A woman who has recently given birth complains of pain and tenderness in her leg. On physical examination, the nurse notices warmth and redness over an enlarged, hardened area. Which condition should the nurse suspect, and how will it be confirmed?

Correct Answer: C

Rationale: Pain and tenderness in the extremities, which show warmth, redness, and hardness, is likely thrombophlebitis. A Doppler ultrasound examination is a common noninvasive way to confirm the diagnosis. A diagnosis of DIC is made according to clinical findings and laboratory markers. With DIC, a physical examination will reveal symptoms that may include unusual bleeding, petechiae around a blood pressure cuff on the woman’s arm, and/or excessive bleeding from the site of a slight trauma such as a venipuncture site. Symptoms of vWD, a type of hemophilia, include recurrent bleeding episodes, prolonged bleeding time, and factor VIII deficiency. A risk for PPH exists with vWD but does not exhibit a warm or reddened area in an extremity. ITP is an autoimmune disorder in which the life span of antiplatelet antibodies is decreased. Increased bleeding time is a diagnostic finding, and the risk of postpartum uterine bleeding is increase

Correct Answer: A

Rationale: The steady trickle of bright red blood from the vagina in the presence of a firm fundus suggests uterine atony. Uterine atony is a condition where the uterus fails to contract effectively after childbirth, resulting in postpartum hemorrhage. The firm fundus indicates that the uterus is not properly contracting to control bleeding, leading to the continuous flow of blood from the vagina. Prompt intervention is crucial to manage uterine atony and prevent further complications such as excessive blood loss.

Correct Answer: A

Rationale: In managing postpartum hemorrhage (PPH), the primary medication used is oxytocin (Option A). Oxytocin is a uterotonic agent that helps stimulate uterine contractions, thus aiding in the control of bleeding after childbirth. It is considered the first-line treatment for PPH due to its effectiveness in promoting uterine tone and reducing blood loss. Methergine (Option B) is another uterotonic agent, but it is typically used for the prevention and treatment of uterine atony, not as the first-line treatment for acute PPH. Terbutaline (Option C) is a tocolytic agent used to inhibit uterine contractions and is not indicated in the management of PPH. Hemabate (Option D) is a prostaglandin analog that can be used as a second-line treatment option for PPH when oxytocin is ineffective, making it incorrect as the primary medication for managing PPH. Understanding the appropriate medications for managing PPH is crucial for healthcare professionals involved in obstetric care. Proper knowledge of these medications ensures timely and effective intervention in cases of postpartum hemorrhage, ultimately improving maternal outcomes and reducing the risk of complications.

Correct Answer: B

Rationale: The correct method for estimating blood loss in the delivery room, as implemented in new protocols, is option B) Collect blood in calibrated, under-buttocks drapes for vaginal birth. This method is preferred because it provides a more accurate measurement of blood loss compared to the other options. By using calibrated drapes, the healthcare team can quantitatively assess the amount of blood lost during the postpartum period, leading to better monitoring and management of potential complications. Option A is incorrect because relying on a subjective assessment from the patient about the number of peripads soaked can be unreliable and inconsistent. Option C, placing a basin at the foot of the delivery table, may not capture all blood loss accurately and could lead to underestimation. Option D, relying on the primary healthcare provider's estimate, may lack precision and standardization, potentially resulting in inaccurate assessments. Educationally, understanding the importance of accurate estimation of postpartum blood loss is crucial for nurses working in labor and delivery settings. It ensures timely identification of complications such as postpartum hemorrhage, allowing for prompt intervention and improved patient outcomes. Implementing evidence-based practices, such as using calibrated drapes, enhances the quality of care provided to postpartum women and promotes patient safety.

Correct Answer: C

Rationale: In postpartum care, assessing for signs of hemorrhage is crucial. Option C, "Changes in blood pressure may not be an immediate sign," is correct because postpartum hemorrhage can initially present with subtle changes in blood pressure or even normal readings before a sudden drop occurs. This delay in blood pressure changes can make it challenging to identify hemorrhage through vital sign evaluation alone. Option A, "Blood pressure may be elevated from prenatal conditions," is incorrect because elevated blood pressure from prenatal conditions would not necessarily mask signs of hemorrhage. Option B, "Respirations are increased due to activity of labor," is incorrect as increased respirations are not typically a primary indicator of postpartum hemorrhage. Option D, "Heart rate may increase with intensity of labor," is also incorrect as an increased heart rate during labor is expected and may not directly correlate with hemorrhage risk. Educationally, this question highlights the importance of understanding the nuances of vital sign assessment in postpartum patients to effectively identify complications like hemorrhage. It emphasizes the need for a comprehensive assessment that goes beyond routine vital signs to ensure early detection and prompt intervention in postpartum care.