Postpartum hemorrhage can occur immediately after birth of the placenta or in the hours and days following birth. Risk factors include grand multiparity (ie, >= 5 births), intrauterine infection, prolonged labor, use of oxytocin during labor, and coagulopathy. A perineal pad that is saturated in <= 1 hour indicates heavy/excessive bleeding, which may lead to hemodynamic compromise if not recognized and corrected with interventions (eg, fundal massage, uterotonics). A client with a high parity who saturated a pad every hour for the past two hours is experiencing excessive bleeding, potentially due to uterine atony. The nurse should immediately assess the client's fundal tone, lochia amount, and vital signs and notify the health care provider (Option 4).
(Option 1) Foul-smelling lochia is a sign of endometritis, a diagnosis that requires further evaluation and antibiotic treatment but is not a priority over hemorrhage.
(Option 2) Venous stasis and hypercoagulability play a role in the development of postpartum deep venous thrombosis (DVT). For clients with a DVT, anticoagulants such as enoxaparin (Lovenox) help prevent pulmonary embolism (PE). Should symptoms of PE (eg, dyspnea, chest pain) occur, immediate assessment is required.
(Option 3) Fever and a red, swollen breast are symptoms of mastitis, a diagnosis that requires antibiotics and breastfeeding support but is not life-threatening.
Educational objective: The nurse should prioritize assessment of clients with signs of immediately life-threatening postpartum complications (eg, hemorrhage, pulmonary embolism). A perineal pad that is saturated in <= 1 hour indicates excessive bleeding and requires immediate assessment to prevent hemodynamic compromise.
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(Option 3) Fever and a red, swollen breast are symptoms of mastitis, a diagnosis that requires antibiotics and breastfeeding support but is not life-threatening.
Educational objective: The nurse should prioritize assessment of clients with signs of immediately life-threatening postpartum complications (eg, hemorrhage, pulmonary embolism). A perineal pad that is saturated in <= 1 hour indicates excessive bleeding and requires immediate assessment to prevent hemodynamic compromise.
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