Nursing Diagnosis & Care Plan for Postpartum Hemorrhage (PPH)

Included In This Lesson

Study Tools
Outline
Transcript

Study Tools

Outline

Pathophysiology

Postpartum hemorrhage is the excessive bleeding following delivery of a baby. For vaginal delivery, excessive bleeding would be more than 500ml and for cesarean delivery, more than 1000ml.

Etiology

Normally, the uterus continues to contract after the delivery of the baby and placenta. These contractions help close the vessels that supplied blood from mother to baby. If these contractions cease or are not strong enough, hemorrhage occurs. A tear in the cervix, placenta, or the blood vessels within the uterus may also cause hemorrhage. Risk factors include obesity, multiple births (twins or more), many previous pregnancies, blood clotting disorders, infection, prolonged labor, or use of assistive devices in delivery such as forceps or a vacuum.

Desired Outcome

A patient will maintain optimal fluid balance and vital signs within normal limits

Postpartum Hemorrhage (PPH) Nursing Care Plan

Subjective Data:

Pain in the vaginal area (if due to hematoma)
Dizziness

Objective Data:

Uncontrolled bleeding
- Excessive saturation of perineal pads
Hypotension
Tachycardia
Low hematocrit

Nursing Interventions and Rationales

Nursing Intervention (ADPIE)	Rationale
Assess vital signs and monitor for signs of shock	The decreased fluid volume will cause blood pressure to drop and the patient will go into shock
Monitor blood loss: Site Type Amount- should be no more than 1 perineal pad per hour Presence of clots	The amount of blood loss and the presence of blood clots can help determine treatment.
Monitor intake and output	30ml – 50 ml/hr urine output; may require indwelling catheter insertion for accurate measurement Decreased urine output may be a sign of hematomas that put pressure on the urethra, or maybe a late sign of hypovolemic shock.
Assess for vaginal hematoma	If bleeding is due to a vaginal hematoma, rest and application of an ice pack may be sufficient treatment
Monitor lab values to determine the need for transfusions or signs of complications	Watch hematocrit and clotting levels to know if blood transfusion is necessary and for signs and severity of DIC.
Administer IV fluids, medications and blood products as necessary: Oxytocin Antibiotics Analgesics	Fluid replacement may be necessary and, depending on the amount of blood lost and hematocrit level, a blood transfusion may be required. Oxytocin is sometimes given to initiate contractions that will help stop bleeding.
Perform uterine massage to stimulate contractions following delivery	Begin fundal massage and educate patients on how to massage the abdomen to stimulate contractions. These contractions may help stop bleeding.
Monitor and manage pain	Continued, unrelieved pain may be due to hematomas or lacerations within the vagina
Place the patient on bed rest with legs elevated	Rest and elevation of legs helps venous return and slows bleeding
Prepare patient for surgery if indicated; remain on NPO status	If bleeding can’t be managed otherwise, surgery may be required

Writing a Nursing Care Plan (NCP) for Postpartum Hemorrhage (PPH)

A Nursing Care Plan (NCP) for Postpartum Hemorrhage (PPH) starts when at patient admission and documents all activities and changes in the patient’s condition. The goal of an NCP is to create a treatment plan that is specific to the patient. They should be anchored in evidence-based practices and accurately record existing data and identify potential needs or risks.

References

Transcript

Hey everyone. Today, we are going to be creating a care plan for postpartum hemorrhage. So, let’s get started. First, we’re going to go over the pathophysiology of postpartum hemorrhage: excessive bleeding, following delivery of a baby vaginal delivery; excessive bleeding would be more than 500 mL and a cesarean delivery would be more than 1,000 mL. Nursing considerations: you want to assess vital signs, monitor blood loss, assess for hematoma, monitor I & O, monitor lab values, administer IV fluids, medications, or blood products, fundal massage, manage pain, keep the patient on NPO status, and prepare the patient for surgery, if needed. Some desired outcomes: a patient will remain in optimal fluid balance and vital signs will be within normal limits.

So, we’re going to go ahead and start a care plan. We’re going to go over some of the subjective data, and we’re going to go over some of the objective data that you’re going to see with these patients. One of the main things of subjective data we’re going to see is they’re going to have a lot of pain in the vaginal area, which is usually due to a hematoma that is present. Some objective data that you’re going to see is going to be some uncontrolled bleeding. And then you will also see that the patient will have hypotension. So decreased BP, they will have an increased heart rate and they will have a low hematocrit.

So, some interventions that we’re going to look at for some of these patients, we’re going to assess their vital signs. We want a baseline of where their vital signs are at. See if they are hypertensive or tachycardic. Usually with these patients, their blood pressure can drop so much, they can go into shock. We want to monitor blood loss; so, when we monitor blood loss, we want to know the site, we want to know the type, the amount. We don’t want to have more than one peri pad an hour. We want to look for any sort of presence of clots and the amount of blood loss and presence of blood clots can help determine the type of treatment for the pain. We want to assess any sort of hematoma. So, if they have a hematoma, we want to assess that. So, if bleeding is due to a vaginal hematoma, usually resting and an application of an ice pack on the peritoneal area may be sufficient enough for treatment. We want to make sure that we’re going to be assessing intake and output. Usually, you want to have about 30 to 50 mL per hour minimum – a foley may be required and able to get an accurate measurement. And of course, making sure you’re doing foley care, decreased output could be a sign of a hematoma, which is going to be putting pressure on that urethra or a late sign of hypovolemic shock. We want to make sure we’re monitoring lab values and determining if a blood transfusion is needed and any sort of complications. So, we’re going to see about a low hematocrit. We’re going to be checking any sort of clotting factors. See if blood transfusions are necessary and look for any sort of signs of DIC. Some other interventions that we’re going to be doing are we’re going to be administering IV fluids, medications, and possible blood products as necessary. So certain medications would be oxytocin, which is sometimes given and able to initiate those contractions, but also helps stop the bleeding for the patient. Also given are some antibiotics, some analgesics for pain, and obviously some fluid replacements may be necessary. We’re going to perform a uterine massage. So fundal massages help stimulate uterine contractions after birth and assist to stop the bleeding.

Other things that we may want to consider is managing the patient’s pain, especially if the hematoma is present and or lacerations within the vagina after birth. When appropriate, place the patient on bedrest with the legs elevated. So, you want to make sure their legs are upright and not straight down like that. So, rest and elevation of the legs helps prevent venous return and slows the bleeding down. That’s the important part. It’s going to help slow the bleeding. And if the patient is having surgery, we want to make sure we’re keeping them on NPO status. If the bleeding cannot be managed, they will have to have surgery to stop the bleeding.

So key points we want to go over here. Postpartum hemorrhage is excessive bleeding following the delivery of a baby. So, 500 mL for the vaginal, and about 1,000 mL for a cesarean section. Contractions after birth aren’t strong enough to help close the vessels, supplying the blood from mother to baby or tears in the cervix, placenta, or blood vessels within the uterus can be possible. Some subjective and objective data. You’ll see they’re going to be dizzy and complain of pain in the vaginal area. If a hematoma is present, there could be uncontrolled bleeding. So excessive saturation of one peri pad an hour, hypotension, tachycardia, and low hematocrit. You want to monitor the blood loss, the amount you want to assess for hematoma. And we want to do fundal massages. That helps the contraction after the birth of the baby. And that helps stop and prevent more blood loss. We want to do IV fluids, meds, or blood transfusion if needed. We want to make sure that we’re keeping the patient on bedrest, keeping up NPO in case they end up needing surgery because they can’t stop the blood loss. And there you guys have it. That was an excellent care plan.

I hope you guys have a good rest of your day and as always happy nursing.

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Nursing Care Plans

Course Description

Jon Haws, BS, BSN, RN, CCRN Alumnus

Miriam Wahrman, MSN/Ed, RNC-MNN

Nichole Weaver, MSN/Ed, RN, CCRN

Clyde Lewis, BSN, RN, CCRN

Kristen Salisbury, BSN, RN

How do I write a Nursing Care Plan? Why and how do we even use Nursing Care Plans? This course is going to expand on that for you and show you the most effective way to write a Nursing Care Plan and how to use Nursing Care Plans in the clinical setting. PLUS, we are going to give you examples of Nursing Care Plans for all the major body systems and some of the most common disease processes. When you complete this course, you will be able to write and implement powerful and effective Nursing Care Plans.

Module 0 – Nursing Care Plans Course Introduction

00.01 Nursing Care Plans Course Introduction

Module 1 – Understanding Nursing Care Plans

01.01 Purpose of Nursing Care Plans

01.02 How to Write a Nursing Care Plan

Questions: 16

01.03 Using Nursing Care Plans in Clinicals

Module Cardiovascular (Cardiac, CVD) Care Plans

Nursing Care Plan (NCP) for Angina

Questions: 5

Nursing Care Plan (NCP) for Atrial Fibrillation (AFib)

Questions: 5

Nursing Care Plan (NCP) for Aortic Aneurysm

Questions: 6

Nursing Care Plan (NCP) for Arterial Disorders

Questions: 5

Nursing Care Plan (NCP) for Cardiogenic Shock

Questions: 10

Nursing Care Plan (NCP) for Cardiomyopathy

Questions: 5

Nursing Care Plan (NCP) for Congenital Heart Defects

Questions: 3

Nursing Care Plan (NCP) for Congestive Heart Failure (CHF)

Questions: 5

Nursing Care Plan (NCP) for Endocarditis

Questions: 3

Nursing Care Plan (NCP) for Gestational Hypertension, Preeclampsia, Eclampsia

Questions: 5

Nursing Care Plan (NCP) for Heart Valve Disorders

Questions: 5

Nursing Care Plan (NCP) for Hypertension (HTN)

Questions: 5

Nursing Care Plan (NCP) for Marfan Syndrome

Questions: 8

Nursing Care Plan (NCP) for Myocardial Infarction (MI)

Questions: 5

Nursing Care Plan (NCP) for Pericarditis

Questions: 1

Nursing Care Plan (NCP) for Thrombophlebitis / Deep Vein Thrombosis (DVT)

Questions: 5

Nursing Care Plan (NCP) for Decreased Cardiac Output

Questions: 4
Cheat Sheets: 1

Nursing Care Plan (NCP) for Activity Intolerance

Questions: 1
Cheat Sheets: 1

Module Eyes, Ears, Nose, Throat (EENT) Care Plans

Nursing Care Plan (NCP) for Cleft Lip / Cleft Palate

Questions: 7

Nursing Care Plan (NCP) for Epiglottitis

Questions: 3

Nursing Care Plan (NCP) for Glaucoma

Questions: 3

Nursing Care Plan (NCP) for Infective Conjunctivitis / Pink Eye

Questions: 4

Nursing Care Plan (NCP) for Otitis Media / Acute Otitis Media (AOM)

Questions: 6

Nursing Care Plan (NCP) for Tonsillitis

Questions: 1

Module Gastrointestinal (GI) Care Plans

Nursing Care Plan (NCP) for Abdominal Pain

Questions: 5

Nursing Care Plan (NCP) for Appendicitis

Questions: 5

Nursing Care Plan (NCP) for Celiac Disease

Questions: 3

Nursing Care Plan (NCP) for Cholecystitis

Questions: 2

Nursing Care Plan for Cirrhosis (Liver)

Questions: 5

Nursing Care Plan (NCP) for Constipation / Encopresis

Questions: 5

Nursing Care Plan (NCP) for Diverticulosis / Diverticulitis

Questions: 5

Nursing Care Plan (NCP) for Eating Disorders (Anorexia Nervosa, Bulimia Nervosa, Binge-Eating Disorder)

Questions: 5

Nursing Care Plan (NCP) for Epiglottitis

Questions: 3

Nursing Care Plan (NCP) for Gastroesophageal Reflux Disease (GERD)

Questions: 3

Nursing Care Plan (NCP) for Hyperemesis Gravidarum

Questions: 5

Nursing Care Plan (NCP) for Imperforate Anus

Questions: 5

Nursing Care Plan (NCP) for Inflammatory Bowel Disease (Ulcerative Colitis / Crohn’s Disease)

Questions: 5

Nursing Care Plan (NCP) for Intussusception

Questions: 5

Nursing Care Plan (NCP) for Omphalocele

Questions: 5

Nursing Care Plan (NCP) for Pancreatitis

Questions: 2

Nursing Care Plan (NCP) for Peptic Ulcer Disease (PUD)

Questions: 4

Nursing Care Plan (NCP) for Vomiting / Diarrhea

Questions: 5

Nursing Care Plan (NCP) for GI (Gastrointestinal) Bleed

Questions: 5

Nursing Care Plan (NCP) for Bowel Obstruction

Questions: 3
Cheat Sheets: 1

Module Genitourinary (Renal) (Kidney) (Nephrotic) Care Plans

Nursing Care Plan (NCP) for Acute Kidney Injury

Questions: 5

Nursing Care Plan (NCP) for Benign Prostatic Hyperplasia (BPH)

Questions: 5

Nursing Care Plan (NCP) for Chronic Kidney Disease

Questions: 5

Nursing Care Plan (NCP) for Enuresis / Bedwetting

Questions: 6

Nursing Care Plan (NCP) for Glomerulonephritis

Questions: 2

Nursing Care Plan (NCP) for Nephrotic Syndrome

Questions: 1

Nursing Care Plan (NCP) for Renal Calculi

Questions: 3

Nursing Care Plan (NCP) for Urinary Tract Infection (UTI)

Questions: 5

Module Hematology (Blood, labs), Oncology (Cancer) & Immunology (Immunity) Care Plans

Nursing Care Plan (NCP) for Acquired Immune Deficiency Syndrome (AIDS)

Questions: 8

Nursing Care Plan (NCP) for Anemia

Questions: 5

Nursing Care Plan (NCP) for Disseminated Intravascular Coagulation (DIC)

Questions: 5

Nursing Care Plan (NCP) for Dehydration & Fever

Questions: 5

Nursing Care Plan (NCP) for Hemophilia

Questions: 6

Nursing Care Plan (NCP) for Herpes Zoster – Shingles

Questions: 5

Nursing Care Plan (NCP) for Hepatitis

Questions: 3

Nursing Care Plan (NCP) for Leukemia

Questions: 2

Nursing Care Plan (NCP) for Lyme Disease

Questions: 5

Nursing Care Plan (NCP) for Lymphoma (Hodgkin’s, Non-Hodgkin’s)

Questions: 3

Nursing Care Plan (NCP) for Neutropenia

Questions: 5

Nursing Care Plan (NCP) for Sickle Cell Anemia

Questions: 2

Nursing Care Plan (NCP) for Skin cancer – Melanoma, Basal Cell Carcinoma, Squamous Cell Carcinoma

Questions: 8

Nursing Care Plan (NCP) for Thrombocytopenia

Questions: 5

Nursing Care Plan (NCP) for Varicella / Chickenpox

Questions: 7

Nursing Care Plan (NCP) for Hypoglycemia

Questions: 5

Module Integumentary (Skin) Care Plans

Nursing Care Plan (NCP) for Burn Injury (First, Second, Third degree)

Questions: 5

Nursing Care Plan (NCP) for Eczema (Infantile or Childhood) / Atopic Dermatitis

Questions: 5

Nursing Care Plan (NCP) for Impetigo

Questions: 3

Nursing Care Plan (NCP) for Pressure Ulcer / Decubitus Ulcer (Pressure Injury)

Questions: 5

Nursing Care Plan (NCP) for Skin cancer – Melanoma, Basal Cell Carcinoma, Squamous Cell Carcinoma

Questions: 8

Nursing Care Plan (NCP) for Cellulitis

Questions: 3

Module Mental Health Care Plans

Nursing Care Plan (NCP) for Alcohol Withdrawal Syndrome / Delirium Tremens

Questions: 5

Nursing Care Plan (NCP) for Alzheimer’s Disease

Questions: 5

Nursing Care Plan for (NCP) Autism Spectrum Disorder

Questions: 3

Nursing Care Plan (NCP) for Dissociative Disorders

Questions: 5

Nursing Care Plan (NCP) for Anxiety

Questions: 5

Nursing Care Plan (NCP) for Mood Disorders (Major Depressive Disorder, Bipolar Disorder)

Questions: 5

Nursing Care Plan (NCP) for Paranoid Disorders

Questions: 5

Nursing Care Plan (NCP) for Personality Disorders

Questions: 5

Nursing Care Plan (NCP) for Post-Traumatic Stress Disorder (PTSD)

Questions: 5

Nursing Care Plan (NCP) for Schizophrenia

Questions: 5

Nursing Care Plan (NCP) for Somatic Symptom Disorder (SSD)

Questions: 5

Nursing Care Plan (NCP) for Suicidal Behavior Disorder

Questions: 8

Nursing Care Plan (NCP) for Dementia

Questions: 7
Cheat Sheets: 1

Module Metabolic & Endocrine Care Plans

Nursing Care Plan (NCP) for Addison’s Disease (Primary Adrenal Insufficiency)

Questions: 5

Nursing Care Plan (NCP) for Diabetes

Questions: 10

Nursing Care Plan (NCP) for Diabetes Insipidus

Questions: 2

Nursing Care Plan (NCP) for Diabetic Ketoacidosis (DKA)

Questions: 5

Nursing Care Plan (NCP) for Diabetes Mellitus (DM)

Questions: 9

Nursing Care Plan (NCP) for Hypothyroidism

Questions: 5

Nursing Care Plan (NCP) for Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS)

Questions: 2

Nursing Care Plan (NCP) for Hyperthyroidism

Questions: 3

Nursing Care Plan (NCP) for Myasthenia Gravis (MG)

Questions: 1

Nursing Care Plan (NCP) for Syndrome of Inappropriate Antidiuretic Hormone (SIADH)

Questions: 3

Nursing Care Plan (NCP) for Systemic Lupus Erythematosus (SLE)

Questions: 1

Nursing Care Plan (NCP) for Hypoglycemia

Questions: 5

Nursing Care Plan (NCP) for Fluid Volume Deficit

Questions: 3

Nursing Care Plan (NCP) for Nutrition Imbalance

Questions: 5

Module Neurological Care Plans

Nursing Care Plan (NCP) for Alzheimer’s Disease

Questions: 5

Nursing Care Plan (NCP) for Brain Tumors

Questions: 2

Nursing Care Plan (NCP) for Cerebral Palsy (CP)

Questions: 6

Nursing Care Plan (NCP) for Encephalopathy

Questions: 1

Nursing Care Plan (NCP) for Hydrocephalus

Questions: 1

Nursing Care Plan (NCP) for Increased Intracranial Pressure (ICP)

Questions: 4

Nursing Care Plan (NCP) for Meningitis

Questions: 2

Nursing Care Plan (NCP) for Multiple Sclerosis (MS)

Questions: 6

Nursing Care Plan (NCP) for Neural Tube Defect, Spina Bifida

Questions: 1

Nursing Care Plan (NCP) for Parkinson’s Disease

Questions: 4

Nursing Care Plan (NCP) for Spinal Cord Injury

Questions: 3

Nursing Care Plan (NCP) for Stroke (CVA)

Questions: 5

Nursing Care Plan (NCP) for Syncope (Fainting)

Questions: 5

Module Obstetrics (OB) & Pediatrics (Peds) Care Plans

Nursing Care Plan (NCP) for Abortion, Spontaneous Abortion, Miscarriage

Questions: 7

Nursing Care Plan (NCP) for Abruptio Placentae / Placental abruption

Questions: 2

Nursing Care Plan for (NCP) Autism Spectrum Disorder

Questions: 3

Nursing Care Plan (NCP) for Bronchiolitis / Respiratory Syncytial Virus (RSV)

Questions: 1

Nursing Care Plan (NCP) for Cerebral Palsy (CP)

Questions: 6

Nursing Care Plan (NCP) for Chorioamnionitis

Questions: 4

Nursing Care Plan (NCP) for Cleft Lip / Cleft Palate

Questions: 7

Nursing Care Plan (NCP) for Clubfoot

Questions: 1

Nursing Care Plan (NCP) for Congenital Heart Defects

Questions: 3

Nursing Care Plan (NCP) for Cystic Fibrosis

Questions: 4

Nursing Care Plan (NCP) for Disseminated Intravascular Coagulation (DIC)

Questions: 5

Nursing Care Plan (NCP) for Eating Disorders (Anorexia Nervosa, Bulimia Nervosa, Binge-Eating Disorder)

Questions: 5

Nursing Care Plan (NCP) for Ectopic Pregnancy

Questions: 6

Nursing Care Plan (NCP) for Enuresis / Bedwetting

Questions: 6

Nursing Care Plan for (NCP) Fetal Alcohol Syndrome (FAS)

Questions: 9

Nursing Care Plan (NCP) for Hyperbilirubinemia of the Newborn / Infant Jaundice / Neonatal Hyperbilirubinemia

Questions: 5

Nursing Care Plan (NCP) for Imperforate Anus

Questions: 5

Nursing Care Plan (NCP) for Incompetent Cervix

Questions: 2

Nursing Care Plan (NCP) for Infective Conjunctivitis / Pink Eye

Questions: 4

Nursing Care Plan (NCP) for Intussusception

Questions: 5

Nursing Care Plan (NCP) for Marfan Syndrome

Questions: 8

Nursing Care Plan (NCP) for Mastitis

Questions: 5

Nursing Care Plan (NCP) for Meconium Aspiration

Questions: 6

Nursing Care Plan (NCP) for Pediculosis Capitis / Head Lice

Questions: 5

Nursing Care Plan (NCP) for Premature Rupture of Membranes (PROM) / Preterm Premature Rupture of Membranes (PPROM)

Questions: 6

Nursing Care Plan (NCP) for Phenylketonuria (PKU)

Questions: 9

Nursing Care Plan (NCP) for Postpartum Hemorrhage (PPH)

Questions: 6

Nursing Care Plan (NCP) for Preterm Labor / Premature Labor

Questions: 9

Nursing Care Plan (NCP) for Reye’s Syndrome

Questions: 4
Cheat Sheets: 1

Nursing Care Plan (NCP) for Rheumatic Fever

Questions: 6

Nursing Care Plan (NCP) for Newborns

Questions: 6

Module Respiratory Care Plans

Nursing Care Plan (NCP) for Acute Respiratory Distress Syndrome

Questions: 3

Nursing Care Plan (NCP) for Anaphylaxis

Questions: 5

Nursing Care Plan (NCP) for Aspiration

Questions: 4

Nursing Care Plan (NCP) for Asthma

Questions: 5

Nursing Care Plan (NCP) for Asthma / Childhood Asthma

Questions: 8

Nursing Care Plan (NCP) for Blunt Chest Trauma

Questions: 11

Nursing Care Plan (NCP) for Bronchoscopy (Procedure)

Questions: 5

Nursing Care Plan (NCP) for Bronchiolitis / Respiratory Syncytial Virus (RSV)

Questions: 1

Nursing Care Plan (NCP) for Chronic Obstructive Pulmonary Disease (COPD)

Questions: 5

Nursing Care Plan (NCP) for Emphysema

Questions: 6

Nursing Care Plan (NCP) for Influenza

Questions: 7

Nursing Care Plan (NCP) for Meconium Aspiration

Questions: 6

Nursing Care Plan (NCP) for Pertussis / Whooping Cough

Questions: 8

Nursing Care Plan (NCP) for Pneumonia

Questions: 5

Nursing Care Plan (NCP) for Pneumothorax/Hemothorax

Questions: 8

Nursing Care Plan (NCP) for Respiratory Failure

Questions: 5

Nursing Care Plan (NCP) for Restrictive Lung Diseases

Questions: 6

Nursing Care Plan (NCP) for Thoracentesis (Procedure)

Questions: 6

Nursing Care Plan (NCP) for Tuberculosis

Questions: 10

Nursing Care Plan (NCP) for Pulmonary Embolism

Questions: 6
Cheat Sheets: 1

Nursing Care Plan (NCP) for Impaired Gas Exchange

Questions: 7

Module Sepsis (Septic) & Shock Care Plans

Nursing Care Plan (NCP) for Cardiogenic Shock

Questions: 10

Nursing Care Plan (NCP) for Hypovolemic Shock

Questions: 3

Nursing Care Plan (NCP) for Sepsis

Questions: 5

Nursing Care Plan (NCP) for Acute Pain

Questions: 3

Nursing Care Plan (NCP) for Infection

Questions: 6

Module Musculoskeletal and Skeletal (Osteo) (Bones) Care Plans