Medical+Management+Including+Pharmacology

=Medical Management Including Pharmacology = Perry, S., Hockenberry, M., Lowdermilk, D., & Wilson, D. (2010). //Maternal child nursing care//. (4 ed., pp. 576-579). Maryland Heights, MO: Mosby Elsevier.
 * First step is to evaluate the contractility of the uterus.
 * Initial management is a firm massage of the uterine fundus, expression of any clots in the uterus, and eliminating bladder distension.
 * Continuous IV infusion of 10- 40 units of oxytocin in 1000 ml of Ringer's lactate or normal saline solution to contract uterus and decrease bleeding.
 * If the uterus fails to respond to oxytocin, a dose of 0.2 mg ergonovine (Ergotrate) or methylergonovine (Methergine) may be given IM to produce sustained uterine contractions.
 * It is more common to administer 0.25 mg dose of derivative of prostaglandin F2 alpha (carboprost tromethamine) IM to help the uterus contract.
 * Oral 400-800 mg and rectal 1000 mg misoprostol has also been administered.
 * Recombinant factot VIIa may also be useful in managing PPH.
 * Restore circulating blood volume and eliminate the cause of hemorrhage
 * To restore circulating blood volume, a rapid IV infusion of crystalloid solution is given at a rate of 3 ml infused every 1 ml of estimated blood lostt.
 * Pack red blood cells are usually infused if the woman is still actively bleeding and no improvement in her condition is noted after the initial crystalloid infusion.
 * Infusion of fresh frozen plasma may be needed if clotting factors and platelet counts are below normal values.
 * Provide discharge planning instructions:
 * Woman may feel fatigue and exhaustion because of blood loss.
 * Limit activities to conserve strength.
 * Increase dietary iron and protein intake, iron supplements may be ordered.
 * Observe for delayed or insufficient lactation and postpartum depression.
 * Refer to home care or to community resources.