Care Plan on Hemorrhage
Student Name
Program Name, Institution
COURSE CODE: Course Title
Instructor Name
Month, Year
Care Plan on Hemorrhage
Case Scenario
30-year-old G1 P1, Caucasian female, came to the facility at 0800hrs today, 40-week gestation female baby weighing 10lbs 3oz, prolonged labor under vacuum-assisted delivery and a midline episiotomy, EBL of 250ml during delivery, 600ml Oxytocin IV in 1000ml of LR given after delivery, labor complicated with chorioamnionitis, IV antibiotics given immediately after delivery, history of Asthma with inhaler use, and fundus is boggy at midline umbilicus that firms with massage, moderate bleeding and passing of clots with massage, lochia soaked 3 perineal pads within the last hour.
Pathophysiology of the disease
Hemorrhage entails blood leaking from the blood vessels to the surrounding tissue. When a vessel is damaged, the hemorrhage occurs as long as the vessel stays open and the pressure inside the vessel dominates the pressure outside of the vessel. Coagulation usually seals the vessel and prevents bleeding (Macdonald & Schweizer, 2017). Uncontained hemorrhage can lead to anticoagulant medication, hemophilia, or substantial injury to the blood vessel, resulting in extensive loss of blood and shock. The signs and symptoms include breathlessness, unconsciousness, vomiting, nausea, and swollen abdomen.
Steps of the disease
The steps of hemorrhage disorder which involve four classes. The first class involves loss of around 15% of the amount of blood. There is generally no improvement in common signs, and there is typically no need for fluid resuscitation (Gayet-Ageron et al., 2018). The second class involves 20 percent of the overall blood flow. The patient is frequently tachycardic (increased heartbeat) with a drop in the disparity among diastolic and systolic blood pressures. The body is attempting to recompense for peripheral vasoconstriction. Skin may start to appear thin and be soft when touched. The patient can undergo minor behavioral changes. Volume recovery with colloids is all that is usually needed. Transfusion of blood is not typically needed.
The third class entails a reduction of 30 to 40 per cent of flowing blood volume. The client’s blood pressure reduces, the pulse rate elevates, peripheral hypo perfusion and reduced capillary fill-up develops, and the emotional state worsens (Gayet-Ageron et al., 2018). Fluid rebirth with crystalloid and transfusion of blood is typically expected. Class IV Hemorrhage entails a depletion of less than40 per cent of circulating blood flow. The body’s remuneration cap is exhausted and rapid resuscitation is needed to avoid death.
Nursing Diagnosis:
Measurable Goal:
Nursing Interventions:
Outcome:
Interrupted
Breastfeeding R/T
separation of
infant for medical
treatment AEB
emotional distress
second to balloon
tamponade and
uterine curettage
Patient will achieve
satisfaction with
effective breastfeeding
before discharge home
from hospital
1. Assess patients’
level of distress
and support her by
teaching that
breastfeeding can
continue when the
procedures are
complete and PPH
is under control
2. Teach patient the
importance of the
medical treatments
to manage
postpartum
hemorrhage and
complications
3. Notify Lactation
Consultant/Specialist
st to schedule time
when mother can
breastfeed after
procedure
4. Assist with
emotional distress
by providing skin to
skin, comfort,
holding techniques,
support with
latching to breast,
identifying infant
cues, and providing
resources for
breastfeeding once
bleeding is under
control
The goal was partially
met. The mother was
able to effectively
breastfeed her infant
once the postpartum
hemorrhage was under
control, but she is not
completely satisfied
with breastfeeding. She
expressed that she
would continue to
work on breastfeeding,
and she will use the
resources she was
given to get more
lactation help with a
Specialist.
Scarce Fluid
Volume R/T
extreme blood
loss after giving birth AEB
3 soaked perineal
pads within 1 hr second
to postpartum
hemorrhage
Client will have a
lochia drift of less than
1 saturated perineal
pad/hr by discharge
from hospital
1. Evaluate and record
type, quantity, and
bleeding site
2. Weigh and count
perineal pads to
assess accurate
amount of bleeding
3. Consider the location
and level of
contractility of the
uterus/fundus with
massage
4. Monitor VS- BP and
HR to assess for s/s
of hypovolemia or
shock
The goal was met. With
the interventions in
place, the postpartum
hemorrhage was
managed and the
patient now has a
lochia flow of less than
1 saturated perineal
pad/hr before
discharge home
Severe Pain R/T
nursing and
therapeutic
interventions to
manage bleeding
AEB pain of 7 on 0-
10 pain assessment
scale second to
postpartum haemorrhage
Patient will report
below 3 on the pain
assessment scale
within 2 hours after
interventions are
performed
Clean and position
patient to promote
comfort and
decrease bleeding
2. Provide icepacks
and proper
padding to help
with pain and
swelling
3. Provide pain
medication
ordered for
interventions as
needed per patient
Provide adequate teaching for interventions such as fundal massage to manage bleeding so the patient knows what to expect
The goal was met. The
pain management and
comfort techniques in
place allowed the
patient to report a pain
of 2 on the pain
assessment scale 2
hours after
interventions were
performed
References
Gayet-Ageron, A., Prieto-Merino, D., Ker, K., Shakur, H., Ageron, F. X., Roberts, I., … & Gilliam, C. (2018). Effect of treatment delay on the effectiveness and safety of antifibrinolytics in acute severe haemorrhage: a meta-analysis of individual patient-level data from 40 138 bleeding patients.
The Lancet
,
391
(10116), 125-132.
-Macdonald, R. L., & Schweizer, T. A. (2017). Spontaneous subarachnoid haemorrhage.
The Lancet
,
389
(10069), 655-666.
Shakur, H., Roberts, I., Edwards, P., Elbourne, D., Alfirevic, Z., & Ronsmans, C. (2016). The effect of tranexamic acid on the risk of death and hysterectomy in women with post-partum haemorrhage: statistical analysis plan for the WOMAN trial.
Trials
,
17
(1), 249.
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