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
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
© 2016 Keith Rischer/www.KeithRN.com
, 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.
What data from the histories are RELEVANT and have clinical significance to the nurse?
RELEVANT Data from Present Problem: Clinical Significance:
1. PT is GBS + 1. GBS can be transmitted to the infant even though the
2. PT has been in labor for over 19 mother did receive four doses of penicillin G.
hours 2. Prolonged labor is especially concerning because it increase
3. PTs hemoglobin and hematocrit the mother’s risk for hemorrhaging, infections, and death.
levels are 12.6/38 3. We would see a decrease normally in a laboring woman’s
4. PT’s blood pressure is 110/67 H+H, but in this case we want to monitor them especially
5. PT is producing 50 mL of blood- close considering how long she’s been in labor. It could be
tinged urine indicative of rapid blood loss.
6. PT is having increased feelings of 4. We need to monitor the blood pressure closely as this could
anxiety and physical exhaustion be a sign indicative of rapid blood loss
5. Patient is not peeing enough, and blood-tinged urine
especially can mean anything from a urinary tract infection
to retention of fluid in the bladder. When the bladder is not
emptied sufficiently it can lead to uterus atony which can
lead to a postpartum hemorrhage.
6. As the nurse we will need to provide extra support for the
mother during this time
RELEVANT Data from Social History: Clinical Significance:
1. Is the relationship stable? Is the baby daddy supportive and
1. PT is single but states she still has actively going to provide support once baby is here.
a relationship with the baby 2. Understanding how much support the patient has as
daddy home, what her living situation is like, the responsibilities
2. Lives with parents, who are she has, her employment status, will all impact the types
supportive of resources we as the nurse will want to provide.
What is the RELATIONSHIP of your patient’s past medical history (PMH) and current meds?
(Which medication treats which condition? Draw lines to connect.)
PMH: Home Meds: Pharm. Classification: Expected Outcome:
G1-T1-P0-A0-L1 Prenatal vitamin 1 tab Vitamins Prevention of nutritional
PO daily deficiencies that can impact
© 2016 Keith Rischer/www.KeithRN.com
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
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
© 2016 Keith Rischer/www.KeithRN.com
, 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.
What data from the histories are RELEVANT and have clinical significance to the nurse?
RELEVANT Data from Present Problem: Clinical Significance:
1. PT is GBS + 1. GBS can be transmitted to the infant even though the
2. PT has been in labor for over 19 mother did receive four doses of penicillin G.
hours 2. Prolonged labor is especially concerning because it increase
3. PTs hemoglobin and hematocrit the mother’s risk for hemorrhaging, infections, and death.
levels are 12.6/38 3. We would see a decrease normally in a laboring woman’s
4. PT’s blood pressure is 110/67 H+H, but in this case we want to monitor them especially
5. PT is producing 50 mL of blood- close considering how long she’s been in labor. It could be
tinged urine indicative of rapid blood loss.
6. PT is having increased feelings of 4. We need to monitor the blood pressure closely as this could
anxiety and physical exhaustion be a sign indicative of rapid blood loss
5. Patient is not peeing enough, and blood-tinged urine
especially can mean anything from a urinary tract infection
to retention of fluid in the bladder. When the bladder is not
emptied sufficiently it can lead to uterus atony which can
lead to a postpartum hemorrhage.
6. As the nurse we will need to provide extra support for the
mother during this time
RELEVANT Data from Social History: Clinical Significance:
1. Is the relationship stable? Is the baby daddy supportive and
1. PT is single but states she still has actively going to provide support once baby is here.
a relationship with the baby 2. Understanding how much support the patient has as
daddy home, what her living situation is like, the responsibilities
2. Lives with parents, who are she has, her employment status, will all impact the types
supportive of resources we as the nurse will want to provide.
What is the RELATIONSHIP of your patient’s past medical history (PMH) and current meds?
(Which medication treats which condition? Draw lines to connect.)
PMH: Home Meds: Pharm. Classification: Expected Outcome:
G1-T1-P0-A0-L1 Prenatal vitamin 1 tab Vitamins Prevention of nutritional
PO daily deficiencies that can impact
© 2016 Keith Rischer/www.KeithRN.com
