What symptoms indicate excessive bleeding after a caesarean section, and what methods are used to control bleeding?

Here are the solutions to the questions:

10. After a caesarian section, which of the following symptoms might indicate that the client is having excessive bleeding?

• Step 1: Evaluate each symptom for its relevance to excessive bleeding.
  • I. Hypotension (low blood pressure) and tachycardia (rapid heart rate) are classic signs of hypovolemic shock, which results from significant blood loss.
  • II. Pain and tenderness in the operative area are common post-surgical symptoms and, while severe pain could indicate a hematoma, they are not primary indicators of excessive bleeding in the same way as vital sign changes.
  • III. Apprehension and restlessness can be signs of decreased oxygenation to the brain or early shock, both of which can be caused by significant blood loss.
• Step 2: Identify the combination of symptoms that best indicates excessive bleeding. Symptoms I and III are direct indicators of systemic response to significant blood loss.

The correct option is C. I and III.

11. In caring for a mother who has been delivered by caesarian section, which of the following are usually employed to keep the uterus contracted and control bleeding?

• Step 1: Assess each method for its role in uterine contraction and bleeding control.
  • I. Oxytocic drugs (e.g., oxytocin) are medications specifically used to stimulate uterine contractions, which compress blood vessels and prevent postpartum hemorrhage. This is a primary method.
  • II. An ice bag to the operative area is used to reduce pain and swelling at the incision site, not to contract the uterus or control internal uterine bleeding.
  • III. A pressure dressing and tight abdominal binder provide support to the incision, reduce swelling, and offer comfort. They do not directly cause uterine contraction or control internal uterine bleeding.
• Step 2: Determine which methods are directly employed for uterine contraction and bleeding control. Only oxytocic drugs directly achieve this.

The correct option is A. I Only.

12. Which of the following is NOT a post episiotomy site care measures to be instituted by the midwife?

• Step 1: Review each option to determine if it is a standard post-episiotomy care measure.
  • A. Discourage early ambulation: Early ambulation (getting up and moving around soon after surgery/delivery) is generally encouraged to prevent complications like deep vein thrombosis (DVT) and promote recovery. Therefore, discouraging it is not a correct measure.
  • B. Ensure perineal care and personal hygiene: This is crucial for preventing infection and promoting healing of the episiotomy site.
  • C. Encourage client to eat balanced diet: Good nutrition is essential for wound healing and overall recovery.
  • D. Keep wound site clean and dry: This is fundamental for preventing infection and facilitating healing.
• Step 2: Identify the option that is not a correct care measure.

The correct option is A. Discourage early ambulation.