BP: 110/75 Severity: 6/10 O2 sat: 98% room air Timing: Started one hour after delivery

What VS data are RELEVANT and must be recognized as clinically significant by the nurse? RELEVANT VS Data: Clinical Significance: Pulse is high at 105, and so are respirations at 22, Bp is still low. She also has pain that started one hour after delivery that is a 6/10, in the lower abdomen and is cramp like. This all could be early symptoms of PPH.

Current Assessment:

GENERAL

APPEARANCE:

Appears uncomfortable, restless

RESP: Breath sounds clear with equal aeration bilaterally, nonlabored respiratory effort CARDIAC: Pink, warm/dry, no edema, heart sounds regular with no abnormal beats, equal with palpation at radial/pedal/post-tibial landmarks

NEURO: Alert and oriented to person, place, time, and situation

(x4) BUBBLE-HE

BREAST: Lactating; soft, non-tender with evidence of colostrum

UTERUS: Right of umbilicus, slightly boggy

BLADDER: Voided 50 ml after delivery, bladder distended