OB Exam with rationale
There is assisting a patient who just delivered a healthy baby boy weighing 7 pounds. Upon cord traction of placenta, she notices a sudden gushing of a large amount of blood and the fundus is no longer palpable in the abdomen. What are useful nursing interventions if uterine inversion is suspected? 1. Administering oxytocic 2. Assess vital signs 3. Discontinue uterotonic drugs 4. Do not attempt to remove the placenta 5. Establish IV access and fluids 2. Assess vital signs 3. Discontinue uterotonic drugs 4. Do not attempt to remove the placenta 5. Establish IV access and fluids Rationale: Never attempt to remove the placenta if it is still attached, because this will only create a larger surface area for bleeding. When an inversion occurs a large amount of blood suddenly gushes from the vagina. The fundus is not palpable in the abdomen. If the loss of blood continues unchecked, the woman will immediately show signs of blood loss. Uterine inversion may occur after the birth if traction is applied to the umbilical cord too soon or if the pressure is applied to the uterine fundus when the uterus is not contracted. Administering an oxytocic drug only compounds the inversion. Uterotonic drugs should be discontinued to allow uterine relaxation for replacement. IV fluids should be commenced to support blood pressure.
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