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Nursing Care Plan for Postpartum Hemorrhage (PPH)

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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.  This may happen with vaginal or cesarean delivery and occurs in 1-5 out of 100 women. The hemorrhage may occur immediately after birth, or over several hours following delivery.

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 the mother to the baby. When these contractions do not continue or are not strong enough, hemorrhage occurs. Sometimes, a tear in the cervix, placenta, or the blood vessels within the uterus may 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 such as forceps or vacuum to deliver the baby.

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

  • 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.  
  • Assess for vaginal hematoma
  If bleeding is due to a vaginal hematoma, rest and application of an ice pack may be sufficient treatment  
  • Monitor intake and output for 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.  
  • 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  

References

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  • Question 1 of 5

The nurse is planning care for a client with postpartum hemorrhage. Which of the following interventions is appropriate for a client with this condition? Select all that apply.

  • Question 2 of 5

A charge nurse is making assignments for a labor & delivery unit. When planning resources, the charge nurse knows that which of the following clients would be at the highest risk for postpartum hemorrhage? Select all that apply.

  • Question 3 of 5

The nurse is caring for a client who gave birth to a healthy baby girl at 0726 today. The mother has just transferred to the postpartum unit. She has a postpartum hemorrhage and her estimated blood loss (EBL) from the delivery was 675 ml. Which of the following nursing interventions is the priority for this client?

  • Question 4 of 5

Which of the following conditions would most likely contribute to postpartum hemorrhage?

  • Question 5 of 5

A client gave birth to a healthy baby girl at 0726 today. She has just transferred to the postpartum unit. She has a postpartum hemorrhage and her estimated blood loss (EBL) from the delivery and shortly thereafter was 675 ml. Which of the following lab is the priority to assess?

Module 0 – Nursing Care Plans Course Introduction
Module Obstetrics (OB) & Pediatrics (Peds) Care Plans

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