Reference no: EM133853209

Question

Betsy Lambert is a primigravida who had a spontaneous vaginal delivery at 09:41 today. An overview of her history reveals the following: 23 years old, married, G1P0 on admission to Labor Unit. Pregnancy normal. Rh positive. No drug allergies. Labs on admission to L&D normal with exception of hemoglobin 11 g and hematocrit 32%. Labor: 13 hours. Estimated blood loss: 450 mL. Delivered female (7 lb 7 oz) spontaneously after epidural anesthesia. Apgar 9/10. Newborn examination was within normal limits and routine newborn orders were implemented. Day shift reports firm fundus; voided 210 mL around 1100; vital signs stable. Baby visited and breastfed briefly with help from lactation nurse.

Ate lunch and had Tylenol #3 at 1300 for perineal pain. Has been sleeping for long intervals.

You find Mrs. Lambert still dozing but awaken her for examination and note the following: BP 112/60, HR 116, R 20, T 100. Breasts -soft, nontender, wearing support bra. Uterus-fundus firm and 2 cm below umbilicus slightly left of midline. Bladder-possibly slightly distended but she feels no urge to void. Lochia-the two perineal pads and blue absorbent underpads are covered with bright red blood. Perineum-covered with blood, as are thighs. Some of the blood has dried on the skin. Slight edema noted- midline episiotomy intact. Ice pack in place but ice melted. Homans sign-negative. Emotional status-reports her husband went home to rest and will be back at dinnertime. Talks with excitement about first attempt to nurse baby. Asks for something cold to drink. The patient cannot remember when she was last checked for bleeding. You don gloves and wash her perineum gently and her thighs and change all her pads so you can better assess her degree of bleeding. An IV is in place with 10 units of oxytocin (Pitocin) (100 mL is left in the IV bag).

You return, as promised, in 15 minutes to reevaluate her lochia and find that her perineal pads are again covered in blood.

- Based on your assessments and Mrs. Lambert's laboratory findings, what actions will you take first?

- If one of your anticipated actions is to inform the healthcare provider, what specific information will you report and what management should you anticipate initially?

- What follow-up care will you anticipate performing during the remainder of your shift?