Post Partum Unfolding Case Study (2 parts)
CONCEPT: REPRODUCTION
You are receiving the following report from the off going nurse:
Marina Shmirnov is a 28 year old Russian female admitted to the unit a few hours ago
after suffering postpartum hemorrhage after delivery of infant female. Infant was transferred
to NICU due to complications in delivery (GBS +), questionable gestational age and poor Apgar
scores. The baby’s father speaks minimal English with strong Russian accent so it makes it
even more difficult to understand his questions and gauge his understanding of the situation.
Marina lost an estimated 2.5 liters of blood so far and continues to have a small amount
of bright red blood vaginal bleeding. On admission to your unit, her initial hemoglobin and
hematocrit values were 5.9 and 16.2. She has been resuscitated with 6 liters of crystalloid, 4
units PRBC’s, 4 units of plasma and a 6 pack of platelets. Results for latest draw are pending.
Currently she has LR infusing at 200ml/hr. Her vital signs are BP 88/54, HR 102/m, resp. rate
of 28/m, temp of 37.7 C and oxygen saturation of 96% on 2 l/nc.
Fearing the development of DIC and other complications, the medical staff has
discussed the possibility of the patient needing a hysterectomy but she and her husband do not
want to consider that option.
Answer the following questions:
 Are there any ethical, cultural or age-related issues associated with this patient? If so,
what are they?
 What would you anticipate noticing when you walk into the patient’s room?
 What medical treatment/nursing interventions would you anticipate finding on the
plan of care?
 What medications would you anticipate finding on the patient’s medication
administration record (MAR)?
 If you could ask the off-going nurse only 3 questions, what would they be and why?
 If you were going to do a focused assessment on this patient, what would you
concentrate on and why?
 What issues can you identify as being a priority in caring for this patient?
 What are some potential complications that could occur in this patient that the nurse
needs to be aware of/monitor for
 What members of the multi-disciplinary team have been/or will be involved in the
care of the patient in the case study and what was their role?
Developed by Carol Thorn, RN, MS
May use with permission for the purposes of nursing education
If questions/comments, please contact Carol Thorn at cathorn1123@aol.com
Part II
Two hour update:
You go into check on your patient and you find her with respiratory distress, coughing up pink
frothy sputum, her oxygen saturations are 82% on 4 l/nc, heart rate of 126/m with a blood
pressure of 78/45. She is febrile with a temperature of 39.1, cap refill of > 6 seconds and
shows cyanosis in her oral mucous membranes. She is oozing blood from previous puncture
blood draw sites.
Answer the following questions:

What do you think is going on with this patient? What might have caused this
complication?

What additional assessment do you need to perform for this patient?

What lab/diagnostic tests do you believe will be ordered? What do you anticipate them
showing?

What can an RN initially do for this patient?

What do you need to tell the MD what calling him/her? Utilize the SBAR format to
provide information to the physician.
Developed by Carol Thorn, RN, MS
May use with permission for the purposes of nursing education
If questions/comments, please contact Carol Thorn at cathorn1123@aol.com