Question

The patient is a 22-year-old G1P1 who delivered vaginally a healthy 7 lb 8 oz boy approximately 3 hours ago with a midline episiotomy. Fundus is above the umbilicus, lochia is moderate. She has an intravenous infusion with Pitocin 20 units in her right arm. The patient is complaining of an excruciating headache, blurred vision, and epigastric pain that radiates to the upper right quadrant of her abdomen. The patient is also complaining of perineal pain. Her deep tendon reflexes are brisk, and vital signs are: T. 38.2, HR 98, RR. 18, BP 169/102, SpO² = 92%

Physical examination of the patient’s abdomen reveals a boggy uterus, massage done with the expulsion of medium to large clots and small gushes of blood from the vagina. Her right labia is swollen and firm to touch. A retaining urinary catheter was placed with a urinary output measured in the last hour is 25 mL.

Stat laboratory blood was drawn and sent including complete blood count (CBC), liver function test (LFTs), and comprehensive metabolic panel (CMP). The lab results are:

1. CBC: White cell count = 9,000 x 10³; Hemoglobin = 9.2mg/dL; Hematocrit =27.6%; platelets = 8,000 x 10³

2. LFTs: Alanine Aminotransferase (ALT) = 379 IU/L; Aspartate Aminotransferase (AST) = 425 IU/L; Alkaline Phosphatase (ALP) = 380

3. Comprehensive Metabolic Panel: Na = 138 mEq/L; K = 4.9 mEq/L; Calcium = 8.5 mg/dL, carbon dioxide (CO2) = 21 mmol/L; chloride (Cl) = 103 mmol/L; albumin = 4.3 g/dL, total protein = 6.0 g/dL, bilirubin = 0.1m, BUN = 25 mg/dL, Creatinine = 0.6 mg/dL

Questions:

1. What are the nurse’s priorities for this patient?
2. What symptoms and signs should alert the nurse to potential problems that might need immediate intervention?
3. What would be the best way for the nurse to respond to the patient’s condition?
4. What might be the significance of the patient’s perineal pain?
5. Explain the significance of the patient’s laboratory CBC, and LFT results.

Answer 1

Answer q 1

The nurse should provide a women centred approch to care in the post partum period should assist physical and psychological recovery by being focused on the needs of the patient , in this condition there is an increased blood pressure which may leads to post partum pre eclampsia,.If a post partum women present with signs associated with pre eclampsia the nurse should alert to this possibility and under take observation of the blood pressure and urine and obtain the medical advice. The maternal condition should continue to be monitored. provide treatment with anti hypertensive drugs if the blood pressure exceed the level ,provide calm and quite enviornment, Assess the patient for vaginal bleeding , Maintain the intake out put chart ,

Answer q 2

The elevated blood pressure 169/102 ,heart rate 98b/mts needs an immediate intervention, The elevated blood pressure leads to post partum pre eclampsia which shows the symptoms like blurred vision , head ache and epigastric pain . The nurse should be alert for to any of these signs and symptoms of medical assistantce immediately. The aim of the care at this time is to preclude death of the mother and fetus by controlling hypertension ,inhibiting convulsion and preventing coma.

- There is a sharp rise in blood pressure

-Diminished urinary out put ,which is due to vasospasm

-Head ache which is usually severe ,persistent and frontal in location

-visual disturbance such as blurring of vision

-Epigastric pain which may denote liver oedema and impairment of liver function

these all symptoms the nurse should be assessed and need aimmediate intervention

Answer q 4

Regardless of wether the birth resulted in actual perineal trauma and that has required suturing .The most immediate problem that occur soon after the birth is that the women complains of severe perineal pain. The patient likely to feel bruished around the perineal tissue for the few days after the birth . There are several nerves and muscles present in the perineal area ,so if the women who have undergone any degree of actual perineal injury will experiance pain for several days until healing take place. It has been said that the effect of perineal trauma significantly blight the first experiance of motherhood for many women because of the degree of pain experienced and the effect of this on the activity of daily living . moreover the pain may be a result of the analgesia no longer being effective of increased oedema in the surrounding tissue or more seriously of haematoma formation ,, perineal pain also result from the oedema causing the stiches to feel excessively tight . In the lated stage it may be due to infection

Answer q 5

The complete blood count includes the red blood cell count ,haemoglobin count ,haematocrit ,RBC indices,WBC count with or without differential and platelet count .White blood cell count is also known as leukocyte count , The WBC count increase during the first 24 hours of post partum and then it return to the normal.Haemoglobin level is decreased because of the blood loss ,the patient values indicate the post partum anaemia . The haematocrit value indicates the estimated blood lossduring the delivery.The haematocrit level below 26% reveals the estimated blood loss is >500ml.The platelet count may significantly increase from217000 during the post partum period , both normal and preeclamptic pregnencies . The elevated platelet count can be seen in 2-5 days of the post partum period.

The liver function test values indicates the elevated asparate transaminase ,alanine transaminase and alkaline phosphate. the factors are affect the liver function is the mode of delivery , maternal age at the time of delivary , type of analgesia and perineal trauma. The test value are highest immediately after delivery and it reach normal by 10 days ,it is important to notify the values ,inorder to prevent liver related illness such as pre eclampsia.

Answer q 3

The nurse should be alert for the patient condition and the complications ,provide a calm and quite enviornment to the patient . Assess the patient for the subjective symptoms ,monitor the blood pressure , physical assessment and analyse the laborotary values and inform to the doctor to guide the treatment . continously monitor the vital signs . close attention to pre eclamsia symptoms like head ache ,visual changes , epigastric pain and vaginal bleeding .