Postpartum Hemorrhage (PPH) Brenda Jackson, 22 years old

Postpartum Hemorrhage (PPH) Brenda Jackson, 22 years old.Primary Concept Perfusion Interrelated Concepts (In order of emphasis) 1. Clotting 2. Clinical Judgment 3. Patient Education 4. Communication 5. Collaboration © 2016 Keith Rischer/www.KeithRN.com UNFOLDING Reasoning Case Study: Postpartum Hemorrhage (PPH) History of Present Problem: Brenda Jackson is a 22-year-old African American, G-1, now T-1 P -0 A- 0 L-1 who is Group B strep positive and was treated with four doses of penicillin G. She had a vaginal delivery over an intact perineum after 19 hours of labor at 39 weeks gestation. She has been clinically stable and is about to be transferred to the postpartum unit after a two-hour recovery period. Oxytocin 20 units in 1000 mL of Lactated Ringer’s is infusing at a fixed rate of 125 mL/hr in a 20 g. peripheral IV in her left hand. Type and screen done on admission, Hgb 12.6/Hct 38. Her last set of vital signs were:  T: 99.4 F/37.4 C  P: 95  R: 18  BP: 110/67. She has gotten up to void once and had 50 mL of blood-tinged urine. Her fundus is firm at the umbilicus, and has a small amount of dark red lochia. She is physically exhausted and has been anxious since delivery because her labor and delivery were harder than she ever expected. Personal/Social History: Brenda is an advanced nursing student in her final year. She is single and remains in a relationship with her boyfriend, who is also the father of her baby. She lives at home with her parents, who are supportive.