Post Partum Unfolding Case Study (2 parts)
CONCEPT: REPRODUCTION
You are receiving the following report from the off going nurse:
Marina Shmirnov is a 28 year old Russian female admitted to the unit a few hours ago after suffering postpartum hemorrhage after delivery of infant female. Infant was transferred to NICU due to complications in delivery (GBS +), questionable gestational age and poor Apgar scores. The baby’s father speaks minimal English with strong Russian accent so it makes it even more difficult to understand his questions and gauge his understanding of the situation.
Marina lost an estimated 2.5 liters of blood so far and continues to have a small amount of bright red blood vaginal bleeding. On admission to your unit, her initial hemoglobin and hematocrit values were 5.9 and 16.2. She has been resuscitated with 6 liters of crystalloid, 4 units PRBC’s, 4 units of plasma and a 6 pack of platelets. Results for latest draw are pending. Currently she has LR infusing at 200ml/hr. Her vital signs are BP 88/54, HR 102/m, resp. rate of 28/m, temp of 37.7 C and oxygen saturation of 96% on 2 l/nc.
Fearing the development of DIC and other complications, the medical staff has discussed the possibility of the patient needing a hysterectomy but she and her husband do not want to consider that option.
Answer the following questions:
- Are there any ethical, cultural or age-related issues associated with this patient? If so, what are they?
- What would you anticipate noticing when you walk into the patient’s room?
- What medical treatment/nursing interventions would you anticipate finding on the plan of care?
- What medications would you anticipate finding on the patient’s medication administration record (MAR)?
- If you could ask the off-going nurse only 3 questions, what would they be and why?
- If you were going to do a focused assessment on this patient, what would you concentrate on and why?
- What issues can you identify as being a priority in caring for this patient?
- What are some potential complications that could occur in this patient that the nurse needs to be aware of/monitor for
- What members of the multi-disciplinary team have been/or will be involved in the care of the patient in the case study and what was their role?
Part II
Two hour update:
You go into check on your patient and you find her with respiratory distress, coughing up pink frothy sputum, her oxygen saturations are 82% on 4 l/nc, heart rate of 126/m with a blood pressure of 78/45. She is febrile with a temperature of 39.1, cap refill of > 6 seconds and shows cyanosis in her oral mucous membranes. She is oozing blood from previous puncture blood draw sites.
Answer the following questions:
- What do you think is going on with this patient? What might have caused this complication?
- What additional assessment do you need to perform for this patient?
- What lab/diagnostic tests do you believe will be ordered? What do you anticipate them showing?
- What can an RN initially do for this patient?
- What do you need to tell the MD what calling him/her? Utilize the SBAR format to provide information to the physician.
Developed by Carol Thorn, RN, MS
May use with permission for the purposes of nursing education
If questions/comments, please contact Carol Thorn at