Postpartum Hemorrhage Nursing Diagnosis Risk Factors, Care Plan & Management
What is postpartum hemorrhage?
Postpartum hemorrhage is a severe condition where a woman bleeds excessively following immediately after her delivery or a few hours later. Postpartum hemorrhage nursing diagnosis An excessive bleed is defined as a blood loss of more than 500 ml after a vaginal birth. Similarly, a loss of more than 1000 ml after a C section is considered as a hemorrhage.
Every one to five women in a hundred faces this problem. It primarily occurs because of reduced contractions of the uterus. After delivery, the contraction of the uterus is crucial to the seal of the blood that previously supplied the baby.
When contractions fail to occur, the blood that is supposed to be a seal continues to flow, causing a hemorrhage. In medical terminology, it is called ‘uterine atony.’
On the other hand, retained placental fragments result in hemorrhage, as well. Typically, a placenta is delivered a few minutes after the delivery of the baby. For any reason, the placenta is not entirely delivered, and the retained placenta will cause a massive bleed.
What are the risk factors for postpartum hemorrhage?
Many factors contribute to postpartum hemorrhage. Some of them are listed below:
- Cervical or uterine lacerations
- Abnormal attachment of the placental site such as placenta previa or placental abruption
- Multiple gestations
- Hydramnios, where there is excessive amniotic water collection causing the uterus to stretch extensively.
- Insufficient blood clotting leading to massive hemorrhage
Nursing plan For Postpartum Hemorrhage:
Nurses play a crucial role in any postpartum problems, and they are the experts to deal with such issues first-hand. Nurses intervene and provide the first-line treatment to any woman with postpartum hemorrhage. It is necessary to ensure complete recovery of the patient and her total gain of strength.
Nurses are required to assess and intervene in such conditions. They necessarily look for signs of shock, monitor the patient’s vital signs, evaluate the amount of blood loss by weighing the blood-soaked perineal pads, and continuously assess the movements and the condition of the uterus.
What does the Nursing Care Plan include?
There are eight essential plans that nurses mainly work on and are included in the postpartum hemorrhage nursing diagnosis.
- Assess for decreased fluid volume: to check for fluid deficiency in the body. The outcome of this assessment must be to replenish the fluid. The nurse would immediately start an IV via a cannula placed in the vessel of the patient. Providing fluids via IV would replenish the lost fluids more rapidly. If the blood loss is massive, the patient may also require a blood transfusion.
Assess for fluid overload:
- to check for increased fluid retention in the body. It is monitored via input/output charting. The amount of fluid that goes inside the body should coincide with the amount excreted in the urine. If the amount in urine is less than the fluid intake, a nurse would take measures to increase the urine output. Plus, a urine catheter may be inserted for better monitoring of the fluid loss.
Assess oxygen supply:
- Monitor the amount of oxygen getting absorbed in the body tissues. It is followed via the level of oxygen saturation. If saturation is reduced, then a nurse may have to aid in intubating the patient.
Assess for infections:
- check for an increase in the body temperature that may indicate an infection as acquiring an infection in this state is very common in women. The nurse will monitor the vitals of the patient and administer IV antibiotics as a prophylactic to save the patient from acquiring an infection in this state.
Assess the patient for signs of discomfort or pain:
- If the patient feels uneasy or moan in pain, then it is best to administer pain killers via the IV line or administer sedatives to keep the patient calm and free of pain.
Assess the uterine movements:
- If the uterus of the patient is not contracting on its own, the nurse will have to massage the uterus and contractions. This is compulsory because the contractions of the uterus will reduce blood loss.
Assess for mental problems:
- A woman is agitated, overwhelmed, stressed, and may get depressed after delivery and especially when experiencing hemorrhage. It is normal for the patient to have mood swings. In such situations, the nurse ought to stay with the patient and inform the family of the patient to provide the best support to her during this period. The patient requires both physical and mental support.
Educate the patient about her condition:
- It is crucial to listen and assess how much the patient knows about her health and how well she can take care of herself. The nurse will educate the mother about her breastfeeding techniques, her medications, the cause of the hemorrhage, how to deal with the pain at home, and what to do in case of an emergency. The mother should report to the hospital if she notices anything unusual.