12.07 Meds for PPH (postpartum hemorrhage)

Study Tools

Overview

  1. Stimulate uterine contraction to cause vasoconstriction within the uterine muscle and stop bleeding
    1. They can also cause arterial and coronary artery vasoconstriction

Nursing Points

General

  1. Given immediately  after delivery of placenta
  2. Medications cause vasoconstriction and should be used with caution for patients with hypertension

Assessment

  1. Bleeding
    1. Is the medication working to decrease the bleeding?
    2. Pad counts
  2. Does the patient have hypertension?
    1. Due to vasoconstriction, methylergonovine should not be given to patients with HTN and other medications used with caution
    2. Clarify with MD if patient has any cardiac history
  3. Does the patient have asthma?
    1. Carboprost can cause bronchospasms so contraindicated
    2. Clarify with MD if patient has any history of asthma
  4. Monitoring
    1. Watch for s/s MI, HTN, bradycardia, nausea, dysrhythmias
    2. Monitor VS per order set, especially BP
    3. Monitor hemorrhage and note response to med

Therapeutic Management

  1. Therapeutic management
    1. May need pain meds due to painful, yet necessary, uterine cramping
    2. Hold and clarify if HTN develops
    3. Get baseline vitals before starting

Nursing Concepts

  1. Pharmacology
  2. Safety
  3. Clotting

Patient Education

  1. Expect painful cramping
  2. Necessary to stop or decrease bleeding

Reference Links

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Video Transcript

In this lesson I will explain the medications used for postpartum hemorrhage and your role in administering these.

So the last thing we want is to have our patient deliver and then hemorrhage. So typically immediately after the placenta delivers oxytocin will be given. This will cause uterine contraction and vasoconstriction at the placental site to clot and decrease bleeding. Now what if the patient is still having heavy bleeding? We can give methylergonovine or methergine, carboprost Tromethamine or hemabate. There are extra assessment pieces for these medications so let’s look at that.

So our assessment is going to look at the bleeding. Is there heavy bleeding and we need medication or have we given medications and are they working? Does the patient have hypertension? So all of these medications cause vasoconstriction but methylergonovine should not be given to patients with HTN and is contraindicated. So if your patient has hypertension and is hemorrhaging and the doctor orders methergine just clarify “The patient has hypertension do you still want to give the methergine?” Does the patient have asthma? Carboprost can cause bronchospasms so it is contraindicated with asthma.
Our management will be to treat the patient with pain medications because giving medications that is going to increase uterine contractions will cause pain. Necessary pain but can still offer pain relief. We also want to keep an eye on the blood pressure and monitor for any hypertension. We will educate the patient on what to expect and the importance of using the medication. So it’s going to cause some intense cramping but it is needed to decrease the bleeding.

Onto the concepts. Pharmacology because its medications. Safety because the medications are given for to decrease bleeding and clotting because we need the medications to be given to cause uterine contractions to vasoconstrict and clot off the bleeding.

Let’s review our key points. Methylergonovine or Methergine, Carboprost Tromethamine or hemabate, and Oxytocin or Pitocin are medications used to treat postpartum hemorrhage. They all work to cause uterine contraction and slow bleeding. And remember that methylergonovine should not be used if the patient is hypertensive and Carboprost Tromethamine should not be given to asthmatics.

Make sure you check out the resources attached to this lesson and review the key points. Now, go out and be your best selves today. And, as always, happy nursing.

Read more

  • Question 1 of 7

The nurse is caring for a client on the labor and delivery unit who is prescribed methylergonovine. The nurse knows this medication is given for which of the following reasons? Select all that apply.

  • Question 2 of 7

The nurse is caring for a client with a history of asthma who has just delivered a healthy, ten-pound baby. The mother notifies nursing that she has had some gushing of blood. On assessment she has heavy bleeding and a boggy uterus so the nurse notifies the provider. Which of the following orders given by the provider should the nurse question?

  • Question 3 of 7

A client is given oxytocin after delivery. The nurse knows the medication is successful when which of the following assessments are made? Select all that apply.

  • Question 4 of 7

The nurse is caring for a client who delivered the placenta. Which of the following does the nurse anticipate will be the next order?

  • Question 5 of 7

The nurse is caring for a hypertensive client who is assessed and noted to have a boggy uterus. The nurse starts oxytocin IV and fundal massage but the bleeding is still heavy. The nurse reviews the client’s orders. Which of the following orders is best for this client?

  • Question 6 of 7

Methylergonovine is ordered for a client with postpartum hemorrhage. The nurse is reviewing the client’s history and should notify the provider of which of the following conditions?

  • Question 7 of 7

A high risk pregnant patient has had a complicated delivery and is in the recovery room with active bleeding. The physician has ordered the IV infusion hetastarch in sodium chloride (Hespan). Which best describes the indications for this fluid?

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