Fluid Volume Deficit secondary to Post Partum Hemorrhage

Cues and
Clues
Analysis Goals/Objectives Nursing
Intervention
Rationale Evaluation
Blood loss of
500mL

Heavy Lochia
flow

Elevation of
pulse rate
indicating
hypovolemia

Sudden drop
in blood
pressure
implying
hemorrhage

Soft uterus

Uterus not
well
contracted

Decreased
urine output

Drop in
hemoglobin
laboratory
results
Postpartum
hemorrhage is
defined as any
loss of blood
from the
uterus more
than 500 ml
within a 24
hour period. It
may be
immediate or
late occurring
from the first
24 hours of
delivery up to
the remaining
days of the 6-
week
puerperium.
Short Term Goal:

Long Term Goal:
Client will
maintain fluid
volume at a
functional level
as evidenced by
individually
adequate
hemoglobin,
hematocrit
laboratory
results, stable
vital signs,
adequate urine
output, good
uterine
contractility,
good skin turgor
and capillary
refill after one
week

1.Assess vital
signs and note
for peripheral
pulses



2.Assess uterine
contraction and
lochia flow
every two hours




3. Note clients
physiological
response to
blood loss



4. Keep
accurate record
of the blood
products during
replacement
therapy

5. Maintain bed
rest and
schedule
activities to
provide
undisturbed
rest periods

6.Keep fluids
within reach of
client




1.Changes in BP
and pulse may
be used for
estimating
amount of blood
loss

2.To note how
much blood loss
the client is
experiencing
and to prompt
for immediate
intervention

3.
Symptomatology
May be useful in
gauging severity
of bleeding
episode

4. Potential
exists for over
transfusion of
fluids



5.Activity may
predispose to
further bleeding





6. To encourage
fluid intake






7.Administer
fluids/volume
expanders as
indicated







8.Replace blood
products as
ordered by the
physician






9.Administer
oxytocin as
prescribed by
the physician

10.Monitor
laboratory
studies
(hemoglobin,
hematocrit,
creatinine/BUN)




11.Encourage
client to do
Kegels
exercises every
4 hours

12.Teach client
perineal self-
care



7.Fluid
replacement
with isotonic
crystalloids
solutions
depends on the
degree of
hypovolemia
and duration of
bleeding

8.Fresh whole
blood, platelets
and fresh frozen
plasma are
usually given to
patients
depending on
severity of blood
loss

9.This drug helps
in the
contraction of
the uterus

10.Helps in
monitoring the
effectiveness of
the therapy;
malfunction in
the kidneys may
indicate major
bleeding
episodes

11.It helps
improve the
blood supply in
the perineal
area

12.To prevent
development of
perineal
infections


13.Assist in the
preparation for
surgery
specifically
hysterectomy
13.It is the most
effective in
halting bleeding
especially an
extremely atonic
uterus