PPH
What is consider a PPH?
QBL > 1000ml
When should you call an OB with an elevated BP?
-BP is over ordered parameters
- 160/110 depending on the orders
What is the phone number to Maternity 192 F1
650.725.7131
What is required for ALL patients with an infusing insulin drip?
-D5 solution infusing
When is it appropriate to call an OB Rapid Response
- Intrapartum CSection for fetal indication
- STAT CSection for any reason
-Maternal hemorrhage
- Anaphalaxis
Maternal seizures
-Unstable maternal status for cardiac or resp reason
- Hypertensive crisis requiring a 3rd dose of labetalol or hydralazine
- Bedside provider concern for any sumptoms or status despite stable vital signs
- Delivery outside of the labor and delivery unit
What signs or symptoms appear for a PPH?
What is:
a.Vital sign change >15% from baseline
b. Heart rate ≥ 110
c. Blood pressure ≤ 85 systolic OR 45 diastolic
d. Oxygen saturation < 95%, OR e.
e. Ongoing bleeding during the recovery or postpartum period which is refractory to early pharmacologic (uterotonics) and/or non-pharmacologic treatment.
When would IV Labetalol/hydralazine be held?
-BP is less than 160/110 or as ordered
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What nursing action needs to occur with the primary line prior to starting an insulin drip?
-flush the entire line with a minimum of 20-50 mL of the insulin solution
-Wait 5 minutes, then flush the line again with the insulin solution prior to initiating the infusion
How do you call for an OB Rapid Response?
1. Dial 211 from any hospital phone and request OB Rapid Response 2. Provide unit, room number, and phone extension 3. Place concurrent call to Primary MD
What nursing actions help to prevent PPH?
Check fundus pre and post voids
When should you avoid using Labetalol?
-Should not be used in women with asthma, heart failure or heart rate less than 60.
How do you maintain your BLS?
RQI - you have 3 months to complete
When would you treat for hypoglycemia?
-Blood sugars less than 60 mg/dL or if patient has symptoms of hypoglycemia
Where do you document an OB Rapid Response event?
- On the OB STAT record found on the crash cart/PPH cart
- Icare submitted
- Document in EPIC flowsheet - Shift Event
What actions are taken if a pt is hemorrhaging?
-Call for help
-notify MD/OB rapid response
-continue massaging the uterus -
- VS and cycle every 1min
- grab PPH cart
- administer Oxytocin IM/IV
- open up IV fluids/start IV if no access -
- consider Methergine, Hemabate or Cytotec
- prepare for bakri or Jada placement
How often can Labetalol or Hydralazine be given?
Antihypertensive Medication Algorithm
-Administer IV Labetalol every 10 mins as ordered
Administer IV Hydralazine 5-10mg every 20mins as ordered
What signs or symptoms would you see with Magnesium Toxicity?
lethargy, dizziness, clonus, changes in DTRs, Resp distress, Mag serum level >8,
What interventions are performed for a hypoglycemic patient with low blood sugar who is conscious and eating?
- 4 ounces of (apple) juice or 3 glucose tablets
- Recheck blood sugar within 15 minutes; if the blood sugar is still below 60 mg/dL, repeat above interventions
-continue to check BS Q15min until BS>60mg/dl x 2
When is OB Anesthesia called during a hypertensive crisis?
-when a third dose of IV Labetalol or Hydralazine is needed and an OB Rapid Response is not called
The MD initiates an MTG. What is the minimum amount of info needed to retrieve blood?
-MTG form/Emergency Release of Blood Products form filled by MD(located by tube station)
-2 pt’s labels
When should the RN consider calling an OB Rapid Response during a hypertensive crisis?
-If BP threshold is still exceeded after 2 doses of IV antihypertensives (whether 40mg Labetalol or 10mg Hydralazine) and requires a 3rd dose of antihypertensive
If your pt is Mag toxic, what would you do?
Turn off the Magnesium infusion\
Call the OB
Request a Magnesium serum level
Consider treatment with [BONUS]
c.g.
What is required for an unconscious patient with low blood sugars?
-If on an insulin drip, STOP infusion.
-call for help -MD called/OB STAT
-Obtain STAT finger stick and serum blood glucose.
- Administer 1 ampule of dextrose 50% IV push, if IV access
-If no IV access, give Glucagon 1 mg IM
What does the OB Rapid Response team consist of?
1. OB chief
2. Anesthesia chief
3. L&D nurse team leader (TL)