Which of the following signs, if noted, would be an early sign of excessive blood loss in a mother in immedia… - DSSSB - 28 August 2019 (Shift-1)

DSSSB - 28 August 2019 (Shift-1)

Obstetrics & Gynaecology

Medium

Appeared in: DSSSB - 28 August 2019 (Shift-1)

Explanation

Tachycardia (a heart rate over 100 bpm) is a primary compensatory mechanism for hypovolemia.
When blood volume decreases, stroke volume falls. The body increases the heart rate to maintain cardiac output (CO = SV x HR).
This sympathetic nervous system response occurs before blood pressure drops, making it a crucial early indicator of hemorrhage.
The pulse rate increasing from 88 to 102 bpm crosses the clinical threshold for tachycardia, signaling significant distress.

Option A: A drop in blood pressure is a late sign of shock. The body's compensatory mechanisms, like vasoconstriction, maintain blood pressure until significant blood volume (15-30%) is lost. The change shown is also minor.
Option B: While tachypnea (increased respiratory rate) occurs in shock, it is typically a response to developing metabolic acidosis from tissue hypoxia, which happens after the initial cardiovascular compensation. It is a later sign than tachycardia.
Option C: A low-grade fever is common in the first 24 hours postpartum due to dehydration and the exertion of labor. It is not a sign of hemorrhage. A high fever would suggest infection (puerperal sepsis), not blood loss.

Clinical Relevance

Nursing practice connection: Use the key finding related to The concept tested is the early recognition of postpartum hemorrhage (PPH) by identifying the initial physiological compensatory mechanisms to guide bedside assessment, documentation, and the next nursing action.
A nurse's primary responsibility in the immediate postpartum period is to monitor for hemorrhage. Recognizing tachycardia as an early sign allows for prompt intervention before the patient's condition deteriorates into severe shock.
Postpartum hemorrhage is a leading cause of maternal mortality worldwide. Vigilant monitoring of vital signs, uterine tone, and vaginal bleeding is essential for patient safety.
What if? If the patient's pulse was 90 bpm but her blood pressure dropped to 90/50 mmHg, the priority would shift to immediate, aggressive fluid resuscitation and identifying the cause of bleeding. The hypotension indicates that compensatory mechanisms have already failed, representing a more advanced stage of shock than isolated tachycardia.

How to Approach the Question

First, identify the core of the question: it asks for an 'early' sign of postpartum blood loss.
Analyze each option in the context of the body's response to hemorrhage (hypovolemic shock).
Recall the sequence of physiological compensation: The body first tries to maintain perfusion by increasing heart rate. Blood pressure is maintained until compensation fails.
Evaluate Option D: An increase in pulse from 88 to 102 bpm represents tachycardia (>100 bpm), a classic early compensatory sign.
Evaluate Option A: A drop in blood pressure is a late sign of shock, indicating decompensation.
Evaluate Option B: An increased respiratory rate is also a compensatory sign but is typically later than tachycardia.

Concept Tested & Keywords

Concept Tested: The concept tested is the early recognition of postpartum hemorrhage (PPH) by identifying the initial physiological compensatory mechanisms.
Stem keywords: early sign, excessive blood loss, immediate postpartum period
Lead-in keywords: Which of the following
Clinical cues: The question specifies an 'early sign', which is key to differentiating between compensatory changes and signs of decompensation.

QnWD-SWFOMjkoh3OCkGaOC

E6 Obstetrics Williams p. 47-65

E6 Midwifery Obstetrics and Gynecology Nursing Sandeep Kaur p. 1-3