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3A Clinical Scenarios

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Youbin Jo (Jay) Clinical Scenario: 3A Clinical Scenario #1 How would you answer the question? A vaginal exam can increase the risk of infection. Whenever a vaginal exam is done, bacteria can be pushed up the vagina and the cervix. In your case, you are having active vaginal bleeding. I assessed your peri-pad 10 minutes after placing it on you and the pad was fully soaked. You cannot have a vaginal exam because the exam makes more prone to have infection. Nursing diagnoses #1 Deficient fluid volume related to excessive blood loss manifested by soaked full pad in 10 minutes, cool and diaphoretic skin, and decreased blood pressure = 100/60. This patient has been lost a large amount of blood. The patient started …show more content…

Start an IV with 16-18 gauge of needle and administer fluid replacement as an order. Rationale: Signs and symptoms of hypovolemia are cool skin, increased pulse rate, decreased blood pressure, poor muscle tone and oliguria. The patient’s blood pressure drops from 140/80 to 100/60. Also, her skin is cool, pulse rate is 108. In order to correct hypovolemia, rapid fluid replacement may be needed. I also need to use a large bore needle for blood replacement if it is ordered. 2. Obtain blood for type, crossmatch, hemoglobin and hematocrit level test for blood transfusion. Rationale: The patient may need blood transfusion because she shows symptoms of hypovolemic shock. Her pulse is 108, blood pressure drops from baseline 140/80 to 100/60, and cool and clammy skin. She is losing a large amount blood because her peri-pad is fully soaked in 10 minutes. Also, sudden decreased blood pressure indicates a large amount blood loss. Before I transfuse blood to the patient as ordered, I need to know her blood type and crossmatch. Also, hemoglobin and hematocrit levels show if she needs blood transfusion or not. For example, hemoglobin and hematocrit levels will be lower than normal range if she lost a large amount of blood. Normal range of hemoglobin is >11, hematocrit is …show more content…

Monitor the patient’s vital signs and the fetal heart rate tracing to determine side effects of pain medications. Also, evaluate the patient’s pain, including quality, frequency, location and intensity to know if the pain medications work. Rationale: Opioids analgesics are used to manage severe pain. The common side effects of opioid analgesics are respiratory depression in mom and fetus. Symptoms of respiratory depression are decreased respiratory rate, decreased oxygenation saturation, and abnormal fetal heart rate taraicng. It is important to monitor the patient’s vital sign and the fetal heart rate tracing to determine respiratory depression. Also, I would reassess the patient’s pain to know if she needs more pain medications. 3. Provide nonpharmacological pain managements, including, massage, music, and meditation. Rationale: If she can cope with her pain after taking pain medications, I would provide nonpharmacological pain managements. For example, I would ask what relaxation methods she wants. The methods can be reading a book, watching TV, listening to music, applying heat compresses, or massaging the patient.

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