Question

In: Nursing

Create a careplan for a hypothetical patient who has postpartum hemorrhage, using 4 nursing diagnoses

Expert Solution

Definition

Postpartum hemorrhage - Postpartum hemorrhage is the loss of blood from the genital tract after the birth of the fetus, exceeding 500 ml or adversely affect the general condition of the patient

Nursing diagnosis -1:

Deficient fluid volume

Care plan:

Monitor	Assess	Act
Monitor the patient's vitals (blood pressure, oxygen saturation, pulse rate) Maintain input and output record. Monitor the patient's complete blood count - this gives an idea about the blood loss and concominant infections (raised white blood count) Hematocrit - this give an idea both the amount of blood lost Monitor Platelet count - platelets play an important role in the blood coagulation process. It also help to take decision about the need for platelet tranfusion. Montor - Prothrombin time, INR, Fibrin and fibrin degradation products - this helps to diagnose disseminated intravascular coagulation	Assess the type and amount of bleeding (by quatifying the amount of bleeding or the blood soaked pads) Identify and note conditions that may be responsible for PPH ( genital tear, abruptio placenta, retain products of conception) Assess the external genitalia for the presence of hematoma	Insert a large bore i.v line. This will help to administer intravenous fluid and maintain the intravascular volume Keep the patient nil by mouth (as the patient might need surgical intervention) Insert a folleys cathether Administer oxytocin, methergine, Prostaglandin -these drugs increase the tone of the uterine muscles and reduce the bleed. start the patient on broad spectrum antibiotics which will help to prevent infections and septicemia. Insert a large indwelling catheter inside the cervical canal. Inject 60 ml of saline into the balloon. The inflated balloon will act as a tamponade and reduce the bleeding

Nursing diagnosis -2

Risk of excess fluid volume

Nursing care:

Monitor

Act

Monitor the patient's vitals (blood pressure, oxygen saturation, pulse rate)
Maintain input and output record.
Look of new symptoms of breathlessness, wheezing and expectoration (pink colored sputum). This could suggest the presence of pulmonary edema secondary to volume overload.
Monitor the patient's jugular venous pressure - this will give an idea about the volume status
Ausculate the patient chest - look for new onset rales.
Monitor electrolytes - Development of hyponatremia may be secondary to dilution.
Monitor urine specific gravity - increase fluid volume leads to reduction in the specific gravity of the urine

Get a chest x-ray done - the presence of bilateral perihilar opacities suggest the presence of pulmonary edema (bat-wing appearance)
Stop intravenous fluid infusion.
Administer diuretics like furosemide.
If require give the patient non-invasive positive pressure ventilation - the positive pressure helps to thin out the edema fluid in the alveoli and improves blood oxygenation.

Nursing diagnosis - 3

Risk of infections

Nursing care plan

Monitor

Act

Monitor the rate of involution of the uterus ( the process of reduction in the size of the uterus to the pre-gravid state)
Monitor the type of genital tract discharge
Look for evidence of constitutional symptoms like fever, breathlessness, palpitations.
Monitor the episiotomy sutures or abdominal sutures for evidence of infection (discharge, delayed healing, suture dehisence)

Send genital tract discharge (the discharge or swabs) for gram staining and antibiotic sensitivity testing.
Send blood culture.
Start the patient of antibiotics as per the hospital policy.
Don't wait for the culture reports for starting antibiotics.
The antibiotic therapy can be changed based on clinical assessment and laboratory report (not solely based on the laboratory reports)
Regular dressing of the episiotomy or abdominal sutures.
Timely removal of sutures.
Identity and treat underlying comorbidities that can delay healing (malnutrition, diabetes, anemia)

Nursing diagnosis -4

Risk of anxiety

Nursing plan

Assess the patient's undrstanding of PPH.
Stay with the patient and calm the patient. Be sympathetic towards the patients concerns.
Provide knowledge and correct the misconceptions the patient has about the condition.
Make the patient aware of the negative thoughts and encourage her to block (stop) them.
Take the help of psychiatric specialist of the patient continues to remain anxious.

Nightingale answered 2 years ago

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