What is the primary purpose of administering oxytocin to a patient during the third stage of labor?

B) To enhance uterine contractions and facilitate placental expulsion

A) To reduce the patient's blood pressure

B) To enhance uterine contractions and facilitate placental expulsion

C) To alleviate the patient's discomfort

D) To increase the newborn's heart rate

In the initial assessment of a patient in the third stage of labor, the nurse notes that the uterus is soft and the placenta has not yet been expelled. What is the most appropriate initial nursing intervention to promote placental expulsion?

B) Perform a gentle fundal massage

A) Administer a blood transfusion

B) Perform a gentle fundal massage

C) Instruct the patient to avoid any movement

D) Apply external fetal monitoring

What is the primary reason for administering oxytocin to a postpartum patient following delivery?

B) To promote uterine contraction and prevent hemorrhage

A) To decrease maternal blood pressure

B) To promote uterine contraction and prevent hemorrhage

C) To increase milk production in lactating mothers

D) To reduce postpartum pain sensations

What is the primary purpose of administering oxytocin to a postpartum patient?

B) To increase uterine contractions

D) To reduce pain during breastfeeding

During the initial postpartum assessment, which finding indicates good uterine tone and reduces the risk of postpartum hemorrhage?

B) A firm fundus at the level of the umbilicus

A) A fundus that is boggy and above the umbilicus

B) A firm fundus at the level of the umbilicus

C) A fundus that is displaced to the right

D) A fundus that is not palpable

What is the primary reason for a nurse to palpate the fundus during the postpartum period?

B) To evaluate the firmness and position of the uterus

A) To assess the mother's pain level

B) To evaluate the firmness and position of the uterus

C) To determine the amount of lochia

D) To check for signs of infection

During the postpartum assessment, which of the following findings is considered a normal physiological change that the nurse should monitor closely?

B) Blood pressure of 116/76 mmHg

C) Respiratory rate of 18 breaths per minute

D) Oxygen saturation of 98% on room air

Which of the following is the most appropriate nursing intervention for a postpartum patient experiencing mild anemia?

C) Advise on a diet rich in iron

A) Encourage increased fluid intake

B) Monitor for signs of infection

C) Advise on a diet rich in iron

Which vital sign change in the patient indicates a favorable response to the nursing interventions?

A) Heart rate returning to baseline

B) Blood pressure remaining stable

C) Respiratory rate remaining normal

D) Oxygen saturation staying at 98%

What is the expected normal finding for uterine involution during the immediate postpartum period?

A) The fundus is firm and located at the umbilicus

B) The fundus is boggy and located above the umbilicus

C) The fundus is firm and located 2 cm below the umbilicus

D) The fundus is boggy and located 2 cm below the umbilicus

3rd stage of labour - Nursing Case Study

Pathophysiology

• Primary mechanism: The third stage of labor involves the separation and expulsion of the placenta from the uterine wall. This process is primarily driven by continued uterine contractions that help shear the placenta away, aided by the natural shrinking of uterine size post-delivery.

• Secondary mechanism: The compression of uterine blood vessels during contractions also plays a crucial role by promoting hemostasis and reducing blood loss. This is facilitated by the uterine muscle fibers interlacing and contracting effectively.

• Key complication: Retained placenta can occur if the placenta does not detach fully or is not expelled, potentially leading to postpartum hemorrhage due to incomplete uterine contraction and continued bleeding from placental sites.

Patient Profile

Demographics:

28-year-old female, teacher

History:

• Key past medical history: No significant past medical history

• Current medications: Prenatal vitamins

• Allergies: None

Current Presentation:

• Chief complaint: In labor, 3rd stage

• Key symptoms: Uterine contractions, passage of placenta

• Vital signs: Blood pressure 120/80 mmHg, heart rate 85 bpm, respiratory rate 18 breaths per minute, temperature 98.6°F, SpO2 98% on room air

Section 1

Initial Assessment Findings:

As the third stage of labor progresses for the 28-year-old patient, the initial assessment reveals that the placenta has not yet been expelled after 15 minutes, which is slightly longer than average, though not uncommon. The nurse notes that the patient's uterine contractions continue, albeit with reduced intensity. The uterus is palpated and felt to be soft, indicating that it is not contracting as effectively as it should to assist with the expulsion of the placenta. The fundus is located at the umbilicus, which suggests that uterine involution is not optimal. The patient reports feeling mild discomfort but remains stable and is not displaying any signs of excessive bleeding.

Vital signs continue to be stable with blood pressure at 118/78 mmHg, heart rate at 88 bpm, respiratory rate at 18 breaths per minute, and SpO2 remaining at 98% on room air. The nurse performs a gentle fundal massage to stimulate uterine contractions and administers a prescribed dose of oxytocin, as per the facility's protocol, to enhance uterine tone and facilitate placental expulsion. The patient is reassured and encouraged to breastfeed her newborn, as this can also stimulate natural oxytocin release, promoting uterine contraction.

With these interventions, the nurse monitors the patient closely for any changes in bleeding or vital signs, as well as signs of the placenta being delivered. The case remains straightforward, with the potential for resolution as the nursing team continues to support the natural physiological processes and address the minor complication of retained placenta promptly. If the situation does not resolve, further assessment and intervention may be necessary, such as manual removal by a healthcare provider.

Section 2

Response to Interventions:

Following the administration of oxytocin and the initiation of fundal massage, the patient begins to experience more effective uterine contractions. Within the next ten minutes, the nurse observes an increase in the intensity and frequency of the contractions, indicating that the interventions are having the desired effect. The patient's fundus, previously soft, is now firm upon palpation, which is a positive sign of improved uterine tone. The patient reports feeling stronger contractions and some pressure, suggesting that the placenta may be ready to be expelled.

The nurse continues to monitor the patient's vital signs closely. Blood pressure remains stable at 116/76 mmHg, heart rate is slightly elevated at 92 bpm due to the increased contraction activity, respiratory rate is steady at 18 breaths per minute, and oxygen saturation is still at 98% on room air. These stable vital signs reassure the nurse that no adverse effects from the interventions have occurred. Additionally, the patient continues to breastfeed her newborn, further promoting natural oxytocin release and assisting with uterine contraction.

Shortly thereafter, the patient feels a noticeable release of pressure, and the nurse observes the delivery of the placenta intact, with no signs of retained fragments. A quick examination of the placenta confirms its completeness, reducing the risk of postpartum hemorrhage. The nurse continues to monitor the patient for any signs of excessive bleeding, but the bleeding is minimal and within normal limits. The successful expulsion of the placenta marks a positive outcome to the minor complication, allowing the patient to transition smoothly into the postpartum period with continued support and monitoring. The nursing team remains alert for any further complications but is optimistic about the patient's recovery and well-being.

Section 3

As the patient transitions into the postpartum period, the nursing team conducts an initial assessment to ensure her continued stability. The nurse checks the patient's vital signs and finds them to be within normal postpartum ranges: blood pressure remains stable at 114/74 mmHg, heart rate has decreased slightly to 88 bpm, respiratory rate is steady at 18 breaths per minute, and oxygen saturation is still at 98% on room air. The nurse also palpates the fundus, which remains firm and positioned at the level of the umbilicus, indicating good uterine tone and reducing the risk of postpartum hemorrhage.

A thorough physical examination reveals that the patient's lochia is rubra, with a moderate flow that is appropriate for this stage of recovery. The patient's perineal area shows mild swelling, which is expected, and she reports mild discomfort that is manageable with ice packs and analgesics as needed. Her episiotomy site, if applicable, appears intact with no signs of infection or dehiscence. The nurse also notes that the patient is able to void without difficulty, and her bladder is not distended, which is crucial to prevent uterine displacement that could lead to increased bleeding.

The nursing team remains vigilant for any new complications, such as signs of infection or unexpected bleeding. They educate the patient on recognizing symptoms of postpartum complications, such as increased bleeding or foul-smelling discharge, and encourage her to report any concerns. The patient expresses understanding and feels reassured by the team's thorough care. As she continues to bond with her newborn and participates in breastfeeding, the natural release of oxytocin further supports uterine contraction and recovery. The team plans to reassess in the next few hours to ensure ongoing stability and to provide continued support and education as the patient progresses through her postpartum journey.

Section 4

As the patient continues her recovery in the postpartum unit, the nursing team conducts a routine reassessment. During this assessment, the nurse notes a slight increase in the patient's heart rate to 92 bpm, which remains within an acceptable postpartum range but warrants close observation. Blood pressure is stable at 116/76 mmHg, and respiratory rate and oxygen saturation are unchanged at 18 breaths per minute and 98% on room air, respectively. The nurse palpates the fundus again, confirming it is still firm and positioned at the level of the umbilicus, maintaining good uterine tone.

The nurse observes the patient's lochia, noticing the flow has increased slightly but remains within normal limits for rubra. However, to ensure comprehensive care, the nurse decides to review the patient’s latest hemoglobin and hematocrit levels, which were taken shortly after delivery. The lab results indicate a mild decrease in hemoglobin to 10.8 g/dL and hematocrit to 32%, slightly lower than expected but not critically low. This decrease is consistent with normal postpartum changes but prompts the nurse to monitor the patient for further signs of anemia, such as fatigue or dizziness, and to encourage a diet rich in iron.

The nursing team also focuses on the patient's pain management. While the patient continues to report mild discomfort in the perineal area, she acknowledges relief with the use of ice packs and prescribed analgesics. The nurse reinforces the importance of regular perineal care to prevent infection and advises on signs of worsening pain or swelling that should be reported immediately. As the patient continues to breastfeed successfully, the team provides additional education on positioning and latch techniques to ensure comfort and effective feeding, which is critical for both maternal recovery and newborn nutrition. The next scheduled assessment will further evaluate the patient's response to these interventions, ensuring she remains on a stable recovery path.

Section 5

As the nursing team continues to monitor the patient's progress, attention is drawn to her response to the interventions, which is crucial for ensuring her smooth recovery. During the next scheduled assessment, the nurse notes that the patient's heart rate has returned to her baseline of 84 bpm, indicating a favorable response to the interventions and close observation. Her blood pressure remains stable at 118/78 mmHg, and her respiratory rate and oxygen saturation continue to be normal at 18 breaths per minute and 98% on room air, respectively. The palpation of the fundus reveals that it is still firm and located at the umbilicus, which reassures the team that uterine involution is progressing well.

The patient's lochia is reassessed, and while the flow remains slightly increased, it is still within the expected range for lochia rubra, with no concerning changes in color or odor. The nursing team takes this opportunity to educate the patient about the normal progression of lochia and what changes might warrant further evaluation, such as an abrupt increase in flow or passage of large clots. Encouragingly, the patient reports feeling less fatigued and denies any dizziness, suggesting that her mild anemia is not impacting her daily functioning significantly. The nurse reiterates the importance of maintaining an iron-rich diet and ensures the patient has access to dietary resources.

The patient continues to experience mild perineal discomfort, but she reports that regular use of ice packs and adherence to prescribed pain management strategies are effective in alleviating her discomfort. The nurse takes this opportunity to reinforce perineal care education and reminds the patient to report any development of new symptoms such as increased pain, redness, or discharge. As the patient successfully breastfeeds, the nurse provides ongoing support and encourages her to continue practicing effective latch techniques, which will enhance her breastfeeding experience and support her infant's nutritional needs. The next assessment will focus on ensuring these positive trends continue, allowing for the patient's safe discharge planning.