Maternal morbidity and mortality is a national health problem. Preventing complications of pregnancy is included in the 2020 National Health Goals. The purpose of this written assignment is to describe how evidenced based findings can improve patient outcomes related to obstetrical care.
Tanya Kim, 36, G4 P4, was in labor for 36 hours when she had a cesarean birth for a failed induction of labor. She delivered a 9 pound 8 ounce male infant. Tanya’s labor was induced with oxytocin at 41 weeks gestation and continuous epidural was placed during active labor. The epidural was discontinued after delivery. She has iron deficiency anemia but otherwise an unremarkable medical history. She has no known allergies. Her obstetrical history includes 1 spontaneous abortion 6 years ago, vaginal delivery of twins 4 years ago, one singleton vaginal delivery 2 years ago and the cesarean birth today. Tanya plans to breastfeed her infant.
Two hours post-delivery the RN assesses the following:
Vital signs: BP 90/62, pulse 88, Respirations 22, temperature 98.6°F
Skin color: pink
Fundus: boggy, firms with fundal massage, midline and at umbilicus.
Lochia: Heavy rubra with nickel-sized clots
Pain: Uterine cramping rates pain 4 out of 10 on verbal pain scale
Intravenous fluids: 3000 mL Lactated Ringers with 20 units of Pitocin in each bag.
Urinary output: 200 mL since delivery (urinary catheter in place)
Patient comments: “I’m really tired. I have been up for the last two nights.”
One hour later the patient puts her light on and makes the following comment:
“I’m really bleeding a lot!” The RN comes in the room and notes increased vaginal bleeding. The patient is pale, diaphoretic, and the uterine fundus is boggy. The fundus does not firm with massage.

Using APA format, write a 2-3 page paper (excludes cover and reference page) that addresses the following:
Identify at least one (1) risk factor from the patient’s obstetrical history associated with the primary problem. Describe why this piece of obstetrical history places the patient at risk for the identified problem.
Early identification of emergencies in the obstetric setting is essential to save lives. Four (4) approaches are identified in the literature that can be utilized to positively impact patient outcomes: simulations, drills, protocols, vital sign alerts. Select one of these approaches and address the following:
Discuss two (2) benefits and two (2) limitations of the selected approach.
Describe two (2) ways by which this approach will improve patient outcomes in the perinatal setting.
A minimum of two (2) current professional references must be provided. Only one (1) textbook that is no more than one (1) edition old may be used.
Current references include professional publications that reflect nursing care provided within the United States. Current nursing professional references must be current (five [5] years or less). Reliable internet sources such as those offered by government agencies, academic institutions or nationally recognized professional organizations may also be used. Examples of unacceptable internet sources include but are not limited to: Wikipedia,,, and any nursing blog site.
Compose your work using a word processor (or other software as appropriate) and save it frequently to your computer. Use a 12 font size, double space your work and use APA format for citations, references, and overall format.




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