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Tina Nelson delivered a healthy male infant 6 hours ago. She had a midline episiotomy. This is her third pregnancy. She is now a G3P3003. She had an epidural block for her labor and delivery. She is now admitted to the postpartum unit.

  1. What is important to note in the initial postpartum assessment? Include at least 5 assessments. Why is it important to assess for these things and what do the findings mean?
  2. What are potential indications of a postpartum hemorrhage? List at least three indications.
  3. What would you do if you found a boggy uterus?
  4. What are the normal dose range and administration routes for oxytocin?

a. Induction/Stimulation of Labor:
b. Postpartum Hemorrhage:
c. Incomplete/Inevitable Abortion:

  1. What are the contraindication, side effects, and adverse effects of oxytocin?
  2. Complete the following dosage calculation:
    a. The physician has ordered 1000 mL Lactated Ringers (LR) with 10 units IV oxytocin. Begin at 1 mU/min and then increase by 1 mU/min every 30 minutes until regular contractions occur. Maximum dose is 20 mU/min.
    i. What is the beginning IV rate in mL/hr?
    ii. What is the maximum IV rate in mL/hr?
  3. What is the indication for Methergine, and what is a normal dose?
    a. What are contraindications for Methergine?
    b. What are the adverse reactions or possible side effects for Methergine?
  4. What interventions would you anticipate in the event of a postpartum hemorrhage (independent and dependent nursing interventions)? List at least 5 interventions in order of priority.
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