Problem
Janelle is a 40-year-old G6T5P0A0L5. She gave birth to a 4200 kg healthy male infant via spontaneous vaginal birth 3 hours ago. She has no medical problems. Her pregnancy history was normal. Her labour course was normal, although her membranes were ruptured for 24 hours before birth. She had no lacerations at birth. Her BMI is 36. Her vital signs are temperature of 37.8°C, P 118, blood pressure 120/70, R 20. She is receiving intravenous (IV) lactate Ringer's 1000 with 20 units of oxytocin infusing.
A. What risk factors does Janelle have for postpartum hemorrhage?
B. The nurse performs an assessment of Janelle with the following additional findings: her uterine fundus is palpable 4 cm above the umbilicus and deviated to the right side; it is not firm; a large amount of vaginal bleeding and clots are noted saturating the obstetrical pad. What is the nursing priority in this situation?
C. What etiologies other than uterine atony could be contributing to this postpartum hemorrhage?
D. The physician evaluates Janelle and finds no lacerations and orders carboprost tromethamine 250 mcg intramuscularly. Why is this drug ordered?
E. What are common adverse effects with the use of Hemabate?
F. What are the ongoing nursing assessments and education needed with Janelle?
G. Reference the information.