QLexNursing

💎 Fundus slightly boggy and displaced to the right:

📌A boggy (soft) uterus indicates uterine atony, the most common cause of postpartum hemorrhage (PPH).

📌When the uterus fails to contract effectively after delivery, blood vessels at the placental site remain open, leading to excessive bleeding.

📌Displacement to the right often signifies bladder distension, which interferes with uterine contraction. The nurse should have the patient void or catheterize if unable to urinate.

📌A firm, midline uterus should be expected postpartum; any deviation signals abnormal uterine tone or bladder issues.

💎 Heavy bleeding with large clots (~300 mL/hour):

📌Normal blood loss after a vaginal delivery is ≤500 mL total, not per hour.

📌Losing 300 mL in one hour is considered abnormally high and meets the criteria for early PPH.

📌The presence of large clots suggests retained placental fragments or uterine atony, both of which require immediate intervention such as uterine massage or oxytocin administration.

📌Ongoing heavy bleeding can quickly lead to hypovolemic shock if untreated.

💎 BP decreased to 98/60 mmHg and HR increased to 108 bpm:

📌A drop in blood pressure with a compensatory rise in heart rate is an early sign of hypovolemia due to excessive blood loss.

📌The body increases the heart rate to maintain perfusion as circulating volume decreases.

📌Continuous monitoring of vital signs is crucial in detecting PPH before severe decompensation (e.g., hypotension, tachycardia >120 bpm, pallor, diaphoresis).

📌Immediate actions include notifying the provider, assessing the uterus, and starting IV fluids or uterotonic medications.

💎 Feeling lightheaded:

📌Lightheadedness or dizziness is a subjective symptom of decreased perfusion to the brain caused by blood loss and reduced circulating volume.

📌It indicates the onset of early hypovolemic shock and must be treated as a warning sign of significant hemorrhage.

📌The nurse should assist the client to lie flat, elevate her legs, and initiate emergency postpartum hemorrhage protocol.

📌Prompt recognition prevents progression to syncope or collapse.