Discussion:
The patient is a 22-year-old G1P1 who delivered vaginally a healthy 7 lb 8 oz boy approximately 3 hours ago with a midline episiotomy. The fundus is above the umbilicus, lochia is moderate. She has an intravenous infusion with Pitocin 20 units in her right arm. The patient is complaining of an excruciating headache, blurred vision, and epigastric pain that radiates to the upper right quadrant of her abdomen. The patient is also complaining of perineal pain. Her deep tendon reflexes are brisk, and vital signs are: T. 38.2, HR 98, RR. 18, BP 169/102, SpO² = 92%
Physical examination of the patient’s abdomen reveals a boggy uterus, massage done with the expulsion of medium to large clots and small gushes of blood from the vagina. Her right labia is swollen, bulging, and firm to the touch. A retaining urinary catheter was placed with a urinary output measured in the last hour is 25 mL.
Stat laboratory blood was drawn and sent including complete blood count (CBC), liver function test (LFTs), and comprehensive metabolic panel (CMP). The lab results are:
a. CBC: White cell count = 9,000 x 10³; Hemoglobin = 9.2mg/dL; Hematocrit =27.6%; platelets = 8,000 x 10³
b. LFTs: Alanine Aminotransferase (ALT) = 379 IU/L; Aspartate Aminotransferase (AST) = 425 IU/L; Alkaline Phosphatase (ALP) = 380
c. Comprehensive Metabolic Panel: Na = 138 mEq/L; K = 4.9 mEq/L; Calcium = 8.5 mg/dL, carbon dioxide (CO2) = 21 mmol/L; chloride (Cl) = 103 mmol/L; albumin = 4.3 g/dL, total protein = 6.0 g/dL, bilirubin = 0.1m, BUN = 25 mg/dL, Creatinine = 0.6 mg/dL
Answer and discuss the following questions with your colleagues:
1. What are the nurse’s priorities for this patient?
2. What symptoms and signs should alert the nurse to potential problems that might need immediate intervention?
3. What would be the best way for the nurse to respond to the patient’s condition?
4. What might be the significance of the patient’s perineal pain?
5. How would you measure the patient’s blood loss?
6. Explain the significance of the patient’s laboratory CBC, and LFT results.
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The patient is a 22-year-old G1P1 who delivered vaginally a healthy appeared first on blitzarchive.com.