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RR >20 per minute can be due to blood loss and decreased oxygen carrying
capacity of blood. HR >100 BPM could be caused by and increased need for the
heart to work harder due to insufficient volume as well. And, when circulating blood Plan ongoing,
Pt BP 115-130/65-85, volume falls, as in hemorrhage which occurs in the postpartum period, blood outcome not met. Pt
HR 60-100, RR 14-20 Assess HR, BP, RR pressure falls. The body can only remain in this altered state for so long before HR>100, RR>20, SBP
as assessed q4h and q4h and PRN decompensation occurs quickly. Sudden changes or numbers trending outside the <115
PRN expected range need to be closely monitored as hemorrhage can had fatal
consequences. (Olds866, class notes)
Outcome Intervention
Outcome Intervention Assessing output and bladder fullness frequently is important because a full bladder Outcome met. Plan
Pt will void q3-4 h Monitor urinary interferes with involution of the uterus. In the immediate postpartum period many ongoing until
(awake) and PRN: and
output q shift
UO >30ml/hr q shift women may not be aware of a full bladder because the ligaments are still stretched. discharge.
Postpartum period a woman experiences diuresis and the bladder may fill more
rapidly than normal, and a full bladder can displace the uterus affecting its
contractility and tone, putting the patient at risk for increased blood loss. A
decreasing urine output could be indicative of insufficient renal perfusion and further
interventions would take place to determine if there is adequate fluid volume before