Reference no: EM133850908
Question
Sybil is a 23-year-old G1P1 status post normal spontaneous delivery under spinal anesthesia to a live baby boy at 38 weeks AOG with an APGAR score of 9,9. Estimated blood loss 450 ml.
She is in the recovery room and the doctor ordered the following:
May transfer to recovery room
Vital signs every 15 minutes until clear to transfer to regular room
May have liquid diet then progress to soft diet if tolerated
Check urine output 6 hours after delivery
IVF:
D5NR 1L + 10 units syntocinon to run for 10 hours then discontinue
PNSS 1L to run for 8 hours
Medications:
Paracetamol Aeknil 600 mg IV every 6 hours for 3 doses then shift to Paracetamol 1,000 mg PO every 6 hours
Amoxicillin 500 mg PO every 8 hours
Materna 1 tab PO once a day
Please refer to OB and anesthesia services before transfer.
The recovery room nurse hooked Sybil to the cardiac monitor and this is her initial vital signs
HR: 50 BPM
RR: 18 CPM
Temp: 37.8 degree Celsius
BP: 120/80
Her fundus is palpable between the symphysis pubis and the umbilicus and the uterus is well contracted.
Pain scale is 4/10. Lochia is moderate flow. Perineum shows episiorrhaphy, patient sustained 2nd degree laceration right lateral.
Her stay in the recovery room is uneventful, the nurse referred her to be transferred to a regular room and the doctors agreed.
Day 2: Post-partum
Sybil is on her 2nd day post-partum the maternity ward nurse is now taking her vital signs every 4 hours and her latest vital signs are as follow:
HR: 60 BPM
RR: 18 CPM
Temp: 36.6 degree Celsius
BP 110/70
Her latest CBC shows signs of increased WBC. Higher than normal. Hgb is normal. The reason why the doctor ordered latest CBC is because she felt dizzy and almost fainted when she stood up for the first time to urinate in the bathroom. Her BP at that time is 80/60. She recovered eventually and did not experience dizziness since then. Sybil urine output is at 3,000 ml/day and was not able to passed stool yet. Her lochia remains moderate in flow and her uterus is well contracted.
Sybil said that her abdomen still looks huge, she is hoping to get back to her "normal" shape and weight as soon and possible, she is also very concerned about her bleeding. Her pain is tolerable pain scale of 4/10 but feels so much discomfort in her perineal area and lower abdominal area. She also feels bloated.
The nurse also noticed that she is not touching her baby, the nurse asked the reason for it and she said because she is scared that she might inflict harm to her baby. This is her first baby and she wants to breastfeed him however, she is not comfortable handling her baby because of her fear. She said "He looks so fragile"
Questions:
1. What is the frequency of vital signs monitoring during post-partum? What is the rationale for this?
2. How will the nurse quantify post-partum bleeding?
3. Why did the doctor ordered to check urine output 6 hours after delivery?
4. How will you interpret the initial vital signs of Sybil in the recovery room?
5. How should a nurse palpate the fundus? Where should the nurse locate the fundus at day 2 post-partum?
6. How should a nurse perform assessment of the perineum?
7. How will you interpret the increased WBC count of patient Sybil?
8. What is the cause off Sybil's orthostatic hypotension? And what should be your nursing responsibility for this?
9. Why do you think Sybil has increased urine output? What are the nursing considerations for this?