Intervention for low HCT, Hgb, and Lymphocytes

Specialties Ob/Gyn

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If a patient had an emergency c section and their HCT and hgb and lymphocytes have dropped what interventions can be done?

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Specializes in OB-Gyn/Primary Care/Ambulatory Leadership.

I dislike being asked to do your homework for you.

What do YOU think would be appropriate interventions if a pt's H&H have dropped after emergency surgery? What would cause that drop?

This is what they mean by "critical thinking."

We would be doing you no favors by spoon-feeding the answers to you.

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A little hint.... Decreased H/H, blood loss.

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This is what they mean by "critical thinking."

I don't even think this qualifies as critical thinking-- just thinking!

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lol well.hopefully they were typed and crossmatched...and i think you mean platelets not lymphocytes because decreased lymphocytes would not be your priority...o neg on a rapid infuser ffp and massive amounts of replacement fluids as well as dopamin to keep blood pressure up while md determines cause of blood loss..fluid management to prevent hypovolemic shock and eventual cardiac arrest would be my priorties..lol but keep in mind i dont start clinicals until august..im just an er tech...rn in would put in large bore peripheral ivs ..sometimes have seen central lines placed during csection just my two cents..if a real rn reads this i would be curious how far off i am ? lol

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lol well.hopefully they were typed and crossmatched...and i think you mean platelets not lymphocytes because decreased lymphocytes would not be your priority...o neg on a rapid infuser ffp and massive amounts of replacement fluids as well as dopamin to keep blood pressure up while md determines cause of blood loss..fluid management to prevent hypovolemic shock and eventual cardiac arrest would be my priorties..lol but keep in mind i dont start clinicals until august..im just an er tech...rn in would put in large bore peripheral ivs ..sometimes have seen central lines placed during csection just my two cents..if a real rn reads this i would be curious how far off i am ? lol

oh and depending on reason for bleeding a uterine vasoconstrictive like methergine might be given...

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nessajune21- very true. but sometimes you have to point out the obvious.

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Specializes in OB-Gyn/Primary Care/Ambulatory Leadership.
lol well.hopefully they were typed and crossmatched...and i think you mean platelets not lymphocytes because decreased lymphocytes would not be your priority...o neg on a rapid infuser ffp and massive amounts of replacement fluids as well as dopamin to keep blood pressure up while md determines cause of blood loss..fluid management to prevent hypovolemic shock and eventual cardiac arrest would be my priorties..lol but keep in mind i dont start clinicals until august..im just an er tech...rn in would put in large bore peripheral ivs ..sometimes have seen central lines placed during csection just my two cents..if a real rn reads this i would be curious how far off i am ? lol

Real world nursing - you're a bit off. All of those things you describe would be done for postpartum hemorrhage. But for a low H&H after a C/S, probably not that aggressive.

OBs tend to be less aggressive with low H&H than docs on other floors. I've seen a hemoglobin of 6 get discharged home with no interventions, assuming she's asymptomatic.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

You have to know the ENTIRE clinical picture....some people are symptomatic with such drops; others not so affected. What was the H/H and CBC like when they came in? What is going on with your patient? What is her history (hematologic, in particular), Hx of pre-eclampsia, liver problems, bone marrow diseases, etc? There is so much to consider. Knowing the hx and clinical picture fills in those squares and helps you decide what interventions are needed, and what can wait.

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Real world nursing - you're a bit off. All of those things you describe would be done for postpartum hemorrhage. But for a low H&H after a C/S, probably not that aggressive.

OBs tend to be less aggressive with low H&H than docs on other floors. I've seen a hemoglobin of 6 get discharged home with no interventions, assuming she's asymptomatic.

Thanks for the reply.. I really like what if scenarios,,, I have ER on the brain I guess.. too agressive ,,, on a good note... I had a nurse tell me today after she found out I was a student that NCLEX always has a Digoxin question and hers was on how to give a 4mth old PO digoxin.. and the options were with the formula, 2 hours before the formula or immediately after the formula... I thought digoxin=binds to protein , formula=protein so with formula bad...right after formula,,,bad... 2 hours post formula ... opportunity for digestion of proteins to have taken place so... 2 hours before...good.. and I was so proud of myself when she said I was right.. she was surprised because most of the new grads she had asked couldnt answer correctly.. I am so nervous starting clinical seems like I do nothing but read..lol.. and allnurses of course..

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Specializes in OB-Gyn/Primary Care/Ambulatory Leadership.
Thanks for the reply.. I really like what if scenarios,,, I have ER on the brain I guess.. too agressive ,,, on a good note... I had a nurse tell me today after she found out I was a student that NCLEX always has a Digoxin question and hers was on how to give a 4mth old PO digoxin.. and the options were with the formula, 2 hours before the formula or immediately after the formula... I thought digoxin=binds to protein , formula=protein so with formula bad...right after formula,,,bad... 2 hours post formula ... opportunity for digestion of proteins to have taken place so... 2 hours before...good.. and I was so proud of myself when she said I was right.. she was surprised because most of the new grads she had asked couldnt answer correctly.. I am so nervous starting clinical seems like I do nothing but read..lol.. and allnurses of course..

You really sound on top of your game! It seems to me that your critical thinking skills are pretty spot-on (as evidenced by the bleeding scenario above).

It's mostly the difference between textbook nursing and real world nursing. But for purposes of school and passing the NCLEX, you're doing it exactly right - plenty of time to learn bad habits once you're a nurse on your own. ;)

But for a Code White scenario, that detailed and thoughtful answer you gave above was exactly right.

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Specializes in L&D.

The question was what to do if the H&H dropped after the C/S. It always drops after a C/S because there is always blood loss. Since it is expected, it is quite possible that nothing needs to be done. Everyone else has covered very well what to do with PPH or a significant and symptomatic drop in H&H. I just wanted to point out that decrease may also be a perfectly normal and expected outcome.

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