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CASE STUDY 01 (POSTPARTUM)
Assessment

A 1,000 ml bag of Lactated Ringer's solution containing 10 units of Pitocin (oxytocin) is infusing via an 18 g peripheral IV in the left forearm at 125 ml per hour, with 300 ml remaining in the bag. The IV is patent, without redness or swelling, and can be discontinued when this bag's infusion is complete.

1. Prior to discontinuing the IV Pitocin (oxytocin), which assessment is most important for the nurse to obtain? [pic]A) Vital signs.
[pic]B) Vaginal discharge.
[pic]C) Uterine firmness.
[pic]D) Oral intake.

2. What is the priority nursing diagnosis for Marie, who is experiencing residual effects of epidural anesthesia? [pic]A) Risk for injury.
[pic]B) Impaired physical mobility.
[pic]C) Altered urinary elimination.
[pic]D) Risk for infection.

3. What is the priority nursing action to address Marie's needs related to the repair of her 4th degree perineal laceration? [pic]A) Provide prescribed oral pain medication and stool softener. [pic]B) Encourage warm sitz baths 2 to 3 times daily.

[pic]C) Apply perineal ice packs consistently for the first 24 to 48 hours. [pic]D) Teach proper and frequent use of the peri-bottle.

Early detection of, and intervention for, postpartum complications promotes positive client outcomes. Postpartum protocol requires that the nurse assess Marie's vital signs, fundus, perineum, vaginal bleeding, pain, leg movement, and IV every 15 minutes for the first hour and then every hour for the next three hours.

4. Considering Marie's history, which postpartal complication is she most at risk for? [pic]A) Endometritis.
[pic]B) Subinvolution.
[pic]C) Deep vein thrombosis.
[pic]D) Hemorrhage.

Postpartum Crisis

Fifteen minutes after the initial assessment, the nurse finds Marie disoriented and lying on her back in a pool of vaginal blood, with the sheets beneath her saturated with blood.

5. What is the priority nursing action?
[pic]A) Massage the fundus.
[pic]B) Take vital signs.
[pic]C) Increase the IV rate.
[pic]D) Check the bladder.

6. What is the best method for the nurse to use to obtain immediate assistance? [pic]A) Telephone the healthcare provider from the client's room. [pic]B) Go to the nurse's station to notify the charge nurse. [pic]C) Activate the priority call light from the bedside.

[pic]D) Call for help from the doorway of the client's room.

The nurse has requested assistance and personnel are on their way.

7. While waiting for help to arrive, what is the next priority action? [pic]A) Obtain vital signs.
[pic]B) Apply oxygen.
[pic]C) Assess for bladder distention.
[pic]D) Increase the IV infusion rate.

The charge nurse, two staff nurses, and an unlicensed assistive personnel (UAP) rush in to assist the nurse with Marie.

8. Which task is best delegated to the UAP during this crisis? [pic]A) Bring IV fluids and supplies from the supply room.
[pic]B) Change the bed linens and bathe the client.
[pic]C) Start O2 per nasal cannula.
[pic]D) Obtain the vital signs and O2 saturation.

The healthcare provider is notified that Marie is hemorrhaging and has an estimated blood loss of 1,200 ml since delivery. The client's blood pressure is 70/40, pulse 120, respirations 28, and O2 saturation 73%. The healthcare provider's prescriptions include stat oxytocin 10 units in each liter of normal saline to infuse at 40 milliunits (mU)/minute. The healthcare provider also prescribes 0.2 mg methylergonovine maleate (Methergine) IM to be given immediately. The vial of oxytocin is labeled 10 units/ml.

9. How many ml of oxytocin should the nurse draw up in the syringe to inject into the 1000 ml bag of normal saline? [pic]A) 1 ml.
[pic]B) 10 ml.
[pic]C) 4 ml.
[pic]D) 0.04 ml.

The oxytocin must be administered via an IV infusion pump.

10. What is the flow rate needed to deliver 40 mU/minute?
[pic]A) 40 ml/hr.
[pic]B) 240 ml/hr.
[pic]C) 24 ml/hr....
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