The nurse is massaging a boggy uterus. The uterus does not ...

[Metfan725]

The nurse is massaging a boggy uterus. The uterus does not respond to the massage. Which medication would the nurse expect would be given first:
 
  a. Methergine
  b. Ergotrate
  c. Carboprost
  d. Oxytocin or pitocin

Question 2

Karen, a G2, P1, experienced a precipitous birth 90 minutes ago. Her infant is 4200 grams and a repair of a second-degree laceration was needed following the birth.
 
  As part of the nursing assessment, the nurse discovers that Karen's uterus is boggy. Furthermore, it is noted that Karen's vaginal bleeding has increased. The nurse's most appropriate first action is to:
  a. Assess vital signs including blood pressure and pulse.
  b. Massage the uterine fundus with continual lower segment support.
  c. Measure and document each perineal pad changed in order to assess blood loss.
  d. Ensure appropriate lighting for a perineal repair if it is needed.

[Jayson]

Answer to Question 1

ANS: d
If the cause of the hemorrhage is uterine atony, continual fundal massage with lower uterine segment support is mandatory. While one member of the team massages the fundus, another nurse establishes intravenous access with a large bore needle and administers oxytocic drugs in the following order: oxytocin (Pitocin), followed by methylergonovine (Methergine) or ergonovine (Ergotrate), and carboprost (Hemabate).

Answer to Question 2

ANS: b
As the primary caregiver, the registered nurse may be the first person to identify excessive blood loss and initiate immediate actions. The nurse should first locate the uterine fundus and initiate fundal massage. Nursing actions performed after the massage are frequent vital sign measurements with an automatic device, measuring the length of time it takes for blood loss to saturate a pad, and assessing for bladder distention.

[Metfan725]

Excellent

[tkempin]

Gracias!