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23.04 Meds for Postpartum Hemorrhage (PPH)

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Overview

  1. Stimulate uterine contraction to cause vasoconstriction within the uterine muscle and stop bleeding
    1. They can also cause arterial and coronary artery vasoconstriction

Nursing Points

General

  1. Given immediately  after delivery of placenta
  2. Medications cause vasoconstriction and should be used with caution for patients with hypertension

Assessment

  1. Bleeding
    1. Is the medication working to decrease the bleeding?
    2. Pad counts
  2. Does the patient have hypertension?
    1. Due to vasoconstriction, methylergonovine should not be given to patients with HTN and other medications used with caution
    2. Clarify with MD if patient has any cardiac history
  3. Does the patient have asthma?
    1. Carboprost can cause bronchospasms so contraindicated
    2. Clarify with MD if patient has any history of asthma
  4. Monitoring
    1. Watch for s/s MI, HTN, bradycardia, nausea, dysrhythmias
    2. Monitor VS per order set, especially BP
    3. Monitor hemorrhage and note response to med

Therapeutic Management

  1. Therapeutic management
    1. May need pain meds due to painful, yet necessary, uterine cramping
    2. Hold and clarify if HTN develops
    3. Get baseline vitals before starting

Nursing Concepts

  1. Pharmacology
  2. Safety
  3. Clotting

Patient Education

  1. Expect painful cramping
  2. Necessary to stop or decrease bleeding

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  • Question 1 of 8

The nurse is caring for a hypertensive client who is assessed and noted to have a boggy uterus. The nurse gives oxytocin IV and fundal massage but the bleeding is still heavy. The nurse reviews the client’s orders. Which of the following orders is best for this client?

  • Question 2 of 8

The nurse is caring for a client with a history of asthma who has just delivered a healthy, ten-pound baby. The mother notifies the nurse that she has had some gushing of blood. On assessment she has heavy bleeding and a boggy uterus so the nurse notifies the provider. Which of the following orders given by the provider should the nurse question?

  • Question 3 of 8

A high-risk pregnant client has had a complicated delivery and is in the recovery room with active bleeding. The physician has ordered the IV infusion hetastarch in sodium chloride (Hespan). Which best describes the indications for this fluid?

  • Question 4 of 8

The nurse is caring for a client who just delivered the placenta. Which of the following does the nurse anticipate will be the next order?

  • Question 5 of 8

A client is given oxytocin after delivery. The nurse knows the medication is successful when which of the following assessments are made? Select all that apply.

  • Question 6 of 8

The nurse is caring for a client on the labor and delivery unit who is prescribed methylergonovine. The nurse knows this medication is given for which of the following reasons? Select all that apply.

  • Question 7 of 8

Methylergonovine is ordered for a client with postpartum hemorrhage. The nurse is reviewing the client’s history and should notify the provider of which of the following conditions?

  • Question 8 of 8

A client who is recovering from a vaginal delivery of an infant has developed postpartum hemorrhage. Which of the following medications would most likely be administered for management of this condition?

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