Tonya Woodward
04/02/2017
Postpartum Hemorrhage
Student: Tonya Woodward Date: 04/01/17
South Piedmont Community College
Practical Nursing
Nur 103AB: Postpartum Assessment
Vital Signs
Vital signs per unit routine. Notify healthcare
provider if: Systolic BP less than 90 or greater
than 140 or Diastolic BP less than 60 or greater
than 90, Temp greater than 38C, HR greater
than 110, RR greater than 28, onset of asthma
symptoms
Medications
Docusate sodium 100mg PO twice a day as
needed for constipation (at bedside)
Propoxyphene 65mg/aspirin 389mg/caffeine
32.4mg 1 tablet PO every three to four hours as
needed for pain Ibuprofen 800mg PO every
six to eight hours as needed for cramps (18
tablets at bedside)
Oxycodone 5-20mg. evergy 4-6 hours, prn for
pain Flurazepam 30mg PO at bedtime as
needed for sleep Albuterol inhaler at bedside,
two puffs as needed for acute onset of asthma
symptoms
Breasts
Uterus
Bladder
Bowels
Location: Postpartum Unit
Assessed vital signs every 15 minutes
Temp: 99.20F, P: 93, R: 20 BP: 130/80,
PulseOx: 98% (taken @ 1430)
Palpated fundus of the uterus for firmness and
location every 15 minutes
Assessed uterine observed peripad for the
amount of lochia, color, odor, and presence of
clots
Monitor I& O
Pain Level 0/10
Received Ducosate @ 0900 to relieve
constipation
Pt refused Propoxypene for pain as stated
doesn't really help w/ pain .
Ibuprofen given @ 1200 for cramps
Albuterol given twice @ 0930 and 0120 as
auscultation of wheezing present
Pt states no breast or nipple pain present.
Breasts lightly palpated, no engorgement,
nipples inspected for redness, irritation,
blisters, bleeding-none found
Uterus palpated for location and consistency-
firm and in the midline
Palpation of the bladder assessed- no bladder
distension present. pt able to move to the
bathroom to void q2h Output 50ml @ 10:00,
60 mL @ 12:00
Pt states "she has not had a bowel movement-
encouraged to drink extra fluids, fruits and
vegetables, notified Dr for order to administer
stool softener. Encouraged walking to promote
increase peristalis. pt states passing gas
 Tonya Woodward
04/02/2017
Postpartum Hemorrhage

Lochia Peripad inspected, noted Lochia rubra

moderate small clots(dark red blood)
discharge
Episiotomy/Lacerations Pt placed on side lying position w/ upper knees
forward. Inspected for bruising, edema, and
hematoma- small hemorrhoids present, sitz
bath to aid relief of pain

Legs Pt states no leg pain present, temperature of

legs cool.. pedal edema present (normal) , no
redness, warmth or tender areas
Emotions Postpartum blues-tearfulness, irritability,
fatigue

Signs/Symptoms Some Causes of Interventions Effective Outcomes

Low Hemorrhages Massage the Stop
hematocrit Uterine fundus excessive
uncontrolled Atony monitor bleeding and
bleeding Lacerations Vital signs improve fluid
decreased of the asess and volume
blood vagina estimate Vital signs
pressure Cervix, blood loss
within
increased perineum, or by pad
normal limits
heart rate labia count
Patient
swelling and hematoma Monitor
verbalizes
pain in the developmen hemoglobin
anxiety is
vaginal area t and
under control
hematocrit
levels
Administer
medications
, fluids as
prescribed
and monitor
I&O
 Tonya Woodward
04/02/2017
Postpartum Hemorrhage

Postpartum Hemorrhage Two Hours Following Delivery

1. What is the normal location of the fundus two hours post vaginal delivery?
After delivery and expulsion of the placenta, the uterus is about the size of a grapefruit
and is located midline in the abdomen, halfway between the umbilicus and symphysis pubis.
.Slowly, over the next several hours, the fundus, which is the top portion of the uterus will rise on
the midline of the abdomen to the level of or slightly above the umbilicus. Thereafter, the height
of the fundus decreases by at least 1 cm or 1 finger-breadth daily as the uterus goes through the
process of involution.

2. What assessments are vital for the nurse to perform on the postpartum patient?
The postpartum period covers the time period from birth until approximately six to eight
weeks after delivery. This is a time of healing and rejuvenation as the mothers body returns to
pre-pregnancy states. A physical assessment should include temperature, heart rate, respiration,
blood pressure, and pain level because temperature may rise due to the dehydration or infection
that can accompany labor. Pulse rates may be somewhat elevated but should return to their pre-
pregnant status gradually. A sustained rapid pulse can indicate hemorrhage. Respiratory rates
may be low after epidural anesthesia and after a cesarean birth but should gradually return to the
expected range. Orthostatic hypotension is common after delivery. Hypotension can indicate
hemorrhage, and hypertension may persist in women who have had pre-eclampsia. In addition, a
focal assessment of the reproductive system needs to be performed. Such assessment will include
the breasts,uterus, bladder, bowels, lochia, episiotomy/laceration, legs, and emotions

3. What factors increase a womans risk for postpartum hemorrhage?

Postpartum Hemorrhage is defined as a blood loss of more than 500 mL for a vaginal
delivery and more than 1,000 mL for a Cesarean delivery. Risk factors for PPH include:
Obesity Retained placenta Failure to progress during the second stage of labor Placenta
accreta Lacerations Large for gestational age (LGA) newborn Instrumental delivery
Hypertensive disorders Induction of labor Augmentation of labor with oxytocin Over
distension of the uterus Previous PPH

4. What are the differences between early and late hemorrhage?

The first 24 hours after birth and is called early hemorrhage, which most likely begins to
occur in the first 4 hours after birth. Late hemorrhage occurs after 24 hours and before 6
weeks post-partum

5. Why is the nursing assessment vital to caring for the postpartum woman?
The nursing assessment is vital to caring for the postpartum woman to monitor the body
for potential problems such as infections, hemorrhaging and cardiovascular problems.

6. What is uterine atony, and how does it cause postpartum hemorrhage?

Uterine atony is a loss of tone in the uterine muscle. Once a baby is delivered, the
uterus normally contracts and pushes out the placenta. After the placenta is
delivered, these contractions help put pressure on the bleeding vessels in the area
 Tonya Woodward
04/02/2017
Postpartum Hemorrhage

where the placenta was attached. If the uterus does not contract strongly enough,
these blood vessels bleed freely causing hemorrhaging to occur.

7. What are other causes of postpartum bleeding?

Postpartum hemorrhage may also be caused by a tear in the cervix or tissues of the
vagina, tear in a blood vessel in the uterus, bleeding into a hidden tissue area or space in
the pelvis causing hematoma, blood clotting disorders and placenta problems.

8. How is postpartum hemorrhage treated?

The aim of treatment of postpartum hemorrhage is to find and stop the cause of the
bleeding as soon as possible. Treatment often includes uterine massage and medication.
In rare cases, blood transfusion, removal of residual placenta, or a hysterectomy may be
needed.

9. What are the indications and contraindications of common medications used to

treat postpartum hemorrhage? Uterine stimulants such as oxytocin, methylergonovine,
carboprost, and Misoprostol are medications given to cause a woman's uterus to contract, or to
increase the frequency and intensity of the contractions by acting on the uterus to mimic
naturally occurring hormones. and are often used for the prevention and treatment of postpartum
hemorrhage. Contraindications of these drugs include drug allergy to a specific product, pelvic
inflammatory disease, uterine fibrosis, placenta previa, hypertonic uterus, uterine prolapse, or
any other condition in which vaginal delivery increases bleeding risks.