Simulation Laboratory Activities: Sarah Davies

Following the birth Sarah’s perineum was checked for lacerations. A small tear was found that didn’t require suturing. A slight trickle was noted coming from her vagina. There was a moderate amount of blood on the peripad and it was changed. Sarah had previously indicated her desire to breast feed so Jane was tried on the breast. Sarah expressed a few drops of colostrum from her breast onto her nipple. The sensation of Sarah’s nipple on Jane’s cheek attracted Jane to the nipple. Jane’s mouth opened wide in a seeking response and correctly attached to the breast.

After Jane was fed you perform the initial postnatal check on Sarah. Her vital signs were temperature 37.0º C, pulse 70bpm, BP 120/80. On palpation the fundus was firm and central just below the umbilicus. It was estimated that Sarah had lost approximately 400 mls of blood at the birth. As the birth area was busy Sarah, Bill and Jane were transferred to the postnatal ward one hour after the birth (04:10, 17th October).

You orientate Sarah and Bill to the postnatal ward.

Blood bank phones through Baby Janes blood group result (A +ve). You notify the RMO of the result. The RMO orders Rh D immunoglobulin (anti-D) to be given to prevent potential harm (haemolytic disease of the newborn) for future pregnancies.

Simulation Laboratory Activities

• Revise the skills you may have missed last week
• Identify the differences between the lactating and non-lactating breast model
• Assist Jane with the breastfeed.
• Perform and record a postnatal check on Sarah for day 1.

Findings are: fundus firm, central, well contracted, and at level of umbilicus, lochia (see activity 4), perineum clean and dry, breastfeeding with assistance, breasts soft, nipples NAD, tolerating a normal diet, voided 300mls after catheter removed, bowels not opened, showered with assistance, up and about, attended nappy change class.

• Evaluate Sarah’s lochia and record on the postnatal assessment
• Administer the Rh D immunoglobulin to Sarah as prescribed
• Administer the oral medications as prescribed
• Complete your nursing documentation

Sarah, Bill and Jane were discharged home on Day 3. They will be followed up by the discharge midwife and have been advised to attend their local early childhood clinic.