Postpartum hemorrhage is defined as any blood loss from the uterus of more than 500ml during or after delivery. It may occur either early (within the first 24 hours after delivery), or late (anytime after the 24 hours during the remaining days of the six-week puerperium).
Nursing Care Plans
The primary role of the nurses is to assess and intervene early or during a hemorrhage to help the patient regain her strength and to prevent complications. Data such as the amount of bleeding, the condition of the uterus, checking of the maternal vital signs and observing for signs of shock would play a vital role in the care of the patient with hemorrhage.
- Deficient Fluid Volume (isotonic)
- Risk for Excess Fluid Volume
- Risk For Infection
- Risk For Pain
- Risk for Altered Parent-Infant Attachment
- Deficient Knowledge
Risk For Infection
- Risk For Infection
- Decreased hemoglobin.
- Invasive procedures.
- Stasis of body fluids (lochia).
- Traumatized tissues.
Possibly evidenced by
- [Not applicable]
- 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.
|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.|
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Maternal and Newborn Care Plans
Nursing care plans related to the care of the pregnant mother and her infant. See care plans for maternity and obstetric nursing:
- Abruptio Placenta| 3 Care Plan
- Cesarean Birth | 10 Care Plans
- Cleft Palate and Cleft Lip | 6 Care Plans
- Dysfunctional Labor (Dystocia) | 4 Care Plans
- Elective Termination | 6 Care Plans
- Gestational Diabetes Mellitus | 4 Care Plans
- Hyperbilirubinemia | 4 Care Plans
- Labor Stages, Induced and Augmented Labor | 36 Care Plans
- Neonatal Sepsis | 5 Care Plans
- Perinatal Loss | 5 Care Plans
- Placenta Previa | 3 Care Plans
- Postpartum Hemorrhage | 8 Care Plans
- Postpartum Thrombophlebitis | 4 Care Plans
- Prenatal Hemorrhage | 7 Care Plans
- Prenatal Substance Dependence/Abuse | 6 Care Plans
- Precipitous Labor | 3 Care Plans
- Pregnancy Induced Hypertension | 6 Care Plans
- Premature Dilation of the Cervix | 3 Care Plans
- Prenatal Infection | 3 Care Plans
- Preterm Labor | 6 Care Plans
- Puerperal Infection | 4 Care Plans