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Laura Mingle Case Study Instructions: Read chapter 31 and complete the case study on postpartum.

The case study will be peer reviewed in class. This assignment will account for 1% of the Obstetric Active Learning
Exercises (ALEs) course grade. Due January 23, 2012. Client Profile Laura is a 38 year old G5P5005 at two hours postpartum. She delivered her baby at the local hospital. She had a normal spontaneous vaginal delivery (NSVD) with no episiotomy or tears. Her uterus has remained contracted. Her lochia is rubra moderate. Estimated blood loss was 350 ml. Postpartum Case Study At two hours postpartum Laura says she has to go to the bathroom. She is assisted to sit at the bedside for a few minutes prior to standing. When she does stand up there is a brief gush of blood from the vagina. Laura is now 12 hours post delivery on the mother baby floor. Nursing assessment reveals fundus at -2 below the umbilicus and deviated to the right. Lochia is large rubra with small clots. BP 128/70, T. 99.4, P.70, R. 20. She complains of being cold and is shivering and shaking. An IV of 1000 cc LR with Pitocin 10 u is infusing into the right arm. She complains of after pains. Her breasts are slightly engorged with the nipples erect without redness. She is voiding large quantities with each void without discomfort or burning. Her perineum is swollen, especially on the right side and she has not had a BM. She has one small external hemorrhoid and her Homans sign is negative. The baby is nursing well with a good latch on and positioning. She is slightly teary eyed and sad.

Questions 1. Why did the nurse have her sit at the bedside for a few minutes prior to taking her to the bathroom? Fainting under the shower or on the way there id d/t fatigue, medication effect, loss of blood or lack of food intake. 2. What explanation can be given for the brief gush of blood when she stood up? The vagina is not shaped straight it is shaped like a cup so when Pt is sitting down the blood pools down in that cupped area. When Pt gets up the blood is released and pours out. Perineal pads should be applied to prevent discomfort and measure the blood outflow. 3. Assess Lauras vital signs. Are they normal? What are the practice standards of vital signs and checking the fundus in this stage? VSs are in the normal range, no surprises, EBL is w/in the range 350 ml. I saw a discussion that EBL over 500ml is considered abnormal which makes me confused about the numbers I know 500-1000 ml expected. Uterus contracted I think is great considering 5 kids. Pitosin given to prevent/reduce bleeding and shrink uterus (standart). Give a

blanket and insure warmth if mother fills cold which is not abnormal sign. A fundus should not be above the umbilicus and boggy/soft/ it should be well contracted otherwise uterine bleeding should be expected. If above the umbilicus and not centered a full bladder should be expected and Pt should urinate in order to be assessed. 4. Assess each of the nurses observations. What nursing interventions would be appropriate? How should the nurse approach Lauras emotional state at this time? Reassurance from family, husband, nurse that postpartum bleeds is normal feeling /taking-in/ Ruben and granted permission to cry will release the pressure. 5. Why are Lauras after pains so strong? What measures can be taken to give her relief? Laura should be advised that after pain are normal. Pt is most likely to be multiparous w/more then one birth. Advise ambulation, warmth, sitz baths, if mother is breast feeding analgesics/mild/ could be prescribed 30-1 hour to prevent/promote comfort w/out pain, because when baby is sucking Oxytocin is released stimulating contractions and after pains. Place Pt in a prone position w/a pillow under the belly to compress the uterus, that will keep the contractions active and free of pain after few minutes.