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.
What data from the histories are RELEVANT and have clinical
significance to the nurse? RELEVANT Data from Present Problem:
Clinical Significance: She is group B strep positive so she had
antibiotics before delivery. Her BP is a little low as well. She also got
oxytocin after delivery.
RELEVANT Data from Social History: Clinical Significance: She is a nursing student in her final
year. He boyfriend is there and supportive and she lives with her parents who are also supportive.
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 (PVI) 1 tab PO daily - prevent neural tube defects and help with nutrients
(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.
What data from the histories are RELEVANT and have clinical
significance to the nurse? RELEVANT Data from Present Problem:
Clinical Significance: She is group B strep positive so she had
antibiotics before delivery. Her BP is a little low as well. She also got
oxytocin after delivery.
RELEVANT Data from Social History: Clinical Significance: She is a nursing student in her final
year. He boyfriend is there and supportive and she lives with her parents who are also supportive.
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 (PVI) 1 tab PO daily - prevent neural tube defects and help with nutrients
