Question

Shortly after the client was admitted to the postpartum unit, the nurse notes heavy lochia rubra with large clots. The nurse should anticipate an order for: A. Methergine B. Stadol C. Magnesium sulfate D. Phenergan

Short answer

Answer: Methergine

Step-by-step solution

Understand the situation

A client is admitted to the postpartum unit with heavy lochia rubra and large clots. Lochia rubra is a type of vaginal discharge that occurs after childbirth, consisting of blood and uterine tissues. Heavy bleeding with clots could indicate a postpartum hemorrhage, which requires immediate intervention.

Review the medication options

We are given four medications to consider: A. Methergine B. Stadol C. Magnesium sulfate D. Phenergan

Determine the purpose of each medication

A. Methergine: This medication is used to prevent and control postpartum hemorrhage by causing the uterus to contract and reduce blood loss. B. Stadol: This medication is an opioid analgesic used to manage moderate to severe pain. C. Magnesium sulfate: This medication is used to prevent seizures in pregnant women with eclampsia or severe preeclampsia. It can also be used as a muscle relaxant and can control high blood pressure. D. Phenergan: This medication is an antihistamine with antiemetic properties, primarily used to treat allergy symptoms or prevent nausea and vomiting.

Identify the most appropriate medication for the situation

Based on the description of each medication and the given situation, Methergine (Option A) is the most appropriate medication. It directly addresses the client's heavy bleeding with clots by promoting uterine contractions and reducing blood loss, which is essential in managing postpartum hemorrhage.

Key concepts

Lochia Rubra

Understanding lochia rubra is crucial in postpartum nursing care. This term refers to the red, bloody discharge that occurs immediately after childbirth, typically lasting for the first few days post-delivery. Composed of blood, uterine tissue, and mucus, it signifies the healing process of the placental site in the uterus.

During this phase, it's normal for the lochia to have small clots, but heavy lochia rubra with large clots can be a sign of a complication such as postpartum hemorrhage (PPH). Nurses must be vigilant and assess the volume, color, consistency, and presence of clots in lochia to detect abnormalities early. Intervention may be needed if the lochia appears excessive or deviates from the expected progression to lochia serosa and lochia alba, which are subsequent phases characterized by paler discharge.

Key Nursing Actions for Monitoring Lochia Rubra:

• Perform regular checks on the quantity and quality of lochia.
• Educate the new mother about what to expect and when to report changes.
• Ensure proper hygiene and change of sanitary pads to prevent infection.

NCLEX-PN Pharmacology

Pharmacological knowledge is a cornerstone of nursing care, and those preparing for the NCLEX-PN must be well-versed in various medications and their purposes. Specifically, in the context of postpartum hemorrhage (PPH) management, understanding the pharmacodynamics and indications of drugs like Methergine is imperative.

Methergine is often the medication of choice for treating heavy postpartum bleeding. It's an ergot alkaloid that acts to stimulate uterine muscle contractions, thereby reducing blood loss. The NCLEX-PN will expect familiarity with this medication, including its mechanism of action, proper dosage, contraindications, and potential side effects such as hypertension and nausea.

Critical Pharmacology Points for NCLEX-PN:

• Know the indications and contraindications for medications used in PPH.
• Understand the side effects and necessary monitoring for drugs like Methergine.
• Be able to identify the signs of effective medication therapy, such as decreased bleeding.

Postpartum Nursing Care

Comprehensive postpartum nursing care is aimed at promoting the health and recovery of the mother following childbirth. A critical part of this care involves monitoring for postpartum hemorrhage, a potential life-threatening condition characterized by excessive blood loss. This requires keen assessment skills and prompt intervention to prevent severe complications.

After childbirth, nurses implement various strategies to assist with uterine involution and reduce bleeding risks. Fundal massages and monitoring vital signs are standard practices. Additionally, educating patients about normal and abnormal postpartum experiences is essential, as they are often the first to notice concerning symptoms such as an increase in lochia or changes in its consistency.

Essentials of Postpartum Nursing Care:

• Perform fundal massage to help the uterus contract smoothly.
• Educate mothers on the importance of rest, nutrition, and hydration.
• Provide support and guidance on infant care and breastfeeding.
• Monitor for signs of infection, pain management, and emotional well-being.