S.

no
1.

Assessment

Nursing
Expected outcome
Diagnosis
(goal)
Subjective
Altered tissue Short term
data:
perfusion
To reduce the
Patient
related to
heavy blood
complains of decrease
loss per
weakness and volume of
vagina.
fatigue.
circulating
To maintain
blood due to
an adequate
Objective
the heavy
breathing
data:
blood loss as
pattern.
Patient is
evidenced by
To monitor
having a
post-partum
the patient
heavy
haemorrhage.
closely.
bleeding per
Long term
vagina.
To maintain
the adequate
tissue
perfusion.

Planning
/intervention
Assess the
condition of
the patient.
Provide a
comfortable
position.
Administer
oxygen as
prescribed.
Administer
injection
methergin.
Administer
injection
oxytocin
infusion at
prescribed
rate.
Shift the
patient for
close
observation.
Regular
monitoring of
pulse, BP,
respiration,

Implementation

Condition of
patient was
assessed.
Comfortable
position is
given.
Oxygen
administered
at 2L/minute.
Injection
methergin
0.2mgI IM
given.
20 units
oxytocin
infusion
started at 4060
drops/minute.
Patient shifted
to observation.
Regular
recordings of
pulse, BP,
respiration,
CVP taken.

Rationale

Helps in
assessing the
need of the
patient.
Facilitates the
doctors and staff
to examine the
patient.
Methergin
markedly reduces
the bleeding.
Oxytocin
enhances the
contraction
thereby expulsion
of the remnants.
It help is closely
monitoring the
patient for any
emergency.

Evaluation
Patient
bleeding is
reduced to
some extent
and patient is
now
comfortable.

CVP.

2.

Objective
data:
Patient
complains of
weakness.

High risk of
developing
severe
anaemia
related to the
decreased
Subjective
haemoglobin
data:
level due to
Patient as at a the excessive
risk of
blood loss as
developing
evidenced by
severe
primary postanaemia.
partum
haemorrhage.

Short term To administer

extra IV
fluids.
To transfuse
blood if
required.
To give iron
supplements.
Long term To minimize
the risk of
developing
anaemia.

Assess for skin

(pale), nail
bed, and eyes.
Administer
extra IV fluids.
To arrange for
compatible
blood.
To transfuse
blood if
ordered by the
doctor.
To check for
haematological
investigations
post
transfusion of
blood, if done.
To administer
iron
supplements.
Advice for diet
rich in iron.

Assessment of
the patient was
done.
2L of normal
saline was
administered.
Blood
arrangement
was done for
emergency
transfusion.
Iron
supplements
were
administered.
Patient advised
for
modification
of diet iron
rich
constituents.

It helps to assess
the sign and
symptoms of
anaemia.
It helps in
replenishing the
body by
replacing the
blood loss.
It helps in
increasing the
haemoglobin
level gradually.
It helps in
preventing the
patient from the
risk of
developing
severe anaemia.

Patients
weakness is
reduced and
feels
comfortable.

3.

Subjective
dataPatient
complains of
weakness.
Objective
data:
Patient is
having
general
weakness.

Weakness
and fatigue
related to the
excessive
blood loss as
evidenced by
post partum
haemorrhage.

Short term To administer

IV fluids.
To give
adequate rest.
To provide
iron rich diet.
Long term To reduce the
weakness and
fatigue
gradually.

Administering
IV fluids.
Providing
adequate rest
and sleep.
Continuous
monitoring of
the patient and
keeping a
close watch.
Provision of
side rails in the
bed.
Encourage the
patient to have
good iron rich
diet along with
high protein
diet.
Encourage the

IV fluids are
administered
at the
prescribed
rate.
Patient given
adequate rest
and sleep.
Patient is not
left alone and
maintained a
close watch.
Side rails of
the bed are at
adequate
height.
Patient
encourages for
increasing the
oral intake of

It minimizes the
chances of
dehydration and
replaces the fluid
loss from the
body.
Proper rest helps
in restoring the
energy and
strength of the
body.
Patient should
always be
assisted an
should never be
left alone to
prevent any fall.
Minimizes the
risk of injury or

Patients
weakness is
reduced and
now she
feels relaxed.

oral intake of
fluids.

4.

Subjective
data:
Patient is
very anxious
and fearful.
Objective
data:
Patient is
worried
about the
complication
s.

Short term To provide

Anxiety and
health
fear related to
education to
consequences
the family.
of heavy
To provide
blood loss as
the diversion
evidenced by
therapy.
post- partum
haemorrhage. Long term To reduce the
anxiety and
fear.

Assess the
anxiety level
of the patient.
To give
psychological
support.
Enhance the
knowledge of
the patient.
Give assurance
to the patient.
Provide
diversion
therapy.
Encourage the
patient for

fluids and high

protein and
iron rich diet.

Anxiety level
was assessed.
Psychological
support was
given by
giving the
assurance that
everything will
be alright.
Health
education was
given
regarding the
benefits the
patient will

fall.
Provides energy
to the body and
increase
haemoglobin
level.

Helps to know
the mental status
of the patient.
Gives a support
to the patient and
reduces the
anxiety of the
patient.
Diversion therapy
diverts the mind
of the patient to
some other area
of interest.

Patient feels
relieved
from the
anxiety and
is now fear
full.

yoga and
meditation.

5.

Subjective
data:
Patient
complains of
having no
knowledge
regarding the
care to be
provided.
Objective
data:

Deficit
knowledge
about the
good perineal
hygiene and
other of
aspects after
delivery.

Short term To provide a

good health
education.
To
demonstrate
a good
perineal care.
To
demonstrate
a good breast
care.
Long term-

Give perineal
care and
explain about
benefits of its
regular
practice.
Give breast
care and
explain about
benefits of its
regular
practice.

have if she
maintains to
have a good
iron rich diet.
Music therapy
was given and
encourages for
yogameditation.

Perineal care
was given.
Breast care
was given.
Health
education
regarding a
regular
practice of
perineal and
breast are was

Patient is
now having
Prevents the
some
accumulation of
knowledge
any bacterial or
regarding
fungal agents on
the perineum, and after
thus the perineum discharge
care.
stays healthy.
Breast care
prevents
engorged breast
and any other

Patient is
knowledge
deficit.

To increase
the
knowledge of
the patient.

Explain about
the techniques
of breast
feeding and
benefits of
adequate
breast feeding.
To give an
effective sitz
bath.

given.
Techniques of
breast feeding
were
demonstrated.
Sitz bath was
given.

infection.
Helps in early
healing of the
episiotomy
sutures and
relieves the pain.