Jane is a 40-year-old G6P5. She gave birth to a 9-pound healthymale infant via normal spontaneous vaginal delivery 3 hours ago.She has no medical problems. Her pregnancy history was normal. Herlabor course was normal, although her membranes were ruptured for24 hours before delivery. She had no lacerations at delivery. Herbody mass index (BMI) is 36.
Her vital signs are T 99.6º F; P 118 bpm; BP 120/70 mm Hg; R 20breaths/min. She has an intravenous (IV) infusion of lactatedRinger (LR) solution 1000 with 20 units of oxytocin.
- What risk factors does Jane have for postpartumhemorrhage?
- What are the ongoing nursing assessments needed with Jane?
Case Study #2(continued)
The nurse performs an assessment of Jane with the followingadditional findings: her uterine fundus is palpable 4 cm above theumbilicus and deviated to the right side; it is not firm; a largeamount of vaginal bleeding and clots are noted saturating theobstetric pad.
- What is the nursing priority in this situation?
- What causes other than uterine atony could be contributing tothis postpartum hemorrhage?
Case Study #2(continued)
The physician evaluates Jane and finds no lacerations and orderscarboprost tromethamine 250 mcg IM (intramuscularly).
- Why is this drug ordered?
- What are the common side effects with the use of carboprosttromethamine?
