Nursing Simulation Scenario: Postpartum Hemorrhage

Summary

This video captures the intense yet vital moments following a woman's labor and delivery. It follows the care provided to Susan Brown, a 28-year-old who experienced a swift delivery and subsequent complications. After a rapid vaginal birth, her postpartum recovery is marked by excessive bleeding due to retained placenta pieces, requiring immediate medical intervention. Throughout the process, various healthcare professionals work together to manage her care, administering pain relief and ensuring her uterus contracts properly. The team addresses her concerns while providing support to both her and her partner, with a focus on resolving the bleeding and stabilizing her condition.

Takeaways

• 😀 The patient, Susan Brown, is a 28-year-old woman who delivered a 9 lb 2 oz baby boy at 6:42 am after a spontaneous rupture of membranes.
• 😀 Susan had a second-degree laceration, which was repaired with local anesthesia after delivery.
• 😀 The baby had an Apgar score of 9 at both 1 and 5 minutes post-delivery, and his birth weight was 9 lb 2 oz (4,173 grams).
• 😀 Susan experienced a spontaneous vaginal delivery and was in active labor when she arrived at the hospital.
• 😀 Initial postpartum vital signs were stable, including temperature 98.8°F, pulse 102, blood pressure 116/72, and respirations 18.
• 😀 The bleeding post-delivery was initially mild (EBL 250 mL), but Susan’s uterus was not contracting properly, leading to further complications.
• 😀 Retained placental tissue was identified as the cause of continued bleeding, requiring manual removal.
• 😀 The healthcare team administered 30 units of Pitocin, IV fluids, and pain relief (ketorolac 30 mg) to help stop the bleeding and manage pain.
• 😀 After the retained placenta was removed, bleeding ceased, and the uterus contracted properly.
• 😀 Ongoing monitoring was performed to track Susan's recovery, with vital signs and uterine tone checked every 15 minutes.
• 😀 Susan’s emotional state was managed with reassurance and communication from the medical team, focusing on her well-being and the baby's health.

Q & A

What is the patient's name and her age?

The patient's name is Susan Brown, and she is 28 years old.

What time did Susan arrive on the unit and what was the state of her labor?

Susan arrived at the unit at 5:30 in active labor. Her membranes ruptured spontaneously at 6:10, and she had a precipitous vaginal delivery at 6:42.

What were the details of the baby's delivery?

The baby was a male weighing 9 pounds 2 ounces (4173 grams). His Apgar scores were 9 and 9, and the estimated blood loss (EBL) during delivery was 250 ml.

What medical interventions were performed after the delivery?

After delivery, Susan received 500 ml of Lactated Ringer's solution and 30 units of Pitocin. She also had a second-degree laceration repaired with local anesthesia and an ice pack applied.

What were Susan's vital signs upon arrival?

Susan's vital signs were as follows: Temperature 98.8°F, pulse 102, blood pressure 116/72, respirations 18, and oxygen saturation 98% on room air.

How did Susan's breastfeeding session go after delivery?

Susan breastfed her baby after delivery, achieving a good latch for 30 minutes.

What complications did Susan experience after delivery?

Susan experienced excessive bleeding due to her uterus not contracting properly, which was caused by retained placenta pieces. The healthcare team had to intervene to stop the bleeding.

How did the medical team manage Susan's bleeding?

The medical team administered 30 units of Pitocin, massaged Susan's uterus, and performed a procedure to remove retained placenta pieces. They also inserted a catheter to help with uterine contraction.

What pain relief was provided to Susan during the procedure?

Susan was given 30 mg of Ketorolac IV push for pain relief while the medical team worked to control the bleeding.

What were the updated vital signs after the procedure?

After the procedure, Susan's vital signs were: Blood pressure 100/60, pulse 120, oxygen saturation 97%, and respirations 22.