Understanding the NCLEX: A Guide.

By Peter Jumba
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  Understanding the NCLEX: A Guide. Understanding the NCLEX: A Guide. The NCLEX (National Council Licensure Examination) is the high-stakes exam used to determine if a candidate is prepared for entry-level nursing practice. It is developed by the National Council of State Boards of Nursing (NCSBN). There are two versions: NCLEX-RN: For those seeking licensure as a Registered Nurse. NCLEX-PN: For those seeking licensure as a Practical or Vocational Nurse. 1. The Computerized Adaptive Testing (CAT) Format The NCLEX does not function like a traditional paper exam. It uses CAT technology, which means the test adjusts its difficulty based on your performance: Correct Answers: The computer gives you a slightly more difficult question. Incorrect Answers: The computer gives you a slightly easier question. The Goal: The computer wants to determine with 95% certainty that your ability level is above the "passing standard." 2. Next Generation NCLEX (NGN) As of April 2023, the exam shi...
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Post Partum Haemorrhage: Causes, Signs and Symptoms, Treatment Options and Nursing Considerations.

By Peter Jumba

Post Partum Haemorrhage: Causes, Signs and Symptoms, Treatment Options and Nursing Considerations. 

Postpartum haemorrhage (PPH) is a medical emergency. Learn about its causes, signs, symptoms, and the critical nursing care involved in its prevention and treatment.


Source: Google Images.







Postpartum haemorrhage (PPH) is significant bleeding after childbirth, defined as blood loss of 500 mL or more after a vaginal birth or 1000 mL or more after a caesarean section within the first 24 hours (primary PPH) or up to 12 weeks after delivery (secondary PPH). It's a leading cause of maternal mortality worldwide.


Causes of PPH

The primary causes of PPH are often remembered by the "4 Ts":

  • Tone: The most common cause, accounting for about 70-80% of cases, is uterine atony. This occurs when the uterus fails to contract adequately after birth, leaving blood vessels open and bleeding.


  • Trauma: This includes lacerations or tears to the cervix, vagina, or perineum. Hematomas (collections of blood) can also form in these areas.


  • Tissue: Retained placental fragments or a retained placenta can prevent the uterus from contracting fully, leading to bleeding. This can also include placental abnormalities like placenta accreta, where the placenta grows too deeply into the uterine wall.


  • Thrombin: Coagulopathies (blood clotting disorders) can impair the body's ability to stop bleeding. This can be pre-existing or acquired during pregnancy or delivery, such as with disseminated intravascular coagulation (DIC).


Signs and Symptoms:

Early detection is crucial. Key signs and symptoms include:


  • Excessive vaginal bleeding that soaks more than one pad in an hour or is heavier than a normal menstrual period.


  • A boggy (soft, not firm) uterus that doesn't contract even with massage.


  • A drop in blood pressure and an increase in heart rate (tachycardia) as the body attempts to compensate for blood loss.


  • Dizziness or fainting.

  • Pale, clammy, and cool skin.


  • Shortness of breath or feeling weak.


Treatment Options:

Treatment focuses on identifying the cause of the bleeding and addressing it promptly.


  • Uterine Massage: The first-line treatment for uterine atony is a firm fundal massage to encourage uterine contractions.


Medications:


  • Oxytocin: The most common drug used to contract the uterus.


  • Misoprostol: A prostaglandin that also causes uterine contractions.


  • Methylergonovine: A medication that stimulates uterine contractions, but is contraindicated in women with high blood pressure.


  • Carboprost: Another prostaglandin used to contract the uterus.


  • Removal of Retained Tissue: Manual removal of any retained placental fragments or a retained placenta.


Surgical Intervention:


  • Uterine Balloon Tamponade: A balloon is inserted into the uterus and inflated to apply pressure and stop the bleeding.


  • Suturing: Lacerations are repaired with sutures.


  • Hysterectomy: In severe cases where other measures have failed, a hysterectomy (surgical removal of the uterus) may be necessary as a life-saving measure.


Nursing Considerations:

Nursing care is vital for both prevention and management of PPH.


  • Early Recognition and Assessment: Nurses must be vigilant in monitoring the postpartum woman for signs of excessive bleeding. This includes frequent vital signs, fundal checks, and perineal pad counts.


  • Uterine Fundus Massage: Instruct the nurse to massage the uterus firmly until it is firm and contracted.


  • Medication Administration: Administer prescribed medications promptly and monitor for their effects and any side effects.


  • Fluid Resuscitation: Ensure the woman has an IV line to administer fluids and blood products as needed to maintain blood pressure and hydration.


  • Patient and Family Support: Provide emotional support and clear information to the patient and their family during this stressful event.


  • Documentation: Meticulous documentation of all interventions, including vital signs, blood loss estimates, and medication administration, is essential.

If you or a loved one are experiencing heavy bleeding after childbirth, seek immediate medical attention.

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