homework help ? postpartum hemorrhage

ericninetwo · Oct 31, 2013

hey everyone, new to the site so i wanted to apologize in advance if i'm posting this in the wrong section but i needed some help on my homework and came across this pretty neat page :)

ok so im writing about postpartum hemorrhage for my OB class this semester, specifically about the "interdisciplinary care and teamwork needed" to manage postpartum hemorrhage in an emergency situation..

my question is this - for some reason it is nearly impossible for me to find the exact "procedures" or "teams" that come to deal with postpartum hemorrhage. a lot of the information i am finding are treatments/interventions that nurses can do on behalf of doctors orders of course. so it seems like only nurses/doctors are involved in a patient with postpartum hemorrhage and my teacher is making it real difficult and wont tell me a clear answer. so basically what other team members such as RT or i dont know would come and help deal with a postpartum hemorrhage? what is the procedure in dealing with PPH?

truckinusa, BSN, LPN, RN · Oct 31, 2013

This is just what my books says:

1. Maintain IV access with Lactated Ringers infusion and add a secondary line with 16G catheter for severe loss.

2. Notify blood bank, as indicated; order 4 to 6 units, as needed.

3. Prompt notification and communication to the perinatal team, which includes anesthesia, primary care provider, nursing and operating personnel, as indicated by the patient's condition.

4. Administer medications, as ordered: for uterine atony-IV administration of oxytocin, IM administration of methylergonovine, or prostaglandins administered IM or directly into myometrium during cesearean delivery, or misprostel 200 to 1000 mcg rectally.

5. Bimanual massage of the uterus.

6. Pain medication may be needed to counter uterine contractions.

7. If placental fragments have been retained, curettage of the uterus may be indicated.

8. Assess for undiagnosed lacerations and repair.

9. Emergency hysterectomy may be necessary.

IamSusan · Oct 31, 2013

Postpartum Hemorrhage Algorithm

https://www.cmqcc.org/resources/ob_hemorrhage/protocols_guidelines

Those links should help

in terms of team members it would depend on how severe. It could range from a RN getting orders from an OB ( but, if you want to add team members you could add charge nurse, second RN, ward clerk, tech, pharmacy and lab )

as you progress to more severe you could be calling a rapid response team, add second OB, anesthesiologist, again lab ( and blood bank ), possibly an interventional radiologist, OR crew .. a mother could end up going to the ICU and then you would have a critical care doctor and RN and RT involved. Social worker. It really depends on your hospital policy who is called when but I hope some of that helps you get on the right track!

ericninetwo · Oct 31, 2013

Postpartum Hemorrhage Algorithm
https://www.cmqcc.org/resources/ob_hemorrhage/protocols_guidelines
Those links should help
in terms of team members it would depend on how severe. It could range from a RN getting orders from an OB ( but, if you want to add team members you could add charge nurse, second RN, ward clerk, tech, pharmacy and lab )
as you progress to more severe you could be calling a rapid response team, add second OB, anesthesiologist, again lab ( and blood bank ), possibly an interventional radiologist, OR crew .. a mother could end up going to the ICU and then you would have a critical care doctor and RN and RT involved. Social worker. It really depends on your hospital policy who is called when but I hope some of that helps you get on the right track!

yes ! thank you so much for your input. i was really struggling and had no idea where to even begin. i really really appreciate what you wrote there.

if you wouldnt mind though (pretty please) could you add onto to the first part where you said "but, if you want to add team members you could add charge nurse, second RN, ward clerk, tech, pharmacy and lab "

like if those members did come in what would their role be such as the second rn and charge nurse since all the other members their roles are pretty self explanatory

ericninetwo · Oct 31, 2013

p.s that one site with all the references are great ! thanks so much again

Esme12, ASN, BSN, RN · Oct 31, 2013

Welcome to AN! The largest online nursing community!

Duplicate threads merged as per TOS. Thread moved for best response

IamSusan · Nov 1, 2013

In real life, in my settings, I would put on a call light or emergency light, and ask for another nurse. Often, this would be the charge nurse, who would then notify anyone who needed to come. Let's say you don't have an IV... you aren't set up at all. One nurse would be doing fundal massage, one might be getting the hemorrhage cart ( that's becoming standard), one would be starting an IV, another might be making phone calls. It would all depend upon your unit, resources, and the severity of the bleeding. Normally, you would not need a pharmacist because all OB units should have the meds they need unit, though I suppose I could imagine needing one if for example the pt was a Jehovah's witness, there are "bloodless" protocols but I would need to look that up. But the lab tech might be getting labs like a CBC with platelets, they would be typing and cross matching blood, the ward clerk could be the one calling in resources, filling out requisitions etc, if you have an OB tech she could do the same, she could be weighing blood loss, getting things needed, someone would be putting on O2.... ideally someone would be talking to the family too. It really all depends on the severity and the staff you have. Some small units might be calling in a house supervisor or rapid response... the idea is that you have a predefined plan on your unit of who does what and takes what role depending on severity. There are lots of things in nursing that run on protocols like this, ACLS, NRP... it's actually a great assignment because your instructor has you thinking about how to communicate in an emergency and reprioritize depending on the changing needs of your patient.

( ps never ever forget psych social in nursing school assignments so make sure you include social worker or nurse to explain to family what is going on and get consents etc)

ericninetwo · Nov 1, 2013

In real life, in my settings, I would put on a call light or emergency light, and ask for another nurse. Often, this would be the charge nurse, who would then notify anyone who needed to come. Let's say you don't have an IV... you aren't set up at all. One nurse would be doing fundal massage, one might be getting the hemorrhage cart ( that's becoming standard), one would be starting an IV, another might be making phone calls. It would all depend upon your unit, resources, and the severity of the bleeding. Normally, you would not need a pharmacist because all OB units should have the meds they need unit, though I suppose I could imagine needing one if for example the pt was a Jehovah's witness, there are "bloodless" protocols but I would need to look that up. But the lab tech might be getting labs like a CBC with platelets, they would be typing and cross matching blood, the ward clerk could be the one calling in resources, filling out requisitions etc, if you have an OB tech she could do the same, she could be weighing blood loss, getting things needed, someone would be putting on O2.... ideally someone would be talking to the family too. It really all depends on the severity and the staff you have. Some small units might be calling in a house supervisor or rapid response... the idea is that you have a predefined plan on your unit of who does what and takes what role depending on severity. There are lots of things in nursing that run on protocols like this, ACLS, NRP... it's actually a great assignment because your instructor has you thinking about how to communicate in an emergency and reprioritize depending on the changing needs of your patient.
( ps never ever forget psych social in nursing school assignments so make sure you include social worker or nurse to explain to family what is going on and get consents etc)

i really cant say in words how much this has helped me . thank you again and yes i do agree it is a good assignment after some of the things that you pointed out i can see similar protocols being made in other situations like possibly cardiac like you said ACLS. much blessings to you

RNnicu42 · Nov 3, 2013

Interdisciplinary care and team work is so important during emergency situations, especially PPH. Have you heard of teamSTEPPS? Do some research on this. It is a program that helps staff learn to work together in emergency situations. During a PPH, RT, pharmacy, nurse supervisor, anesthesia, nurses, OB's, and scrub techs all play integral roles. teamSTEPPS is a program that helps all these groups come together and use a common language and pattern to make the situation go as smoothly as possible. It focuses a lot on communcation and level playing field. Emergency situations are high stress and scary but when all members of a team are able to come together and work towards a common goal, outcomes are usually positive.