Question

A new mother received epidural anesthesia during labor and had a forceps delivery after pushing 2 hours. At 6 hours PP, her systolic blood pressure has dropped 20 points, her diastolic BP has dropped 10 points, and her pulse is 120 beats per minute. The client is anxious and restless. On further assessment, a vulvar hematoma is verified. After notifying the health care provider, the nurse immediately plans to:

1. Monitor fundal height
2. Apply perineal pressure
3. Prepare the client for surgery.
4. Reassure the client

Answer 1

The nurse should immediately apply perineal pressure after a vulvar hematoma is discovered in a postpartum client with hypotension and tachycardia.

Step-by-step explanation:

A new mother received epidural anesthesia during labor and had a forceps delivery after pushing for 2 hours. At 6 hours postpartum (PP), her systolic blood pressure has dropped 20 points, her diastolic BP has dropped 10 points, and her pulse is 120 beats per minute. The client is anxious and restless, and upon further assessment, a vulvar hematoma is verified. After notifying the health care provider, the nurse's immediate plan should be to: apply perineal pressure. This action is directed at controlling the bleeding associated with the hematoma which is likely causing her symptoms of hypotension and tachycardia. However, preparation for surgery may also be warranted if the hematoma is large or the bleeding is not controlled with conservative measures.