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Early Postpartum Hemorrhage Nursing Care Plan & Management

Notes

Description
  1. Early postpartum hemorrhage is defined as class detriment of 500 mL or over during the highest 24 hours behind exhibition.
  2. Post partum hemorrhage is the quantitative aggregater of tender mortality worldwide and a vile aggregater of undue class detriment during the coming postpartum date.
  3. Approximately 5% of women habit some symbol of postexhibition hemorrhage.
Etiology
  1. Major aggregaters of postpartum hemorrhage are uterine atony (lawful for at lowest 80% of all coming postpartum hemorrhages); fracture of cervix, vagina, or perineum; and retained attributental waste-matter.
  2. Predisposing factors embrace hypotonic abridgeions, overhigh-flown uterus, multiparity, liberal newborn, forceps exhibition, and cesarean exhibition.
Pathophysiology
  • The uterus is disqualified to abridge serviceablely and hold hemostasis.
Assessment Findings
Clinical manifestations include:
  1. Vaginal bleeding.
  2. Hypotonic uterus.
  3. Excessive class detriment, which may aggregate hypotension, outoutline pulse, pallor, perturbation, dyspnea, and chills.
Nursing Management
1. Assist delay divert texture to peacerainmate complications.
  • Determine the nearness of uterine determination and dregs and aggregate of vaginal bleeding straightway behind exhibition.
  • Meaabiding and annals serial tender material symptoms behind exhibition- full 5 to 15 microscopics until stable; acception or hitheren the quantity of tribute referring-to to baseoutline and aggregate of bleeding.
  • Notify the practitioner of monstrous tribute findings.
  • Massage the fundus gently, induction anticipateion to livelihood the uterus delay the operative honest over the symphysis pubis.
  • Administer medications as prescribed.
  • Keep an respectful pad number (100 mL per saturated pad).
  • Assess mode of husk, urine output, and flatten of surprise.
2. Provide visible and affecting livelihood. 3. Provide client and extraction teaching.

Exam

Postpartum Hemorrhage Practice Exam (PM)*

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Nursing Prevention Plan


Ineffective Tissue Perfusion

Ineffective Tissue Perfusion: Decreased in the oxygen effecting in the demand to foster the textures at the capillary flatten. May be allied to
  • Hypovolemia (a hitherend dimensions of circulating class in the organization).
Possibly evidenced by
  • Diminished arterial pulsations, indifferent extremities.
  • Decreased capillary furnish.
  • Decreased fix formation.
  • Changes in the material symptoms.
  • Changes in the neurologic standing.
Desired Outcomes
  • Patient get demonsttrounce class urgency, pulse, arterial class gasses (ABGs), and Hematocrit/hemoglobin flatten delayin the expected rank.
  • Patient get demonsttrounce regular hormonal capacitying by protracted fix minister for lactation (as divert) and foreclosure of regular menstruation.
Nursing Interventions Rationale
Monitor material symptoms closely; annals the value and protraction of any hypovolemic episodes. Extent of pituitary involvement may be allied to the value and protraction of hypotension. A respiratory awkwardness may demusic an trial to contention metabolic shrewdosis.
Obbenefit the hue of the nail beds, gums, language and buccal mucosa; Music the atmosphere of the husk. With the vasoconstriction intermissionoration and shunting to material organs, prevalence in the peripheral class vessels is deteriorated, effecting in cyanosis and indifferent husk atmospheres.
Evaluate the neurologic standing and watch for any deportmental substitutes. Changes in the mentation is an coming symptom of hypoxia. Cyanosis, on the other operative, is a spent symptom which may not answer until the PO2 flattens percolate underneath 50 mm Hg,
Check the confront at lowest daily; Inspecting for substitutes in confront bigness and the nearness or scantiness of lactation. Sheehan’s syndrome, besides unreserved as postpartum hypopituitarism classifys prolactin levels, effecting in agalactorrhea (scantiness of lactation) and a hitheren in confront texture.
Monitor Hemoglobin and hematocrit values precedently and behind class detriment. Restrain for the apex and perpendt; Assess the alimentational standing of the client. Such values demusic the injustice of class detrimentes. Preexisting indigent sanity standing acceptions the space of damnification brought environing by the oxygen deficits.
Monitor arterial class gasses (ABGs) and PH flattens. To detail the value of texture hypoxia or shrewdosis, indicating the set-up uo of lactic shrewd effecting anaerobic metabolism.
Administer sodium bicarbonate as denoted. To amend metabolic shrewdosis.
Insert airway; suction as denoted. Facilitates oxygen government in nearness of retained secretions.
Provide additional oxygen as denoted. Maximizes suited oxygen for circulatory rapture to textures.

Risk For Infection

Risk For Infection: At acceptiond destroy of substance invaded by pathogenic organisms.
Risk factors
  • Decreased hemoglobin.
  • Invasive acts.
  • Stasis of organization runnings (lochia).
  • Traumatized textures.
Possibly evidenced by
  • [Not ry]
Desired Outcomes
  • Patient get state an agreement of inequittalented causative/destroy factors.
  • Patient get exhibit unspotted class cell number and material symptoms delayin expected ranks.
  • Patient get exhibit a lochia unoccupied effluvium.
Nursing Interventions Rationale
Monitor trounce of uterine involution and character and the aggregate of lochial dismiss. Infection of the uterus delays complication and procovet the run of the lochia.
Observe for symptoms of fever, chills, organization malaise, anorexia, pelvic denial or uterine benefit. These symptoms ruminate systemic involvement, haply quantitative to bacteremia, appall or uniform mortality if left untreated.
Check the episiotomy residence and abdominal irritate (for caesarian) for symptoms of edema, erythema, disunion of irritate edges, feculent drainage. These denotes localized poison requiring next intercession to peacerainmate ruleic involvement.
Check for other likely objects of poison such as urinary believe poison(urinary quantity/pain, stolid and effluviumiferous urine), mastitis (swelling, erythema, denial) or respiratory poison (productive cough, feculent sputum, fervor). Differential idiosyncraticity is ticklish for servicetalented matter.
Teach and demonsttrounce right operative-washing and stubborn-prevention techniques. Reexamination divert operativeling and dispensation of vitiated materials (eg., dressings, peripads, outlinens). To peacerainmate the disseminate of infectious organisms.
Reexamination WBC number, hemoglobin and hematocrit flattens. Increased unspotted class cell number denotes an poison. Anemia repeatedly accompanies poison, delays the irritate salutary, and enervate the immune rule.
Administer iron addition as denoted. To amend anemia. And haply improves irritate salutary.
Obtain a gram’s dye or cultivation and sensitivity if lochia is glorious to accept an odiferous smell or feculent irritate dismiss is watchd. Gram dye identifies the symbol of poison date cultivations and sensitivity realize the inequittalented pathogen and can demusic which antibiotic is decent to struggle the organism.
Administer IV antibiotics as ordered. Broad spectrum antibiotic may be ordered until the proceeds from cultivation and sensitivity is suited at which occasion organism-inequittalented antibiotic may be launched.


Deficient Running Volume (isotonic)

Deficient Running Volume: It is defined as hitherend intravascular, interstitial, and intracellular running.
May be allied to
  • Excessive class detriment behind race.
Possibly evidenced by
  • Changes in the hypercorporeal standing.
  • Concentrated urine.
  • Delayed capillary furnish.
  • Decrease in the red class cell number (hematocrit).
  • Decrease class urgency (hypotension).
  • Dry husk/mucous membrane.
  • Increase courage trounce (tachycardia).
Desired Outcomes
  • Patient get hold a class urgency of at lowest 100/60 mm Hg.
  • Patient get hold a pulse trounce betwixt 70-90 beats per microscopic.
  • Patient get accept a redressd 24-hour intake and output.
  • Patient get accept a sensitive standing delayin expected rank.
  • Patient get accept a lochia run of hither than one saturated perineal pad per hour.
  • Patient get demonsttrounce progress in the running redress as evidenced by a amitalented capillary furnish, protracted urine output, and husk turgor.
Nursing Interventions Rationale Assess and annals the symbol, aggregate, and residence of the bleeding; Number and perpend perineal pads and if likely rescue class clots to be evaluated by the physician. The aggregate of class detriment and the nearness of class clots get aid to detail the divert redemption demand of the resigned. Assess the dregs of the uterus and value of the abridgeility of the uterus/ Massage boggy uterus using one operative and attribute the neutralize operative over the symphysis pubis. The value of the abridgeility of the uterus get appestablish the standing of the class detriment. Placing one operative honest over the symphysis pubis get peacerainmate likely uterine permutation during a massage. Reexamination the annalss and music convinced modes such as retained attributental waste-matter, any fracture, abruptio placenta, etc. This get aid in determining the matter of the lie thus peacerainmateing further complications. Monitor material symptoms including systolic and diastolic class urgency, pulse and courage trounce. Restrain for the capillary furnish and watch nail beds and mucous membranes. Increased courage trounce, low class urgency, cyanosis, deceased capillary furnish denotes hypovolemia and hovering appall. Curtail running dimensions of 30-50% get ruminate substitutes in the class urgency. Note for the nearness of vulvar hematoma and apfaction an ice throng if denoted. Small hematoma can be controld by an ice throng and peace. Meaabiding a 24-hour intake and output. Watch for symptoms of nulling awkwardness. This get aid in determining the running detriment.A urine output of 30-50 ml/hr or over denotes an protracted circulating dimensions. Voiding awkwardness may arise delay hematomas in the loftier faction of the vagina causing urgency in the urethra. Obbenefit for reputes of perennial perineal pain or sensibility of vaginal repletion. Apfaction numbererurgency on labial or perineal fractures. Hematomas repeatedly effect from continued bleeding from fracture of the race canal. Use foresight when performing vaginal and rectal criterions. May acception hemorrhage if cervical, vaginal, or perineal fractures or hematomas are confer-upon. Note: Careful criterion may be required to adviser standing of the hematoma. Monitor clients delay attributenta accreta (mode that arises when class vessels and other body of the attributenta extend too heartfeltly into the uterine bastion.), PIH or abruptio attributenta for symptoms of Disseminated intravascular coagulation (DIC). Thromboplastin acquitd during attempts at manual oplie of the attributenta may effect in coagulopathy as manifested by continued vaginal bleeding; epistaxis; oozing from incisions, mucous membranes, gums, IV residence. Meaabiding hemodynamic parameters embrace accessible venous urgency (CVP) or pulmonary artery wedge urgency (PAWP)  if suited. This get cater straightforward appraisement of circulating dimensions, redemption demands, and acceptance to therapy in accident of a spirit-threatening lies. Maintain a nothing-by-mouth standing (NPO) date assessing client standing. This get peacerainmate aspiration of gastric deviation in accident that the hypercorporeal standing is adulterated and besides if a surgical matter is required. Maintain a bed peace delay an amelioration of the legs by 20-30° and stem insipid. The lie acceptions venous revert, making abiding a superior availforce of class to the brain and other material organs. Bleeding may be hitherend delay the bed peace. Start  1 or 2 IV instrument(s) of isotonic or electrolyte runnings delay an 18-gauge catheter or via a accessible venous outline. Administer cool unadulterated class or other class products (e.g., platelet assemble, plasma, cryoprecipitate) as denoted This is main for swift or multiple instruments of runnings or class products to acception circulating dimensions and improve clotting. Note: Each idiosyncratic of unadulterated class acceptions the hematocrit flatten by  three percentage objects. Administer medications as ordered:
  • Oxytocin (Pitocin, Methylergonovinemaleate (Methergine), Prostaglandin F2a (Prostin 15M);
Increases abridgeility of the boggy uterus and myometrium, closes off laagered venous sinuses, and plugs hemorrhage in the nearness of atony.
  • Antibiotic therapy (naturalized on cultivation and sensitivity of the lochia)
 Antibiotics act as prophylaxis to peacerainmate infection or may be demanded for an poison that aggregaterd or contributed to uterine subcomplication or hemorrhage. Insertion of implicit Foley catheter (IFC). This get cater an respectful appraisement of the renal standing and perfusion delay compliments to running dimensions. Note: Urgency on the urethra may clog urine run/cause bladder distention if vaginal throngs are inserted. Insertion of a liberal implicit catheter into the cervical canal. Insertion of an implicit catheter into the cervical canal and injecting the balloon delay 60 ml of a saoutline answer that acts as a tamponade accept some reputes of good-fortune in limiting the hemorrhage aggregaterd by elongation of the attributenta into a noncontractile cervical part. Monitor striveatory values as deexalted such as:
  • Hemoglobin and Hematocrit.
  • Hgb and Hct detail the aggregate of class detriment. Each milliliter of class carries 0.5 mg of hemoglobin.
  • Platelet number, activated peculiar thromboplastin occasion (APTT), fibrinogen and Fibrin suspension products (FDP).
Measures injustice of Disseminated intravascular coagulation (DIC); details redemption demands and proceeds of therapy. Prepare for surgical intercession if denoted; e.g., clearance of hematoma and ligation of a bleeding object, fracture or episiotomy extension, D & C, abdominal hysterectomy or bilateral ligation of hypogastric artery. Surgical recover of fractures/episiotomy, clearance of hematoma and oplie of retained textures get plug the bleeding;Immediate abdominal hysterectomy is deexalted for the monstrously comrade attributenta. Note: D & C may not be deexalted if thither is a institution that the act may traumatize the elongation residence and acception bleeding. Assist delay acts as deexalted such as manual disunion and oplie of attributenta. Hemorrhage plugs uniformly attributental waste-matter are removed and uterus abridges, bankruptcy venous sinuses. Uterine redemption or thronging if permutation seems environing to revert. Replacement of the uterus allows it to abridge, bankruptcy venous sinuses and curbling the bleeding.

Risk for Excess Running Volume

Risk for Excess Running Volume: Defined as increased isotonic running discontent.
Risk factors
  • Excessive/swift redemption of running detrimentes, intravascular running shifts (PIH).
Possibly evidenced by
  • [Not ry]
Desired Outcomes
  • Patient get demonsttrounce pulse, class urgency, urine inequittalented priggishness and neurologic symptoms delayin expected ranks and delayout any respiratory complications.
Nursing Interventions Rationale
Assess neurologic standing, observing for any deportmental substitutes and increasing fretful episodes. Changes in the neurologic standing or deportment may benefit as coming symptoms of cerebral edema aggregaterd by the running discontent.
Monitor for symptoms of hypertension and tachycardia; Watch for symptoms of dyspnea; Auscultate for symptoms of stridor, rhonchi or entertaining crackles. Symptoms of circulatory overinculpate and respiratory difficulties may arise as a effect of undue running redemption.
Monitor for the intake/output, urine inequittalented priggishness if denoted. Restrain the instrument trounce of the runnings manually or preferably through the use of instrument pumps. With the stabilization of running flattens, intake should approximate/equal to the output; Urine inequittalented priggishness proceeds substitute inversely to output so that as kidney capacity improves, inequittalented priggishness readings hitherens, and sin versa. Note: In the client delay glomerular spasms aggregaterd by pregnancy-induced hypertension (PIH), the output may classify until extracellular runnings revert to the open prevalence.
Monitor the hematocrit flattens. As plasma dimensions is peaceored, the hematocrit flatten hitherens.


Risk For Pain

Risk For Pain: Defined as an acceptiond destroy of having an unlively sensory and affecting habit aeminence from germinative texture detriment.
Risk factors
  • Tissue detriment.
Possibly evidenced by
  • [Not ry]
Desired Outcomes
  • Patient get realize divert modes to cater succor from denial.
  • Patient get demonsttrounce use of unbendation skills and diversional activities as denoted.
  • Patient get verbalize succor from denial and trouble.
Nursing Interventions Rationale
Assess subjective aggregaters of denial and trouble. Emergency lies may precipitate fear, anxiety which can establish sight of denial and trouble.
Perform denial tribute by realizeing the symbol, dregs, diagnosis, injustice, and protraction of the denial. Use a denial lamina of 0-10; This get aid in differential idiosyncraticity and in determining the ry texture mode.
Encourage the use of unbendation techniques (e.g., heartfelt stay apposition) and diversional activities (e.g., watching TV). To co-operate-delay the client in exploring modes for the curb of denial.
Provide stubborn-approval appraises such as aplie of ice throng into the perineum, use of sitz bath or fever lamp to episiotomy extension. Ice compact hitherens edema and minimizes hematoma and denial surprise date fever prefers vasodilation which smooths resorption of hematoma.
Administer denial medication (analgesic, opiate or allaying) as prescribed. Decreases denial and misgiving; Helps prefer unbendation.

Risk for Altered Parent-Infant Attachment

Risk for Altered Parent-Infant Attachment: Defined as a alienation of the interactive way betwixt a framer and infant that prefer the product of a protective and proped reflexive homogeneity.
May be allied to
  • Anxiety associated delay the framer role.
  • Inforce of framers to pledge indivisible demands.
  • Interruption in the bonding way.
  • Physical barriers.
  • Perceived intimidation to own continuance.
Possibly evidenced by
  • [not ry]
Desired Outcomes
  • Parent get pointed stubborn-approval delay the framering role.
  • Parent get usurp calling for the visible and affecting weal of the infant.
  • Parent get demonsttrounce divert deportments associated delay dogmatical charity to the infant.
  • Parent get pledge in mutually satisfying interaction delay the offshoot.
Nursing Interventions Rationale
Discuss client’s examination of infant anticipateion responsibilities and framering role. To cater counsel environing how a client observe these role substitutes that get aid in realizeing areas of letters demand.
Explain the factors that guide to the disunion of woman and infant brought environing by the postpartum hemorrhage. To minimize misgiving and sensibilitys of aidlessness allied to the woman’s want to usurp the role expected to her.
Provide counsel touching the use of sympathy instrument and delay follow-up sanity anticipateion referrals such as well-baby clinics, framering classes. To classify misgiving and reinforce dogmatical counsel previously abandoned by the sanity team. Promotes pride and indivisible extendth.
Encourage aplie delay infant (e.g.,photos, counsel from the other fellow-creatures who accept seen the infant) until the client can see and set-on-foot to anticipateion for the infant. To reasabiding the woman of the sanity standing of the infant and of the right anticipateion substance abandoned to the infant.
Evaluate the charity way, bonding deportments, and framering talent uniformly client usurps anticipateion of her infant. To cater counsel on the visible, subjective and physiological capabilities of the framer.

Anxiety

Anxiety: Defined as the disturbed sensibility of trouble or shuddering accompanied by an autonomic acceptance (the object repeatedly noninequittalented or ununreserved to the inequitable).
May be allied to
  • Situational/maturational crisis.
  • Interindivisible transmission.
  • Threat of substitute in the sanity standing.
  • Physiological factors (acquit of catecholamines, refuse therapy).
  • Unmet demands.
Possibly evidenced by
  • Increased insight, irregularity, sensibilitys of aidlessness.
  • Expressed institutions due to the substitutes in the spirit uniformts.
  • Sympathetic stimulation.
  • Restlessness and distressed.
  • Preoccupation; adulterated observation.
Desired Outcomes
  • Patient get verbalizes awareness of sensibilitys of misgiving.
  • Patient get realize sanity ways to traffic delay and pointed misgiving.
  • Patient get answer unbended, and can talented to repose divertly.
  • Patient get repute hitherend misgiving episodes.
Nursing Interventions Rationale
Encourage the client and or the extraction to realize sensibilitys of misgiving. Verbalization of misgiving caters an occasion to exonerate counsel, amend misconceptions and compel perspective, facilitating the whole-solving way.
Stay delay the client by providing a appease, empathic and livelihoodive posture. To aid in business affecting curb in acceptance to the changing physiological standing. Helps in hitherening interindivisible transmission of sensibilitys.
Provide counsel environing the texture cheer and serviceableness of the intercessions. Giving respectful counsel can hitheren the misgiving and to realize what is substantiality naturalized.
Assist in enucleateing skills (e.g.,awareness of denying ideas, declaration “Stop” and replacing it delay a dogmatical idea). To elucidate denying ideas and to prefer wellness.
Evaluate physiological acceptance to postpartum hemorrhage (e.g. perturbation, sensibility, tachypnea, tachycardia, hypotension) Changes in the material symptoms may be due to physiologic acceptances, but they can be cogent by subjective factors.
Evaluate the subjective acceptance of the client to the postpartum hemorrhage and sight of the uniformts ariseing. This can aid in determining the project of anticipateion. Client’s examination of the uniformt may be distorted, irritant her flattens of misgiving.

Deficient Knowledge

Deficient Knowledge: Absence of sensitive counsel allied to the inequittalented question.
May be allied to
  • Cognitive shyness.
  • Unfamiliarity delay counsel instrument.
  • Lack of expoabiding to counsel.
Possibly evidenced by
  • Statement of misconceptions.
  • Request for counsel demanded.
  • Indivert deportments.
Desired Outcomes
  • Patient get have-a-share in the letters way.
  • Patient get verbalize in single-minded circumstancess the pathophysiology, symptoms and symptoms and implications of her ailment mode.
  • Patient get realize behaviors and spiritstyle substitutes to improve vindication.
Nursing Interventions Rationale
Assess the client’s flatten of attainments, force to glean. Talk and hearken to the client in a appease demeanor. Cater occasion for questions and precipitations. Provides counsel expedient to enucleate an inequittalented project of anticipateion and pledge in whole-solving techniques. Reduces misgiving and stress, which can stop letters, and caters precipitation and iteration  to improve agreement.
Explain predisposing factors and texture allied to the aggregater of hemorrhage. To cater counsel in aiding the client contend up delay the lie.
Instruct the client to repute want to confrontfeed, fatigue, amenorrhea, detriment of pubic/axillary hair, crude aging and genital atrophy. These are the symptoms of Sheehan’s syndrome which is aggregaterd by the destruction of cells of the introductory pituitary gland by oxygen languishment, usually at the occasion of offshootbirth. The mode may besides effect from septic appall, or a mighty hemorrhage. It repeatedly proceeds in crude aging, irreversible fertility, hitherend oplie to poison,  or acceptiond destroy of appall.
Determine the availforce of indivisible instrument/livelihood bunchs. Explain the moment of having an protracted peace, sanityy stay and pacing of activities. Fatigue allied to hemorrhage get lingering down the client’s foreclosure of regular activities, necessitating whole solving and dependence on others for a date of occasion.
Explain inadequate expression implications of postpartum hemorrhage such as an gap in the way of woman-infant bonding and want to usurp anticipateion of stubborn and infant as promptly as desired. It can classify misgiving and caters a realistic occasion mould for foreclosure of bonding and infant/self-prevention activities.
Explain covet expression implications of postpartum hemorrhage such as uterine atony, infertility if hysterectomy is executed, or destroy of having a postpartum hemorrhage in the coming pregnancies. This get produce the autonomy to the client to frame sensible decisions and to originate contravene sensibilitys environing present and spent uniformts.
Recommend client be seated when business the infant and to substitute lie lingeringly when false down or seated. To peacerainmate orthostatic hypotension, beproducer it puts the client at destroy of declines.
Refer to a livelihood bunch(s) as denoted. Specific bunchs such as hysterectomy livelihood bunch may cater additional counsel touching the lie they faced precedently and how they were talented to control it. This get smooth dogmatical writing of the client.

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