Question: TYING IT ALL TOGETHER You Are A Nurse Working In The Postpartum Unit. You Are Assigned Ms. Mallory, A 42-year-old African American Woman. (Refer To Tying It All Together In Chapters 7 And 10 For Antepar- Tum And Intrapartum Data.) Summary Of Labor And Delivery Record Ms. Mallory Was Admitted 2 Days Ago At 32 Weeks’ Gestation And Managed In The Birthing …

TYING IT ALL TOGETHER You are a nurse working in the postpartum unit. You are assigned Ms. Mallory, a 42-year-old African American woman. (Refer to Tying It All Together in Chapters 7 and 10 for antepar- tum and intrapartum data.) Summary of Labor and Delivery Record Ms. Mallory was admitted 2 days ago at 32 weeks’ gestation and managed in the birthing unit for preterm labor with mag- nesium sulfate and antibiotics. She received betamethasone. The magnesium sulfate was discontinued 3 hours before delivery. Her labor was augmented during the transitional phase. She spontaneously delivered a 1559-g (3 lb. 7 oz.) boy with Apgar scores of 5 and 7 at 1 and 5 minutes. Her baby is experiencing mild signs of respiratory distress and is in the NICU. Postpartum Report Ms. Mallory is 4 hours post-birth and has an IV of DS lactated Ringer’s solution with 10 units of oxytocin running in her left arm. She voided in the recovery unit 2 hours post-birth. Assessment Findings Vitals signs: Temperature 37°C, pulse 98 bpm; respirations 14 breaths/min; blood pressure 110/70 mm Hg Fundus is at the umbilicus and boggy. Lochia is heavy Based on your assessment findings and Ms. Mallory’s history, what are your immediate nursing actions? Discuss the rationale for your nursing actions. You reevaluate Ms. Mallory 10 minutes after your initial nurs- ing actions. Her fundus is firm, midline, and 1 finger breadth below the umbilicus with scant lochia. You continue to moni- tor Ms. Mallory and 15 minutes later her fundus is boggy with heavy lochia. The fundus becomes firm after massage. Her pulse is 100 bpm and blood pressure is 100/60 mm Hg. You notify her CNM and report your findings Detail the aspects of your assessment findings that you will report to the CNM The CNM orders 20 units of oxytocin in 1000 mL of lactated Ringer’s solution. The ordered infusion rate is 10 mL/min, to be regulated by firmness of the uterus. Discuss your nursing actions and rationale for actions. Discuss the assessment data needed to determine effectiveness of medical and nursing actions. You note that in her prenatal chart she has a diagnosis of fibroids. Discuss the implications of the diagnosis as it relates to your nursing care and discharge teaching plan.