Case Studies

Ms. Avery is a G6T5P0A1L5 who had a precipitous vaginal birth of a 9-lb baby and is now 5 hours postpartum. She stands up, a large pool of blood hits the floor, and she reports dizziness/light-headedness. What are the immediate nursing actions?

• Call for help/stay with patient

• Assist back to bed safely

• Assess fundus (firm or boggy?)

• Massage fundus if boggy

• Assess lochia amount, color, clots

• Evaluate VS for shock

• Ensure IV access; start fluids

• Prepare for uterotonics (oxytocin, misoprostol)

• Empty bladder (straight cath if needed)

• Initiate postpartum hemorrhage protocol

Ms. Avery is a multipara (G6) with a 9-lb newborn and a precipitous labor. What risk factors for postpartum hemorrhage does she have?

• Grand multiparity (G6 → uterine atony risk)

• Precipitous birth → rapid uterine stretching/not contracting well

• Macrosomic infant (9 lb) → overdistension

• Early ambulation before full stabilization

• Possible hidden atony despite “intact perineum”

Ms. Avery is showing signs of possible postpartum hemorrhage. What medical management should the nurse anticipate?

• IV oxytocin infusion

• Second-line uterotonics: methylergonovine (if BP normal), carboprost, misoprostol

• IV fluids and possible blood products

• STAT CBC/hemoglobin/hematocrit

• Monitor urine output

• Ultrasound for retained placenta if bleeding persists

• Consider uterine tamponade or surgery if unresponsive

Ms. Hart is a 36-year-old postop cesarean patient (48 hours) with a history of two miscarriages, IVF pregnancy, and a sleepy newborn with elevated bilirubin. During discharge teaching she breaks down crying and says, “I'm so exhausted… this isn’t how I imagined.” What therapeutic, supportive response should you give?

• Validate feelings: “Many new mothers feel overwhelmed — you’re not alone.”

• Normalize the difficulty of recovery + newborn care

• Encourage rest, spacing visitors

• Encourage small, realistic goals

• Reinforce that bonding takes time

• Offer lactation consultant support

• Assess for postpartum mood disorders

Ms. Hart is overwhelmed postpartum with a sleepy hyperbilirubinemic baby going home with a bili-blanket. What suggestions can help her cope?

• Limit visitors to allow meaningful rest

• Teach safe use of bili blanket

• Offer partner-assisted feeding/burping

• Encourage cluster feeding and waking techniques

• Provide info on community/home support resources

• Encourage asking for help from family

• Promote skin-to-skin and comforting routines

Ms. Hart is exhausted, tearful, with multiple psychosocial stressors (IVF, C/S, breastfeeding challenges). What should be included in her plan of care?

• Screen for postpartum depression

• Reinforce rest and recovery needs

• Provide emotional support and reassurance

• Lactation support/feeding plan

• Education about newborn jaundice

• Involve partner in care tasks

• Safety teaching for home‌ postpartum recovery

• Provide resource list for mental-health support

Ms. Hart describes emotional overwhelm. Which personal and pregnancy-related factors increase her risk for postpartum depression?

• History of two miscarriages

• Infertility + IVF conception stress

• Surgical birth (C/S)

• Photo-therapy needs for newborn (added stress)

• Breastfeeding difficulties

• Exhaustion + many visitors

• High expectations for “perfect” postpartum experience

The team described Ms. Hart’s induction as a “failed induction.” How could that wording impact her self-esteem?

• Implies she or her body failed

• Can increase guilt or inadequacy

• May worsen PPD risk

• More compassionate wording:
  “The induction did not lead to a safe vaginal delivery, so a C/S was recommended for you and the baby’s health.”

Why is Ms. Avery’s dizziness and sudden large blood loss on standing a red flag for postpartum hemorrhage even though her perineum is intact?

Because most early PPH is due to uterine atony, not lacerations — large gush on standing suggests pooled blood in uterus.

What postpartum assessment findings in Ms. Avery would confirm uterine atony?

• Soft/boggy fundus

• Fundus displaced (usually to the right → bladder distention)

• Heavy lochia, clots

• Tachycardia and hypotension

Why does having a macrosomic baby (9 lb) increase Ms. Avery’s hemorrhage risk?

Uterus becomes overdistended, preventing effective contraction and leading to PPH.

What specific postpartum teaching should Ms. Hart receive regarding a newborn going home with a bili blanket?

• Keep blanket in contact with skin as directed

• Feed frequently to promote bilirubin excretion

• Monitor for worsening jaundice

• Do not remove for long periods except feeding/bathing

• Ensure infant stays warm

What key safety teaching must Ms. Hart receive as a postoperative C/S mom before discharge?

• No heavy lifting > baby’s weight

• Watch incision for redness, drainage, fever

• Pain management schedule

• Increase ambulation gradually to prevent clots

• Support incision when coughing/laughing

Ms. Avery (G6T5P0A1L5) stands up 5 hours postpartum and experiences a large blood gush, dizziness, and light-headedness. What is the priority nursing action?

A. Check her perineum for lacerations
B. Assist her back to bed and assess fundus
C. Notify the provider immediately
D. Offer oral fluids

B
Priority is safety + fundal assessment to determine uterine atony.

Which risk factor in Ms. Avery most strongly predisposes her to postpartum hemorrhage?

A. Intact perineum
B. Term newborn
C. Precipitous delivery
D. Breastfeeding

C
Rapid birth prevents gradual contracting → atony.

Ms. Hart, 36 years old, postop C/S, crying and overwhelmed, with a jaundiced newborn needing a bili blanket. Which nursing statement is most therapeutic?

A. “Don’t worry, this happens to everyone.”
B. “You should be happy your baby is healthy.”
C. “It sounds like this experience has been harder than you expected. Let's talk about what support you need.”
D. “This is normal. You’ll feel better once you get home.”

C
Validates feelings and opens support discussion.

Which finding in Ms. Hart increases her risk of postpartum depression?

A. Apgar scores of 9/9
B. Married with supportive husband
C. IVF pregnancy with history of miscarriages
D. C/S completed 48 hours ago without complication

C
Past pregnancy losses + IVF are major risk factors.

Which nursing intervention should be included in Ms. Hart’s discharge plan for breastfeeding a sleepy jaundiced infant?

A. Avoid waking the baby for feeds
B. Give water between feedings
C. Wake infant every 2–3 hours to feed
D. Delay breastfeeding until bilirubin decreases

C
Frequent feeding reduces bilirubin.