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Zorluk: Çok zorAnte/Intra/Postpartum and Newborn Care

A 28-year-old client who is 14 hours postpartum following a forceps-assisted vaginal delivery calls for assistance, reporting severe, unrelenting vaginal and rectal pressure. The client states, "I feel like I am bleeding heavily." The practical nurse (PN) assesses the client and finds a perineal pad, which was changed 45 minutes ago, saturated with bright red blood. The fundus is firm, midline, and at the umbilicus. Current vital signs are: heart rate 118 bpm, respirations 22/min, and blood pressure 102/68 mm Hg. Based on these data, which action is the priority for the PN?

  1. Report the assessment findings to the registered nurse immediately for evaluation of a potential laceration or hematoma.Cevap
  2. B
    Perform firm continuous fundal massage to promote uterine contraction and slow the bleeding.
  3. C
    Document the saturated perineal pad as expected early postpartum lochia rubra and continue routine monitoring.
  4. D
    Initiate an intravenous fluid bolus and titrate the oxytocin infusion according to the facility's hemorrhage protocol.

Cevap

Report the assessment findings to the registered nurse immediately for evaluation of a potential laceration or hematoma.
The client is presenting with bright red bleeding, a perineal pad saturated in under an hour, severe rectal and vaginal pressure, and borderline tachycardia. Crucially, the fundus is firm and midline. Heavy bleeding in the presence of a contracted (firm) uterus strongly suggests a laceration of the genital tract or a developing hematoma, especially following an operative (forceps-assisted) delivery. The tachycardia is a subtle, early sign of compensatory shock. The PN must immediately report these findings to the registered nurse (RN) or provider, as this is an emergent complication requiring advanced medical assessment and intervention that falls outside the PN scope of practice.

Adım Adım Çözüm

1
Analyze the source of bleeding by correlating the saturated pad with the tone of the fundus.
The fundus is firm and midline, meaning the heavy bright red bleeding is not caused by uterine atony.
Bleeding in the presence of a firmly contracted uterus points to another source, such as a vaginal or cervical laceration.
2
Evaluate the client's subjective symptoms and vital signs in the context of the delivery method.
The client had a forceps-assisted delivery and now reports severe vaginal/rectal pressure, accompanied by a borderline elevated heart rate of 118 bpm.
Operative vaginal deliveries increase the risk of perineal trauma. Severe pressure indicates a rapidly expanding hematoma, and tachycardia is an early compensatory sign of hypovolemic shock.
3
Determine the appropriate nursing intervention based on the Practical Nurse (PN) scope of practice.
The PN must escalate the findings to the Registered Nurse (RN) or healthcare provider.
The client is experiencing a potentially life-threatening complication that requires advanced assessment, medical diagnosis, and interventions (like suturing or IV medication titration) that fall outside the PN scope.

Anahtar Kavram

Postpartum Hemorrhage Differentiation and PN Scope of Practice
Tahmini Süre:1m 30s
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Konular

Ante/Intra/Postpartum and Newborn Care

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