High-Risk Post-Partum Comprehensive Nursing Essay Example

High-Risk Post-Partum Comprehensive Nursing Essay Example

The purpose of this assignment is to provide a detailed assessment of a high-risk post-partum case scenario and nursing actions involved.(High-Risk Post-Partum Comprehensive Nursing Essay Example)

Based on your assessment findings and Mallory’s history, what are your immediate nursing actions?

1. Massage the fundus using the hand palm.
2. Ensure the bladder is empty(High-Risk Post-Partum Comprehensive Nursing Essay Example)
3. Review prenatal and labor records for risk factors for PPH.
4. Instruct the mother to breastfeed to initiate oxytocin release.
5. Administer oxytocin to facilitate uterine contractions.

Discuss the rationale for your nursing actions.

Massaging the fundus helps increase uterine contractions by releasing oxytocin while emptying the bladder to prevent it from displacing the uterus and increasing the bleeding. On the other hand, reviewing prenatal and labor records reveals risk factors for PPH and subinvolution of the uterus characterized by boggy fundus and heavy lochia (Durham & Chapman, 2019). The boggy fundus is an indication of a noncontracting uterus increasing the risks of blood clots. Blood clots decrease with the increased contraction of uterine blood vessels.(High-Risk Post-Partum Comprehensive Nursing Essay Example)

Detail the aspects of your assessment findings that you will report to the CNM.

1. Fundus is initially firm and midline fundus with scant lochia.
2. Fundus becomes boggy with heavy lochia after 15 minutes.
3. The fundus becomes firm after massage.(High-Risk Post-Partum Comprehensive Nursing Essay Example)
4. Presence of high tachycardia and decreased blood pressure 100/60).

Discuss your nursing actions and rationale for the actions.

1. Administer the oxytocin as per the orders, i.e., increasing or decreasing the infusion rate depending on the uterine response or rate of PPH. 
2. Instruct the patient to report signs of drowsiness, confusion, headache, or lethargy associated with decreased blood flow to the uterus (Durham & Chapman, 2019). Oxytocin stimulates a rhythmic contraction of the myometrium, constricting the flow of blood through the uterus(High-Risk Post-Partum Comprehensive Nursing Essay Example)
3. Monitor the IV infusion frequently. Oxytocin has antidiuretic and vasopressor properties that stimulate the uterine’s smooth muscles to facilitate contraction (Durham & Chapman, 2019). As an antidiuretic, oxytocin can cause fluid retention, and associated toxicity is overused. 

Discuss the assessment data needed to determine the effectiveness of medical and nursing actions.

• Heavy lochia – Heavy lochia is a sign of PPH and/or excessive bleeding (Durham & Chapman, 2019).
• The tone of the uterus – Boggy fundus with heavy lochia, indicates PPH (Durham & Chapman, 2019). The fundus becomes firm after a massage with scant lochia.(High-Risk Post-Partum Comprehensive Nursing Essay Example)
• Blood pressure is within normal limits.

Discuss the implications of the diagnosis as it relates to your nursing care and discharges teaching plan.

Uterine fibroids are a significant risk factor for PPH (Durham & Chapman, 2019). Uterine fibroids can complicate interventions for PPH. Therefore, a blood transfusion may be necessary in case of severe anemia related to excessive blood loss. A nurse should assess the patient and provide medication to counter the effects of fibroids.(High-Risk Post-Partum Comprehensive Nursing Essay Example)

In the discharge plan, a nurse should offer emotional support to the patient and inform them of the available intervention measures. The nurse should educate the patient about fibroids and associated clinical features that necessitates attention, including heavy menstruation and constituent fatigue, dizziness, and headaches. Educate the patient on iron and vitamin supplements and pain medication to aid self-management. Other self-management activities include positioning, physical activity, breathing, and relaxation techniques. Educate the patient on the use of heat packs and ice, importance of voiding and urination. Lastly, inform the patient of the available surgical options, including hysterectomy and myomectomy, the associated benefits, and risks to allow an informed decision. (High-Risk Post-Partum Comprehensive Nursing Essay Example)