Assignment task: You are now caring postpartum for your patient, who delivered a baby girl. She delivered about 1 hour ago. During the delivery, McRoberts Maneuver and suprapubic pressure was applied; the time of the delivery of the fetal head to the body was 22 seconds. After the delivery, the baby required little intervention and weighed 9-6 (we will discuss this later). During the repair of the patient's 2nd degree laceration, you attempt to initiate skin to skin bonding and breastfeeding with mom and baby. The patient declines, stating she wants the baby cleaned off and assessed first because she is too tired. She stated she would attempt later. The epidural was stopped and discontinued after the laceration repair was completed, which occurred 25 minutes after the delivery. The patient now has Pitocin 30U in 1000 mL infusing at 125 mL/hr.
As you perform your 5th postpartum check during the recovery, you find the following: The patient has saturated a large pad in the last 15 minutes. Current assessment reveals the fundus is boggy and elevated to the right. HR 122, RR 20, BP 150/90, pain 1/10. The patient has decreased sensation in lower extremities. She can wiggle her toes but cannot lift legs.
Because the patient cannot feel her legs completely at this time, you decide to insert a foley catheter and obtain 300 mL urine. Afterwards you palpate and massage the fundus and it is still boggy. In the meantime, the patient saturates another large pad with clots.
1) The patient has stabilized for now and the physician orders labs to be drawn; CBC, PTT, INR. Why are these labs important? What are we looking for? What will they most likely show for this patient?
The patient has an H&H of 7.5 and 27. The physician orders 2 units of PRBCs.
2) What is the process of giving blood to a patient? What would be some important considerations? What is the proper procedure for handling blood? What is the proper procedure for giving blood? Tubing? What type of solution accompanies blood product administration?