Hemorrhage (Postpartum Bleeding) for Certified Emergency Nursing (CEN)

A patient has delivered a baby, 1 hour afterwards. A blood pressure of 90/60 mmHg, pulse rate 92 beats/minute, and respiratory rate 16 breaths/minute is noted. She complains of light-headedness and appears restless. The fundus is firm with a moderate amount of lochia rubra. The appropriate nursing action would be to stay with the patient, alert other staff, and:

The nurse knows that a slow rate of continuous postpartum vaginal bleeding usually indicates:

Postpartum hemorrhage can occur after either vaginal or Csection deliveries and can be seen anytime from immediately after delivery to several weeks postpartum. What is the most common cause of early postpartum hemorrhage?

A patient, post deliver in the ED of a healthy baby boy has had excessive bleeding, with stable vital signs and asymptomatic. No transfusion was necessary, however, blood is available should it be needed. After palpating the fundus, and discovering it is soft, the patient is to be admitted to the medical-surgical unit for further observation. The nurse explains to the patient the reason for the admission. Which of the following best indicates that the patient has understood the explanation:

Approximately 1 hour prior to arrival at the ED, a 29-yearold has given birth to a normal, healthy girl. Since arriving in the ED, the patient has completely saturated five perineal pads. Her blood pressure is 100/70 mmHg, pulse rate 82 beats/minute and regular; and respiratory rate, 18 breaths/minute. She has no sign of syncope or light-headedness and has not lost consciousness. Blood specimens are sent to the laboratory for a complete blood count (CBC) with differential, electrolyte levels, and type and cross match. Two units of packed red blood cells are available, if necessary. The nurse palpates the fundus and determines that it is soft. Which nursing intervention would be most appropriate at this time?

Of the following, which assessment finding indicates that the patient is at risk for postpartum hemorrhage?

Which finding suggests postpartum hemorrhage related to a vaginal laceration?

A 33-year-old woman, P6/G6, is admitted to the ED on a stretcher. She arrived by ambulance approximately 1 hour after an extramural delivery of a healthy, 61b, 5oz (2.9-kg) girl at home. While assisting with transferring the patient from the ambulance stretcher to the ED stretcher, the ED nurse notes that the sheets under the patient are saturated with bright-red blood. The patient is pale and restless. Her blood pressure is 90/60 mmHg, pulse rate 108 beats/minute, respiratory rate 28 breaths/minute, and temperature 99.6 F (37.5 C). The fundus is firm at the umbilical level. The patient’s perineal pad is completely saturated with lochia rubra. Blood loss is estimated at greater than 500 mL. After examining the patient, the physician diagnoses postpartum hemorrhage caused by a vaginal laceration. The priority nursing action at this time would be to assess the patient’s:

Two hours later, the bleeding decreases but continues to be heavier than normal. The fundus is soft and located above and to the right of the umbilicus. The most appropriate initial nursing intervention would be to: