Please respond to at least 2 of your peer’s posts. To ensure that your responses are substantive, use at least two of these prompts:
- Do you agree with your peers’ assessment?
- Take an opposing view to a peer and present a logical argument supporting an alternate opinion.
- Share your thoughts on how you support their opinion and explain why.
- Present new references that support your opinions.
Responses need to address all components of the question, demonstrate critical thinking and analysis and include peer-reviewed journal evidence to support the student’s position.
Please be sure to validate your opinions and ideas with citations and references in APA format.
Please review the rubric to ensure that your response meets the criteria.
1- Daisy Smith
What is the diagnosis?
According to Alexander, et al. (2017), this patient is experiencing late postpartum hemorrhage because she presented 48 hours after discharge from the hospital. Postpartum hemorrhage is defined as blood loss greater than 500 ml for a vaginal delivery and over 1000 ml after cesarean delivery and hemorrhage can be overlooked if it is subtle due to a constant flow of blood. Thus, in this instance, the patient has been passing large clots of blood which was also observed during a pelvic exam. (Alexander, et al., (2017). This patient presented with the following symptoms dizziness, pale or clammy skin, and increased heart rate along with dispelling large clots the size of a fist and sudden bleeding after experiencing lochia which is a sign of postpartum hemorrhage (Cleveland Clinic, 2022).
What is your immediate management plan?
The most important thing is to stop the bleeding and replace blood loss. Blood loss could be replenished by blood transfusion, IV fluid rehydration, medication, or abdominal massage to help the uterus contract (Ogunyemi, 2022). The patient could be given oxytocin which is the most effective treatment for postpartum hemorrhage even if used during labor induction of labor thus, in this patient’s instance, this is not applicable since she is not in the 3rd stage of labor (Alexander, et al., 2017).
What is your subsequent management plan?
Subsequently, I would want to find out what caused the bleeding. According to Alexander, et al. (2017), bleeding could be caused by genital tract laceration after vaginal birth (which is said to be the most common cause), retained tissue from the placenta, or uterine tearing caused by placental adherence to the uterine wall which occurs in placenta percreta and placenta accreta during labor. In this patient’s case, her bleeding occurred post-hospitalization, and she may benefit from antibiotics (Alexander, et al., 2017).
Should an ultrasound be ordered?
Yes, a transvaginal ultrasound with curettage would be necessary and should be ordered to determine if any remnants from the delivery have been left or if there is uterine tearing (Alexander, et al, 2017).
2- Dhara Patel
What is the diagnosis?
The diagnosis based on the clinical scenario is postpartum hemorrhage, given this patient’s presenting symptoms of increased heart rate, heavy vaginal bleeding, cold and clammy extremities, feeling faint when standing up, nausea along with confusion, blurry vision, and weakness (Wormer et al., 2023).
What is your immediate management plan?
This patient is in hypovolemic shock and for acute blood loss, will need IV blood cell transfusion and iron supplementation (Effective Health Care Program, 2019). She also needs IV fluids to correct and stabilize her (Wormer et al., 2023). This should be done first while trying to determine the cause of her bleeding.
What is your subsequent management plan?
The subsequent management plan for this patient includes identifying the cause of postpartum hemorrhage as it could be caused by uterine atony, genital tract lacerations, retained placenta, uterine inversion, abnormal placentation, or coagulation disorders (Wormer et al., 2023). The subsequent management should be directed at the cause of the hemorrhage. For example, if the hemorrhage is caused by uterine atony, then medical management with uterotonic agents (Oxytocin, ergot alkaloids, and prostaglandins) along with external uterine massage and bimanual compression is used as first-line treatments (Wormer et al., 2023; Effective Health Care Program, 2019).). If these techniques do not control the hemorrhage, then uterine tamponade or uterine artery embolization can be used, but the patient has to be stable before attempting the embolization method (Wormer et al., 2023). If genital tract laceration is the cause of the bleeding, then it should be surgically repaired (Wormer et al., 2023). If the bleeding is caused by retained products of conceptions, then it should be removed by dilation and curettage, and the patient should be started on IV antibiotics as it can lead to an infection (Wormer et al., 2023). If the cause of bleed is due to uterine inversion, steady pressure with a fist is used to replace the uterus back into its correct position or surgically via laparotomy, and oxytocin should be given once the uterus is into its normal position (Wormer et al., 2023). If the bleeding is due to coagulation disorders, blood factor VIIa can be used to correct the cause (Effective Health Care Program, 2019).
Should an ultrasound be ordered?
Yes, an ultrasound should be ordered to identify the cause of postpartum bleeding. Evidence suggests that it is the imaging modality of choice in emergency settings for assessing postpartum hemorrhage and pelvic pain (Vardar et al., 2022). Along with imaging modality, lab studies are also needed for the evaluation of this patient (Wormer et al., 2023).