Early Postpartum Hemorrhage Nursing Care Plan & Management
Description
- Early postpartum hemorrhage is defined as blood loss of 500 mL or more during the first 24 hours after delivery.
- Post partum hemorrhage is the leading cause of maternal death worldwide and a common cause of excessive blood loss during the early postpartum period.
- Approximately 5% of women experience some type of postdelivery hemorrhage.
Etiology
- Major causes of postpartum hemorrhage are uterine atony (responsible for at least 80% of all early postpartum hemorrhages); laceration of cervix, vagina, or perineum; and retained placental fragments.
- Predisposing factors include hypotonic contractions, overdistended uterus, multiparity, large newborn, forceps delivery, and cesarean delivery.
Pathophysiology
- The uterus is unable to contract effectively and maintain hemostasis.
Assessment Findings
Clinical manifestations include:
- Vaginal bleeding.
- Hypotonic uterus.
- Excessive blood loss, which may produce hypotension, thread pulse, pallor, restlessness, dyspnea, and chills.
Nursing Management
1. Assist with appropriate treatment to prevent complications.
- Determine the presence of uterine firmness and location and amount of vaginal bleeding immediately after delivery.
- Measure and record serial maternal vital signs after delivery- every 5 to 15 minutes until stable; increase or decrease the frequency of assessment relative to baseline and amount of bleeding.
- Notify the practitioner of abnormal assessment findings.
- Massage the fundus gently, taking care to support the uterus with the hand just above the symphysis pubis.
- Administer medications as prescribed.
- Keep an accurate pad count (100 mL per saturated pad).
- Assess condition of skin, urine output, and level of consciousness.
2. Provide physical and emotional support.
3. Provide client and family education.
Exam
Postpartum Hemorrhage Practice Exam (PM)*
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Nursing Care Plan
Ineffective Tissue Perfusion
Ineffective Tissue Perfusion: Decreased in the oxygen resulting in the failure to nourish the tissues at the capillary level.
May be related to
- Hypovolemia (a decreased volume of circulating blood in the body).
Possibly evidenced by
- Diminished arterial pulsations, cold extremities.
- Decreased capillary refill.
- Decreased milk production.
- Changes in the vital signs.
- Changes in the neurologic status.
Desired Outcomes
- Patient will demonstrate blood pressure, pulse, arterial blood gasses (ABGs), and Hematocrit/hemoglobin level within the expected range.
- Patient will demonstrate normal hormonal functioning by adequate milk supply for lactation (as appropriate) and resumption of normal menstruation.
Nursing Interventions | Rationale |
---|---|
Monitor vital signs closely; record the degree and duration of any hypovolemic episodes. | Extent of pituitary involvement may be related to the degree and duration of hypotension. A respiratory difficulty may indicate an effort to combat metabolic acidosis. |
Observe the color of the nail beds, gums, tongue and buccal mucosa; Note the temperature of the skin. | With the vasoconstriction compensation and shunting to vital organs, circulation in the peripheral blood vessels is diminished, resulting in cyanosis and cold skin temperatures. |
Evaluate the neurologic status and observe for any behavioral changes. | Changes in the mentation is an early sign of hypoxia. Cyanosis, on the other hand, is a late sign which may not appear until the PO2 levels drop below 50 mm Hg, |
Check the breast at least daily; Inspecting for changes in breast size and the presence or absence of lactation. | Sheehan’s syndrome, also known as postpartum hypopituitarism reduces prolactin levels, resulting in agalactorrhea (absence of lactation) and a decrease in breast tissue. |
Monitor Hemoglobin and hematocrit values before and after blood loss. Check for the height and weight; Assess the nutritional status of the client. | Such values indicate the severity of blood losses. Preexisting poor health status increases the extent of injury brought about by the oxygen deficits. |
Monitor arterial blood gasses (ABGs) and PH levels. | To determine the degree of tissue hypoxia or acidosis, indicating the build uo of lactic acid resulting anaerobic metabolism. |
Administer sodium bicarbonate as indicated. | To correct metabolic acidosis. |
Insert airway; suction as indicated. | Facilitates oxygen administration in presence of retained secretions. |
Provide supplemental oxygen as indicated. | Maximizes available oxygen for circulatory transport to tissues. |
Risk For Infection
Risk For Infection: At increased risk of being invaded by pathogenic organisms.
Risk factors
- Decreased hemoglobin.
- Invasive procedures.
- Stasis of body fluids (lochia).
- Traumatized tissues.
Possibly evidenced by
- [Not applicable]
Desired Outcomes
- Patient will state an understanding of individual causative/risk factors.
- Patient will display white blood cell count and vital signs within expected ranges.
- Patient will display a lochia free odor.
Nursing Interventions | Rationale |
---|---|
Monitor rate of uterine involution and nature and the amount of lochial discharge. | Infection of the uterus delays involution and lengthen the flow of the lochia. |
Observe for signs of fever, chills, body malaise, anorexia, pelvic pain or uterine tenderness. | These symptoms reflect systemic involvement, possibly leading to bacteremia, shock or even death if left untreated. |
Check the episiotomy site and abdominal wound (for caesarian) for signs of edema, erythema, separation of wound edges, purulent drainage. | These indicates localized infection requiring immediate intervention to prevent systemic involvement. |
Check for other possible sources of infection such as urinary tract infection(urinary frequency/pain, cloudy and odoriferous urine), mastitis (swelling, erythema, pain) or respiratory infection (productive cough, purulent sputum, fever). | Differential diagnosis is critical for effective management. |
Teach and demonstrate proper hand-washing and self-care techniques. Review appropriate handling and disposal of contaminated materials (eg., dressings, peripads, linens). | To prevent the spread of infectious organisms. |
Review WBC count, hemoglobin and hematocrit levels. | Increased white blood cell count indicates an infection. Anemia often accompanies infection, delays the wound healing, and weaken the immune system. |
Administer iron supplement as indicated. | To correct anemia. And possibly improves wound healing. |
Obtain a gram’s stain or culture and sensitivity if lochia is noted to have an odiferous smell or purulent wound discharge is observed. | Gram stain identifies the type of infection while cultures and sensitivity identify the specific pathogen and can indicate which antibiotic is suitable to fight the organism. |
Administer IV antibiotics as ordered. | Broad spectrum antibiotic may be ordered until the results from culture and sensitivity is available at which time organism-specific antibiotic may be started. |