Hypovolemia and OB Shock Case Study

CONCEPT: Reproduction NUR 113

Mrs. Bleed is a 29 year old woman who was admitted yesterday, 10/7/10, at 0600 when she went into labor with her first child. She has received routine prenatal care and has had no complications throughout her pregnancy. She delivered a 7 pound 8 ounce baby boy vaginally with no complications at 2300. You pick her up when your shift starts at 0700 on 10/8/10. Her vital signs are as follows: BP 123/86, HR 80, T 36.6, RR 16. Her vital signs over night have ranged from: BP 118-128/75-88, HR 65-86, T 36.4-36.8, RR 12-18. She has scant, red, vaginal discharge on her pad. Her fundus is slightly boggy upon palpation. She states that her pain level is a 2/10 and is not requesting pain medication at this time. Night shift charted that her total urine output was 800 mL for their 12 hour shift. Mom and baby are stable so you move on to your other patients.

1100: Your assessments and charting are done so you go to check in on Mrs. Bleed and check another set of vital signs. She says she’s feeling thirsty and asks for more ice water. She is alert and oriented. Her vital signs are as follows: BP 116/78, HR 95, T 36.6, RR 16. Her skin feels cool and moist. Her capillary refill time is 4 seconds and she’s looking a little pale. Her vaginal discharge is red and scant, not much more than when you last checked it at 0700.

1200: Mrs. Bleed calls out for assistance to the bathroom. You help her stand when a gush of blood runs down her legs and hits the floor. You pull the emergency cord to get more help. Mrs. Bleed says she feels dizzy and light headed. You lay her back down in bed and tell the CNA to get a set of vitals. Her vital signs are: BP 90/60, HR 120 and thready, RR 24, T 36.8. She is pale and appears anxious.

  1. What type of shock is your patient at risk for?
  2. What assessment findings suggested a possible post partum hemorrhage?
  3. What stage of shock is Mrs. Bleed in at 1200?
  4. What nursing care is needed for this patient?
  5. What assessments/medical treatment would you anticipate for this patient?
  6. What labs would you anticipate being ordered?

Developed by Carol Thorn, RN, MS

May use with permission for the purposes of nursing education

If questions/comments, please contact Carol Thorn at