A nurse is caring for a postpartum patient who has saturated 2 perineal pads in 30 minutes. Fundus is boggy and displaced upward. Which nursing actions are appropriate using the 4 Ts framework? Select all that apply.
Select All That Apply
Choose your responses, then check the answer.
Explanation
4 Ts of postpartum hemorrhage: TONE (uterine atony — 70-80% of PPH; massage, oxytocin, methylergonovine, carboprost, misoprostol; check bladder), TISSUE (retained placenta), TRAUMA (lacerations, hematoma), THROMBIN (coagulopathy — DIC). Choice 1 is dangerous — PPH is a leading cause of maternal mortality; immediate action and provider notification are required, not waiting.
Tone is the FIRST T to evaluate because uterine atony causes 70-80% of PPH. The boggy fundus with displaced position is classic atony often from full bladder. Memorize the uterotonic ladder: oxytocin → methylergonovine (avoid in HTN) → carboprost (avoid in asthma) → misoprostol → tranexamic acid. The "wait and see" trap is fatal in PPH.
Postpartum patient with saturated 2 perineal pads in 30 minutes and boggy upward-displaced fundus. The nurse uses the 4 Ts framework (Tone, Tissue, Trauma, Thrombin) to evaluate postpartum hemorrhage etiology.
4 Ts of PPH — Tone, Tissue, Trauma, Thrombin — systematic evaluation framework for postpartum hemorrhage etiology.
Uterine atony — Boggy uterus failing to contract; 70-80% of PPH; treat with massage, bladder emptying, oxytocin, methylergonovine, carboprost.
Methylergonovine / carboprost cautions — Methylergonovine contraindicated in HTN/preeclampsia; carboprost (Hemabate) contraindicated in asthma.