Lecture Notes: Patient Care and Uterine Management

Introduction

• Introduction of nursing staff and patient
  • Nurse: Caroline Jeffy, on duty until 7:00 p.m.
  • Patient: Susan Brown, 28 years old, had a baby boy, Jonathan.
  • Partner: Bridget, Susan's wife.
• Initial patient condition report
  • No known allergies, negative rubella, GBS positive.
  • Arrived in active labor, spontaneous membrane rupture.
  • Precipitous vaginal delivery with a 9-pound baby.

Postpartum Patient Assessment

• Vital Signs:
  • Temperature: 98.8°F
  • Pulse: 102
  • Blood Pressure: 116/72
  • Respirations: 18
  • Oxygen: 98% on room air
• Post-Delivery Care:
  • Second-degree laceration repaired
  • IV access with saline lock
  • Medications: 500mL LR with 30 units Pitocin.
• Patient condition post-delivery:
  • Breastfed successfully for 30 minutes.
  • Refused pain medication.

Incident of Excessive Bleeding

• Bleeding Observed:
  • Excessive bleeding, need for uterine massage to encourage contraction.
  • Initial BP drop (100/60), pulse increase (120).
  • Emergency measures initiated (oxygen, pain management, catheterization).
• Intervention:
  • Uterine exploration detected retained placenta pieces.
  • Removal of placenta pieces performed.
  • Medication administered: Ketorolac for pain, Misoprostol (Cytotec) inserted rectally for contraction.

Post-Intervention Assessment

• Vital Signs:
  • Final BP: 100/60
  • Pulse: 120
  • SATs: 97% on room air
  • Total estimated blood loss: 800 mL

Outcome and Follow-Up

• Successful control of bleeding post-intervention.
• Patient's condition stabilized.
• Plan for regular follow-up every 15 minutes to monitor fundus and vitals.
• Emotional support provided to patient and partner.

Conclusion

• Midwife Amy confirms successful intervention and stabilization.
• Debriefing scheduled for team evaluation.
• Final pain assessment by the patient rated at 2 out of 10.
• Assurance provided to patient and partner about recovery and continued care.