Postpartum Assessment After 2 hours the patient was transferred to the postpartu
ID: 237786 • Letter: P
Question
Postpartum Assessment After 2 hours the patient was transferred to the postpartum unit with husband and twins at bedside. The patient is oriented to the room and a new perineal pad is applied to the patient during the initial assessment. After one hour the patient press the call light and states she feels blood dripping down her leg. Upon assessment you note a boggy uterus deviated to the right side, her pad is saturated, and there is a constant flow of blood. You perform a fundal massage and the uterus is firm after 2 minutes You apply a new pad and inform the patient that you will return in 15 minutes. After 15 minutes you return to the patient room to assess her bleeding. The pad is saturated again, fundus is boggy, abdomen is distended and you notice blood clots. The palms of her hands are sweaty , she's complaining of abdomen pain and feeling dehydrated. The patient and the husband are concern about her condition Questions: 1. What is your plan of action of this patient? 2. How would you explain this situation to the patient and her husband? 3. Would you consider calling the physician and why? 4. Would orders do you anticipate the physician to order and why? 5. What would be the primary nursing diagnosis?Explanation / Answer
PLAN OF ACTION :
1. Palpate the fundus and massage the uterus to make it hard. The massage is to be done by placing the four fingers behind the uterus and thumb in front. However, if bleeding continues even after the uterus becomes hard, suggests, the presence of genital tract injury.
2.Elevate the bed by 20 - 30 degree and trunk horizontal.
3. Send blood sample to the lab in order to know the blodd loss and replacement.
4. Maintain input and output chart.
5. Maintain Nil per oral.
6. Start I.V. infusion preferably haemacel.
7. Monitor vital signs.
EXPLAIN THE SITUATION TO PATIENT AND HER HUSBAND:
1. Explain what is post partum hemorrhage.
2. Explain what is causing post partum hemorrhage such as atonic uterus, grand multipara, over distension of the uterus, malnutrition, Placental abruption, anaemia, Infection, etc .
3. Explain them your care plan and its rationale.
4. Gain patients and her husbands confidence.
CONSIDER CALLING THE PHYSICIAN :
We should consider calling the physician in case of an emergency as it is not possible to deal with the post partum hemorrhage alone, they are required in order to assist you.
ORDERS YOU MAY ANTICIPATE THE PHYSICIAN TO ORDER:
The physician many order Ergometrine or methargin 0.25 mg as it initiates contraction of the uterus which treats heavy bleeding after giving birth, The route of drug administration is oral, intramuscular or through the veins.
PRIMARY NURSING DIAGNOSIS:
1. Fluid volume deficient related to excessive blood loss as manifested by pale and dry skin.
2. Pain related to post partum hemorrhage as manifested by pain scale score.
3. Deficit knowledge related to post partum hemorrhage as manifested by frequent questions.
4. Imbalanced nutrition related to nil per oral as manifested by weakness.
5. Rick for infection related to post partum hemorrhage.
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