Midline episiotomy

Tina Nelson delivered a healthy male infant 6 hours ago. She had a midline episiotomy. This is her third pregnancy. She is now a G3P3003. She had an epidural block for her labor and delivery. She is now admitted to the postpartum unit.
1. What is important to note in the initial postpartum assessment? Include at least 5 assessments. Why is it important to assess for these things and what do the findings mean?

2. What are potential indications of a postpartum hemorrhage? List at least three indications.

3. What would you do if you found a boggy uterus?

4. What are the normal dose range and administration routes for oxytocin?

a. Induction/Stimulation of Labor:
b. Postpartum Hemorrhage:
c. Incomplete/Inevitable Abortion:

5. What are the contraindication, side effects, and adverse effects of oxytocin?

6. Complete the following dosage calculation:
a. The physician has ordered 1000 mL Lactated Ringers (LR) with 10 units IV oxytocin. Begin at 1 mU/min and then increase by 1 mU/min every 30 minutes until regular contractions occur. Maximum dose is 20 mU/min.
i. What is the beginning IV rate in mL/hr?
ii. What is the maximum IV rate in mL/hr?

7. What is the indication for Methergine, and what is a normal dose?
a. What are contraindications for Methergine?
b. What are the adverse reactions or possible side effects for Methergine?

8. What interventions would you anticipate in the event of a postpartum hemorrhage (independent and dependent nursing interventions)? List at least 5 interventions in order of priority.

 

Sample Solution

Midline episiotomy

The weeks following birth are a critical period for a woman and her infant, setting the stage for long-term health and well-being. to optimize the health of women and infants, postpartum care should become an ongoing process, rather than a single encounter, with services and support tailored to each woman`s individual needs. The comprehensive postpartum visit should include a full assessment of physical, social, and psychological well-being, including the following domains: mood and emotional well-being; infant care and feeding; sexuality, contraception, and birth spacing; sleep and fatigue; physical recovery from birth; the chronic disease management; and health maintenance.

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