Postpartum Hemorrhage (PPH) is a serious complication occurring after childbirth. 1-5% of mothers will experience PPH which is defined as a blood loss of greater than 1,000 mL of blood along with signs of hypovolemia. Primary PPH can occur up to 24 hours after delivery while secondary PPH occurs anywhere from 24 hours to 12 weeks postpartum. Show
The most common cause of PPH is uterine atrophy, which is when the uterus does not contract following delivery of the placenta, leading to abnormal blood loss. If not recognized and corrected promptly, the mother may experience shock and death. PPH is responsible for 25% of maternal deaths worldwide. The Nursing ProcessNurses working in labor and delivery and postpartum settings must understand the signs and symptoms of postpartum hemorrhage and react immediately. Nurses can also educate patients on their risk factors for experiencing this complication and provide effective teaching on monitoring their recovery at home along with follow-up care. Nursing Care Plans Related to Postpartum HemorrhageDeficient Fluid Volume Care PlanA drop in circulating blood volume decreases perfusion to vital organs. Nursing Diagnosis: Deficient Fluid Volume Related to:
As evidenced by:
Expected Outcomes:
Deficient Fluid Volume Assessment1. Monitor vital signs and LOC. 2. Assess the uterus. 3. Obtain lab work. 4. Monitor lochia and characteristics. Deficient Fluid Volume Interventions1. Massage uterus. 2. Administer oxytocin. 3. Maintain bed rest. 4. Administer IV fluids. 5. Administer blood products. 6. Prepare for surgery. Anxiety Care PlanTraumatic birthing experiences can cause anxiety and even post-traumatic stress disorders. Nursing Diagnosis: Anxiety Related to:
As evidenced by:
Expected Outcomes:
Anxiety Assessment1. Determine physiologic vs. psychologic symptoms. 2. Assess the patient’s thoughts and feelings. Anxiety Interventions1. Maintain clear communication. 2. Involve support system. 3. Keep baby and mother together when possible. 4. Provide therapy resources. Deficient Knowledge Care PlanProviding education on childbirth and delivery expectations can prepare the mother and support person for complications before they arise. What are nursing interventions for a boggy fundus?Three nursing interventions for a boggy fundus (uterine atony) include massaging the uterus every 15 minutes until firm making sure the bladder is empty, give the patient Pitocin, or have the patient breastfeed to help contract the uterus making it firm up.
What are the priority nursing interventions when caring for a client who has a boggy fundus?(5) Nursing interventions. (a) Palpate the fundus frequently to determine continued muscle tone. (b) Massage the fundus, if boggy, until firm (do not over massage, this fatigues the muscle). (c) Monitor patient's vital signs every 15 minutes until stable.
What is immediate nursing intervention to manage an atonic boggy uterus?The best safeguard against uterine atony is to palpate the client's fundus at frequent intervals to ensure her uterus remains contracted. The fundus should be firm to compress the bleeding vessels at the placenta site.
What is the first nursing action if there is uterine atony?Uterine atony is an emergency and requires quick action from your healthcare team. The goal of treatment is to stop the bleeding as soon as possible and replace any lost blood or fluids. Even after the bleeding is under control, you may need a blood transfusion or IV fluids to replace what was lost.
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