Question

1.Three weeks postpartum, a women reports that her period has returned and that it is very heavy; each times she changes her pad, it is soaked through. What postpartum complication might this woman be experiencing, and what instructions or information should the nurse provide?

2. The nurse records a blood loss of 500 ml from a woman who had a cesarean delivery less than 24 hours ago and notes she appears to be developing hypovolemic shock. What signs and symptoms of hypovolemic shock should the nurse recognize? What medical management is indicated?

Answer 1

1) A women have heavy bleeding after 3 weeks postpartum. The complication may be postpartum haemorrhage. Postpartum bleeding continues for 3 to 6 weeks as the uterus heals and returns to its normal shape and size. It’s most likely to happen the first 24 hours after delivery. But it can happen anytime within the first 12 weeks after your baby is born.

Causes of postpartum bleeding include loss of tone in the uterine muscles, a bleeding disorder or the placenta failing to come out completely or tearing.

- Or it may be due to haemophilia A. It is a genetic deficiency in clotting factor Vlll, which cause increased bleeding.

- Lochia - there's a term for post-pregnancy bleeding. It's called lochia. Lochia after birth is bloody fluid made up of blood, placental tissue, sloughed off endometrial lining, and mucous.

- may be due to haemotoma.

* Postpartum hemorrhage is serious. It can cause a big drop in your blood pressure. If the pressure gets too low, your organs won’t get enough blood. This is shock, and it can cause death.

Nurse should tell the symptoms of postpartum bleeding like -

- Changes in the mental status.

- Concentrated urine.

- Delayed capillary refill.

- Decrease in the red blood cell count (hematocrit).

- Decrease blood pressure (hypotension).

- Dry skin/mucous membrane.

- Increase heart rate (tachycardia)

And should tell about the possible risk factors and provide overall knowledge about postpartum bleeding.

2)Hypovolemic shock - It is a type of shock which is caused due to decrease in volume of blood.

A condition in which the liquid portion of the blood (plasma) is too low.

Causes of hypovolaemia include vomiting, diarrhoea and excessive bleeding. This can lead to shock, a life-threatening condition in which the organs aren't getting enough blood or oxygen.

Symptoms and signs hypovolemic shock -

• Whole body clinical features -

- dehydration

- low blood pressure

- dizziness

- fainting

- fatigue

- thirst

- weakness

• Gastrointestinal - nausea or vomiting

• Some other common features include-

- fast heart rate,

- insufficient urine production,

- mental confusion,

- pallor,

- sleepiness

# Management include Supportive care, medications, devices and medical procedures

- Supportive care include IV fluids and fluid replacement.

* Ringer lactate

* Crystalloids and colloids

- Medication include - Blood transfusion - Transfer of blood from one person into the veins of another person.

- Devices - Central venous Catheter - A tube is commonly inserted into a large vein in the neck or groin to carry medicines, fluids and nutritional into the body.

- Urinary catherter - inserting a tube in bladder to drain urine.