While you are taking Monique's vital signs and performing a postpartum assessment 4 hours after delivery, she tells you she is feeling lightheaded. She has a history of chronic hypertension and obesity.
Her vital signs are blood pressure 85/57 mm Hg, pulse 132, respirations 28, oxygen saturation 94%. Her uterus is boggy at midline, 1 cm above the umbilicus.
What would be your next steps and anticipated orders?
Massage her fundus until firm and ensure IV access.
Orders for methylergonovine (Methergine) 0.2 mg IM and an oxytocin bolus.
Orders for carboprost tromethamine (Hemabate) 250 mcg IM. .
Orders for carboprost tromethamine (Hemabate) 250 mcg IM. .
Correct Answer : A,B,C
Choice A rationale
Massaging the fundus helps to stimulate uterine contractions, reducing bleeding and promoting firmness in the uterus. Ensuring IV access is critical for administering medications and
fluids quickly.
Choice B rationale
Methylergonovine (Methergine) is used to prevent and control postpartum hemorrhage by promoting uterine contractions. Oxytocin bolus also helps stimulate contractions, preventing
further blood loss.
Choice C rationale
Carboprost tromethamine (Hemabate) is another uterotonic agent used to control severe postpartum hemorrhage by causing uterine contractions. Its use depends on the patient's
response to other treatments.
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Correct Answer is A
Explanation
Choice A rationale
Massaging the fundus can help contract the uterus and reduce bleeding. Ensuring IV access is crucial for administering medications rapidly. Methylergonovine (Methergine) and oxytocin help stimulate uterine contractions and reduce postpartum hemorrhage, which can be life-threatening.
Choice B rationale
Administering pain medication might be necessary, but it doesn't address the immediate issue of uterine atony and hemorrhage. Surgical intervention is a last resort and should be prepared for only if medical management fails.
Choice C rationale
Reassessing vital signs and monitoring is important, but it doesn't provide an immediate solution to the bleeding and uterine atony. Immediate action to contract the uterus is crucial.
Choice D rationale
Contacting the attending physician is important, but immediate intervention to stop the bleeding and address uterine atony is critical to prevent further complications.
Correct Answer is B
Explanation
Choice A rationale
Decreased muscle tone is not typically associated with NAS. NAS often presents with increased muscle tone due to withdrawal symptoms.
Choice B rationale
A continuous high-pitched cry is a hallmark sign of NAS, indicating withdrawal and discomfort. This is due to overstimulation of the central nervous system.
Choice C rationale
Newborns with NAS often have difficulty sleeping due to irritability and discomfort, sleeping for shorter periods.
Choice D rationale
Tremors in NAS are typically pronounced and continuous, not just when disturbed. These tremors result from withdrawal effects on the nervous system.