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.