Chapter 11

Postpartum Hemorrhage Case Study

Answers

1. Correct Answer: B) Uterine atony. The handoff report and physical assessment both indicate that her uterus is boggy, which supports this diagnosis. While the other options are potential causes of postpartum hemorrhage, they are less likely given the information provided.  Vaginal and cervical lacerations would typically present with bright red blood loss but a firm uterus. Retained placental fragments can cause hemorrhage, but it is less likely given that there was no mention of difficulty delivering the placenta.
2. Correct Answer: C) Deficient fluid volume related to excessive blood loss. Her vital signs show hypotension and tachycardia, indicating significant blood loss and hypovolemia.  While the other options might be relevant, they are not the immediate priority in this life-threatening situation. Addressing the fluid volume deficit is crucial to prevent further complications and ensure her survival.
3. Correct Answer: D) Preparing for a blood transfusion per provider order. Given Maria Hernandez’s deteriorating condition, the nurse should anticipate preparing for a blood transfusion immediately. Her vital signs, lab results (low hemoglobin and hematocrit), and ongoing blood loss indicate the need for immediate blood product administration to restore oxygen-carrying capacity and improve blood volume. While the other options may be part of the overall care plan, they are not the immediate priority in this critical situation. Pain management and breastfeeding, although important, are not the focus at this time.  While continuing to monitor vital signs is essential, it’s not the immediate action to take.
4. Correct Answer: B) Assess the amount of blood loss. Maria is experiencing a postpartum hemorrhage, and accurate assessment of blood loss is crucial for determining the severity of her condition and guiding further interventions. While pain management and temperature assessment are important aspects of care, they are not the immediate priority in this critical situation.  Even though the family may be distraught, they may be providing comfort to Maria and should not be asked to leave unless they are interfering with medical care or Maria wishes for them to leave.
5. Correct Answer: C) Palpate the fundus to assess uterine tone and position. Oxytocin stimulates uterine contractions, and administering it without assessing for uterine hypertonicity could lead to complications.  While blood pressure should be monitored regularly, it’s not the most critical assessment before this medication. Pain management is important but not the priority in a potentially life-threatening situation. Consent for oxytocin administration is generally obtained earlier in the labor process.
6. Correct Answer: C) The signs and symptoms of postpartum hemorrhage and when to seek immediate medical attention. This is especially vital since she experienced a postpartum hemorrhage, putting her at risk for future episodes. Early recognition and timely intervention can be lifesaving. While iron supplements, pelvic floor exercises, and breastfeeding techniques are essential, they are not as critical as recognizing the signs of a potentially life-threatening complication.

Mastitis Case Study

Answers

1. Correct Answer: A) “I understand you’re feeling overwhelmed. Tell me more about what’s making you feel this way.” Therapeutic communication should be used to acknowledge Ms. Hernandez’s feelings and encourage her to verbalize her concerns. B dismisses her feelings and does not address her concerns. C, while well-intentioned, minimizes her feelings and offers unsolicited advice. D is not an appropriate response to her emotional distress; the focus should be on addressing her immediate concerns.
2. Correct Answer: A) Acute pain related to breast inflammation and engorgement. Mastitis causes significant pain, which must be addressed before the client can effectively care for herself or her infant. While the other diagnoses may be relevant, they are not the priority at this time. B is not supported by the information provided. Although she is experiencing breast pain, there is no mention of difficulty latching. While C is relevant, it is not the priority over her pain level.  D may be a concern, but addressing her pain is still a higher priority.
3. Correct Answer: C) Educate the client on the signs and symptoms of worsening infection. Client education regarding potential complications is crucial to ensure prompt recognition and treatment, potentially preventing worsening of the infection. While D can promote comfort, it is not the most crucial aspect of her care. A is incorrect as heat, not ice, is recommended for mastitis. B is incorrect as the provider’s order is for acetaminophen, not ibuprofen.
4. Correct Answer: C) Positive blood cultures. The most indicative finding of an infection requiring further intervention is C) Positive blood cultures. This indicates a systemic infection that requires IV antibiotics or other interventions. While an elevated white blood cell count (D) can indicate infection, it is less specific than positive blood cultures. Elevated red blood cell (A) and platelet counts (B) are not typical indicators of infection.
5. Correct Answer: C) The elevated WBC count is consistent with the body’s response to an infection like mastitis. An elevated WBC count is a common finding in the presence of infection, which aligns with Sofia’s diagnosis of mastitis. A is incorrect because there is no indication of a medication allergy. B is incorrect as this finding is not a typical complication of breastfeeding. D is incorrect because an elevated WBC count in the setting of infection requires further monitoring and treatment.
6. Correct Answer: A) Ms. Hernandez reports that her breast pain is now a 2/10 on the pain scale. The best indicator of a favorable response to treatment for mastitis is a reduction in pain, making A the best answer. While the other options are positive findings, they are not as direct a measure of the effectiveness of the treatment on mastitis itself. B is a positive finding but doesn’t directly relate to her mastitis.  While C is a positive finding, it could be due to the antipyretic effects of the acetaminophen. D reflects her commitment to breastfeeding but does not directly indicate improvement in her condition.

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