A nurse is caring for a patient who just stabilized after she had a postpartum hemorrhage with a QBL of 1300 ml. Which of the following are priorities for her care?
Encourage bottle feeding.
Give aspirin for pain.
Perform frequent fundal assessments.
Check a CBC in 6 hours.
Correct Answer : C,D
Choice A rationale
Bottle feeding does not impact recovery from postpartum hemorrhage. Breastfeeding promotes oxytocin release, aiding uterine contractions to minimize bleeding risk, unlike bottle feeding, which has no therapeutic impact.
Choice B rationale
Aspirin is contraindicated postpartum as it increases bleeding risk due to its antiplatelet effects. Analgesic alternatives like acetaminophen are preferred for pain relief in hemorrhage recovery settings.
Choice C rationale
Frequent fundal assessments monitor for uterine atony, a leading hemorrhage cause. Ensuring the uterus remains firm and contracted is critical in preventing recurrent excessive blood loss postpartum.
Choice D rationale
A CBC after six hours checks hemoglobin, hematocrit, and platelet levels, identifying ongoing bleeding or anemia. Timely lab evaluation ensures appropriate interventions like transfusions or iron supplementation.
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Correct Answer is B
Explanation
Choice A rationale
Surgical intervention is not the initial step for uterine atony as conservative measures, such as fundal massage, are prioritized to encourage uterine contraction and reduce bleeding.
Choice B rationale
Fundal massage stimulates uterine contraction by mechanically compressing the myometrium, which helps to constrict the spiral arteries and reduce hemorrhage caused by uterine atony.
Choice C rationale
Establishing venous access is critical for fluid resuscitation but does not directly address the underlying cause of hemorrhage, which requires mechanical or pharmacological uterine contraction.
Choice D rationale
Catheterizing the bladder can prevent displacement of the uterus but does not directly address uterine atony. An empty bladder supports fundal massage by allowing proper uterine positioning.
Correct Answer is B
Explanation
Choice A rationale
Magnesium sulfate is primarily used for seizure prophylaxis in preeclampsia or eclampsia. It does not manage hemorrhagic conditions or uterine atony effectively, making it unsuitable for controlling postpartum hemorrhage.
Choice B rationale
Hemabate or Tranexamic Acid (TXA) addresses postpartum hemorrhage by promoting uterine contraction or inhibiting fibrinolysis. Hemabate is a prostaglandin, while TXA is an antifibrinolytic, both effective in hemorrhagic control.
Choice C rationale
Methergine (methylergonovine) induces uterine contraction to manage postpartum hemorrhage effectively but is contraindicated in hypertensive patients due to the risk of exacerbating hypertension or inducing stroke.
Choice D rationale
Nifedipine is a calcium channel blocker used to treat hypertensive disorders or preterm labor. It has no role in treating postpartum hemorrhage or enhancing uterine tone in such cases.
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