Case Study with NCP: Postpartum Hemorrhage

Postpartum hemorrhage is defined as a loss of blood in the postpartum period of more than 500 mL. The average, spontaneous vaginal birth will typically have a 500 mL blood loss. In cesarean births the average blood loss rises to 800-1000 mL. There is a greater risk of hemorrhage in the first 24 hours after the birth, called primary postpartum hemorrhage. A secondary hemorrhage occurs after the first 24 hours of birth. In the majority of cases the cause of hemorrhage is uterine atony, meaning that the uterus is not contracting enough to control the bleeding at the placental site. Other reasons for a hemorrhage would include retained placental fragments (possibly including a placenta accreta), trauma of some form, like a cervical laceration, uterine inversion or even uterine rupture, and clotting disorders.

Common Signs and Symptoms:

• uncontrolled bleeding
• decreased blood pressure
• increased heart rate
• decrease in the red blood cell count (hematocrit)
• swelling and pain in tissues in the vaginal and perineal area

Conditions that may increase the risk for postpartum hemorrhage include the following:

• placental abruption - the early detachment of the placenta from the uterus.
• placenta previa - the placenta covers or is near the cervical opening.
• overdistended uterus - excessive enlargement of the uterus due to too much amniotic fluid or a large baby, especially with birthweight over 4,000 grams (8.8 pounds).
• multiple pregnancy - more than one placenta and overdistention of the uterus.
• pregnancy-induced hypertension (PIH) - high blood pressure of pregnancy.
• having many previous births
• prolonged labor
• infection
• obesity
• medications to induce labor
• medications to stop contractions (for preterm labor)
• use of forceps or vacuum-assisted delivery
• general anesthesia

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Case Study with NCP: Colorectal Cancer

Colorectal cancer is a disease in which normal cells in the lining of the colon or rectum begin to change, start to grow uncontrollably, and no longer die. These changes usually take years to develop; however, in some cases of hereditary disease, changes can occur within months to years. Both genetic and environmental factors can cause the changes. Initially, the cell growth appears as a benign (noncancerous) polyp that can, over time, become a cancerous tumor. If not treated or removed, a polyp can become a potentially life-threatening cancer. Recognizing and removing precancerous polyps before they become cancer can prevent colorectal cancer.

Predisposing Factors:

• Age above 40 years old
• Diet
• Low in Fiber
• High in fat, protein and refined carbohydrates
• Obesity
• History of chronic constipation
• History of IBD, familial polyposis or colon polyps
• Family history of colon cancer

Most Common Site:

Rectosigmoid area (70%)
Signs and Symptoms:

• Ascending (Right) Colon Cancer
• Occult blood in stool
• Anemia
• Anorexia and weight loss
• Abdominal pain above umbilicus
• Palpable mass
• Distal Colon/Rectal Cancer
• Rectal bleeding
• Changed in bowel habits
• Constipation or Diarrhea
• Pencil or ribbon - shaped stool
• Tenesmus
• Sensation of incomplete bowel emptying

Dukes’s Classification of Colorectal Cancer
Stage A: Confined bowel mucosa, 80-90% 5-year survival rate
Stage B: Invading muscle wall
Stage C: Lymph node involvement
Stage D: Metastases or locally unresectable tumor, less than 5% 5-year survival rate
Guidelines for early detection of Colorectal Cancer

• Digital rectal examination yearly after age 40
• Occult blod test yearly after age 50
• Proctosigmoidoscopy every 5 years after age 50, following 2 negative results of yearly examination

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