The Basics
What is the most common cause of postpartum hemorrhage?
Uterine atony
Which assessment finding is most concerning for postpartum hemorrhage: a firm fundus with scant lochia or a boggy fundus with heavy bleeding?
A boggy fundus with heavy bleeding
What is the primary purpose of magnesium sulfate in severe preeclampsia?
Seizure prevention
A patient is 1 hour postpartum. Her fundus is boggy and she has saturated a perineal pad in 10 minutes. Her BP is 102/64 and HR is 112. What should the nurse do first?
Massage the fundus while simultaneously assessing the amount of bleeding.
The nurse suspects retained placental products in a patient with postpartum bleeding. Which "T" does this represent?
Tissue
What blood pressure finding is considered hypertension in pregnancy when confirmed appropriately?
> 140/90 mmHg or higher
A postpartum patient's uterus is boggy and above the umbilicus. What should the nurse do first?
Massage the fundus
What medication is used to prevent and treat seizures in patients with severe preeclampsia?
Magnesium Sulfate
Does magnesium sulfate primarily treat the patient's hypertension?
No. It is used primarily for seizure prevention/treatment. Antihypertensive medications are used to control severe hypertension.
Which uterotonic medication should generally be avoided in a patient with asthma?
Carboprost (Hemabate)
What are the classic four causes of postpartum hemorrhage, often remembered as the "4 Ts"?
Tone, Trauma, Tissue, Thrombin
A patient receiving magnesium sulfate develops absent deep tendon reflexes, respiratory depression, and decreased urine output. What should the nurse suspect?
Magnesium Toxicity
A patient has heavy postpartum bleeding and a boggy uterus despite fundal massage. Which medication is commonly administered first to treat uterine atony?
Oxytocin (Pitocin)
A patient receiving magnesium sulfate has a respiratory rate of 10/min and absent patellar reflexes. What should the nurse do?
Stop the magnesium infusion and notify the provider; prepare for treatment of magnesium toxicity, including calcium gluconate
A postpartum patient has continued bleeding, a firm uterus, and increasing abdominal pain after delivery. What should the nurse consider in addition to laceration?
Uterine rupture or other traumatic cause
What organ system is primarily affected by the proteinuria associated with preeclampsia?
The kidneys
A postpartum patient has a firm, midline uterus but continues to have bright-red heavy bleeding. What should the nurse suspect?
Trauma, such as a vaginal or cervical laceration
What medication should be readily available when a patient receiving magnesium sulfate develops toxicity?
Calcium gluconate
A patient with severe preeclampsia suddenly begins having a generalized tonic-clonic seizure. What is the nurse's priority action?
Protect the patient from injury and maintain the airway; position her on her side
A patient with preeclampsia suddenly develops right upper quadrant or epigastric pain. What complication should the nurse suspect?
Hepatic involvement/HELLP syndrome
What neurologic symptoms should concern the nurse in a patient with preeclampsia?
Severe or persistent headache, visual disturbances, increased DTR's or clonus or altered neurologic findings
A patient experiencing postpartum hemorrhage becomes pale, confused, tachycardic, and hypotensive. What complication should the nurse recognize?
Hypovolemic shock
A patient with uterine atony has already received oxytocin. Which medication should the nurse question if the patient has severe hypertension?
Methylergonovine (Methergine)
A patient with postpartum hemorrhage has a boggy uterus that remains displaced to the right. What is the most likely cause of the displacement, and what intervention is indicated?
A distended bladder; assist the patient to void or catheterize as ordered
A patient develops severe postpartum hemorrhage after delivery. The uterus is firm and contracted. The patient continues to bleed from multiple sites, including the IV insertion site, and develops oozing from her gums. Laboratory results show a falling fibrinogen level and prolonged coagulation studies. Which complication should the nurse suspect?
Disseminated intravascular coagulation (DIC).