Nursing Care Plan for Postpartum Hemorrhage

Postpartal hemorrhage is usually defined as the loss of more than 500 ml of blood during or after delivery. It is one of the leading causes of maternal mortality. Hemorrhage may occur early, within the first 24 hr after delivery, or late, up to 28 days postpartum (the end of the puerperium).

NURSING PRIORITIES
1. Maintain or restore circulating volume/tissue perfusion.
2. Prevent complications.
3. Provide information and appropriate support for client/couple.
4. Have plan in place to meet needs after discharge.

DISCHARGE GOALS
1. Tissue perfusion/organ function WNL
2. Complications prevented/resolving
3. Clinical situation and treatment needs understood

Nursing diagnosis for postpartal hemorrhage: Fluid volume deficit may be related to excessive vascular loss possibly evidenced by hypotension, tachycardia, changes in mentation, decreased/concentrated urine, dry skin/mucous membranes, delayed capillary refill.

Desired Outcome: Demonstrate stabilization/improvement in fluid balance as evidenced by stable vital signs, prompt capillary refill, appropriate sensorium, and individually adequate urine output and specific gravity.

Nursing intervention and rationale
1. Review records of pregnancy and labor/delivery, noting causative factors or those contributing to hemorrhagic situation (e.g., lacerations, retained placental fragments, sepsis, abruptio placentae, amniotic fluid emboli, or retention of dead fetus for more than 5 wk).
Rationale: Aids in establishing appropriate plan of care and provides opportunity to prevent or limit developing complications. Note: Approximately20% of early postpartal hemorrhage is related to lacerations of the perineum, vagina, or cervix. Late postpartal hemorrhage is usually caused by abnormal involution of the uterus or retained placental fragments.

2. Assess and record amount, type, and site of bleeding; weigh and count pads; save clots and tissue for evaluation by physician.
Rationale: Estimate of blood loss, venous versus arterial, and presence of clots helps to make a differential diagnosis and determines replacement needs. Note: One gram of increased pad weight is equal to approximately 1 ml of blood loss. Blood losses of more than 1000 ml lead to shock state and increase risk of other complications, e.g., infection, extensive pelvic thrombophlebitis.

3.Assess location of uterus and degree of uterine contractility. Massage boggy uterus with one hand while placing second hand just above the symphysis pubis.
Rationale: Degree of uterine contractility aids in differential diagnosis. Increasing myometrial contractility may decrease blood loss. Placing one hand above symphysis pubis prevents possible uterine inversion
during massage.

4. Note presence of vulvar hematoma; apply ice pack as indicated and observe periodically.
Rationale: Small hematomas may be controlled by ice and rest.

5.Monitor BP, pulse; observe capillary refill, nail beds, and mucous membranes.
Rationale: Hypotension, tachycardia, delayed capillary refill; cyanosis of nail beds, mucous membranes, and lips reflects severe hypovolemia and developing shock. Changes in BP are not detectable until fluid volume has decreased by 30%–50%. Cyanosis is a late sign of
hypoxia. Note: Reports of fatigue, headache, thirst, presence of pallor, orthostatic hypotension may be signs of slow moderate blood loss that may be reported during follow-up visit.

6. Measure hemodynamic parameters, such as central venous pressure (CVP) or pulmonary artery wedge pressure (PAWP), if available.
Rationale: Provides more direct measurement of circulating volume, replacement needs, and response to therapy in severe/life-threatening situations.

7.Institute bedrest with legs elevated 20–30 degrees and trunk horizontal.
Rationale: Bleeding may decrease or cease with reduction in activity. Proper positioning increases venous return, ensuring greater availability of blood to brain and other vital organs.

8. Maintain nothing-by-mouth (NPO) regimen while determining client status/needs.
Rationale: Prevents aspiration of gastric contents in the event that sensorium is altered and/or surgical intervention is required.

9.Measure intake and output, and urine specific gravity, as indicated. Investigate reports of difficulty voiding/emptying bladder.
Rationale: Useful in estimating extent/significance of fluid loss. Adequate perfusion/circulating volume is reflected by output 30–50 ml/hr or greater. Note: Difficulty voiding may occur with hematomas in the upper portion of the vagina causing pressure on the urethra or meatus.

10. Monitor clients with placenta accreta (slight penetration of myometrium by placental tissue), PIH, or abruptio placentae for signs of DIC.
Rationale: Thromboplastin released during attempts at manual removal of the placenta may result in coagulopathy as manifested by continued vaginal bleeding; expistaxis; oozing from incisions, mucous membranes, gums, IV site.

4 comments:

  1. Good Day everyone, just want to share my experience here so you all should be more careful when contacting any herbalist for solution cos majority of the testimonies are fake and were the ones that fooled me.they all uses the same local code number (+234) cos i have been screwed by some of them.My Husband was suffering from Hsv for years and i went everywhere to get useful information that will help cure or suppress the disease.then i came across testimonies of those that took my hard earn money without any useful information or cure but they keep telling stories.about two months ago, a new staff was employed in my place of work and when He heard about my Husband Disease He was so remorseful and told me about Dr Emmanuel.but i felt it was still one of those Internet guys so i didn't call or text Dr Emmanuel. later that week, He asked me if i`ve heard from Dr Emmanuel and he gave me proof and reasons to try.well, lots of thanks to Dr Emmanuel cos as im writing this message, my Husband is CURED through the herbs that Dr Emmanuel sent to us.so after my experience, i decided to save some people from falling to the hands of SCAMS.thx for your time and if you require the service of Dr Emmanuel, you have to reach him via email: nativehealthclinic@gmail.com  or WhatsApp/Call +2348140073965
    you can also reach me on  +1(862) 260-4433  
    he have cure to all kinds of virus and disease,thank you Herpes,Hpv,Wart,Cancer,Hepatitis B,COPD,Brain Tumor Etc

    ReplyDelete
  2. I was diagnosed as HEPATITIS B carrier in 2013 with fibrosis of the
    liver already present. I started on antiviral medications which
    reduced the viral load initially. After a couple of years the virus
    became resistant. I started on HEPATITIS B Herbal treatment from
    ULTIMATE LIFE CLINIC (www.ultimatelifeclinic.com) in March, 2020. Their
    treatment totally reversed the virus. I did another blood test after
    the 6 months long treatment and tested negative to the virus. Amazing
    treatment! This treatment is a breakthrough for all HBV carriers.

    ReplyDelete
  3. What has your government done to help save you from your financial instability? you strive to survive and yet you hear stories of how your leaders have become terror in your entities... is time to make a different. for will have made money, and we have also come to help you out from your long time of financial suffering. clearing of credit card is made available, software for hacking ATM machines, bank to bank hacking and transfer, change your school grade and become something useful in the society. we also have other form of services such as Facebook hack, whats-app hack, twitter hack, i cloud hack, tracking of smart phones, hacking CCTV, installation of software on desktop and PC, snap-chat hack, Skype hack, wire wire, bitcoin account hack, erase your criminal record and be free for ever. database hack and many more. e-mail: cyberhackingcompany@gmail.com for your genuine hacking services and we shock we your findings.  

    ReplyDelete
  4. My name is Olisa Blessing, I am so happy. I never believe I will be this happy again in life. I have worked as an air hostess ( cabin crew ) for 3years but early this year, I lost my job because of this deadly disease called Herpes virus (HSV). I never felt sick or notice any symptoms. Not until the day all workers were asked to bring their doctors report card, that was how I got tested and I found out that I'm HSV positive and that made me lose my job because it was considered as an STD and is an incurable disease. I was so depressed that I started thinking of suicide.
    I explained my situation to an older friend of mine, who often said to me 'a problem shared is a problem half solved. She felt so pity for me that she referred me to Dr. Utu Herbal Cure, that was how I contacted Dr. Utu and got the medication from him and was cured for real.
    I went back to my work a month later with another HSV negative test result and they carried out another test to be very sure and they found out I am negative.
    Finally, the initial test was replaced with a negative result and my position was refurbished with an apology letter and a salary increase.
    Beware of impersonators,
    Dr. Utu can only be reached at:
    drutuherbalcure@gmail.com

    ReplyDelete