POSTPARTUM  HEMORRHAGE  

 
 

NURSING  DIAGNOSIS   THERAPEUTIC  MANAGEMENT   OUTCOME  EVALUATION  

Deficient   fluid   volume   related   to  excessive   The   use   of   pharmacological   agents   (e.g.,   •   Patient   will   maintain   a   blood  
blood   loss   after   birth   as   evidenced   by   tranexamic   acid)   and   clotting   factor   pressure  of  at  least  100/60  mmHg.  
decrease  blood  pressure   concentrates  (e.g.,  fibrinogen  concentrates   •   Patient   will   maintain   a   pulse   rate  
and   prothrombin   complex   concentrates)   between  70-­90  beats  per  minute.  
which   results   in   improved   hemostasis   and   •   Patient  will  have  a  balanced  24-­hour  
decreased  bleeding-­associated  mortality.   intake  and  output.  
•   Patient   will   have   a   cognitive   status  
within  expected  range.  
•   Patient  will  have  a  lochia  flow  of  less  
than  one  saturated  perineal  pad  per  
hour.  
•   Patient   will   demonstrate  
improvement  in  the  fluid  balance  as  
evidenced   by   a   good   capillary  refill,  
adequate   urine   output,   and   skin  
turgor.  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
CLAIRE  ALCOBER  
BSN-­‐2A  
  
 
 
THREE  TYPES  OF  LACERATION  
 
•   FIRST  DEGREE  LACERATION-­  involves  only  the  fourchette  
NURSING  DIAGNOSIS   THERAPEUTIC  MANAGEMENT   OUTCOME  EVALUATION  
Risk   for   Impaired   Skin   Integrity   related   to   •   Repair  of  vaginal  and  perineal  tear   •   Patient  reports  any  altered  sensation  or  
trauma   1.   Review  general  care  principles   pain  at  site  of  tissue  impairment.  
2.   Provide   emotional   support   and   •   Patient   demonstrates   understanding   of  
encouragement.  Make  sure  there  are  no   plan  to  heal  tissue  and  prevent  injury.  
known   allergies   to   lidocaine   or   related   •   Patient   describes   measures   to   protect  
drugs.   and   heal   the   tissue,   including   wound  
Polyglycolic   sutures   are   preferred   over   care.  
chromic   catgut   for   their   tensile   strength,   •   Patient’s   wound   decreases   in   size   and  
non-­   allergenic   properties   and   lower   has  increased  granulation  tissue.  
probability   of   infectious   complications.  
Chromic  catgut  is  an  acceptable  alternative,  
but  it  is  not  ideal.  
3.   Administer  local  anesthesia  (lidocaine)  
•   Repair   the   vaginal   mucosa   using   a  
continuous  2-­0  suture  
 
Advise  the  woman  to  clean  the  genital  area,  
including   the   suture   line,   with   clean   water  
twice  daily  and  always  after  defecation.  
Advise   the   woman   on   danger   signs   and  
when  and  where  to  seek  care  if  they  occur.  
 
 
 
 
 
   

CLAIRE  ALCOBER  
BSN-­‐2A  
  
THREE  TYPES  OF  LACERATION  
 
•   SECOND  DEGREE  LACERATION-­  involves  fourchette  and  superficial  perineal  muscles    
NURSING  DIAGNOSIS   THERAPEUTIC  MANAGEMENT   OUTCOME  EVALUATION  
Risk  for  Impaired  skin,  and  muscle  Integrity   •   Repair  of  vaginal  and  perineal  tear   •   Patient  reports  any  altered  sensation  or  
related  to  trauma   1.   Review  general  care  principles   pain  at  site  of  tissue  impairment.  
2.   Provide   emotional   support   and   •   Patient   demonstrates   understanding   of  
encouragement.  Make  sure  there  are  no   plan  to  heal  tissue  and  prevent  injury.  
known   allergies   to   lidocaine   or   related   •   Patient   describes   measures   to   protect  
drugs.   and   heal   the   tissue,   including   wound  
Polyglycolic   sutures   are   preferred   over   care.  
chromic   catgut   for   their   tensile   strength,   •   Patient’s   wound   decreases   in   size   and  
non-­   allergenic   properties   and   lower   has  increased  granulation  tissue.  
probability   of   infectious   complications.  
Chromic  catgut  is  an  acceptable  alternative,  
but  it  is  not  ideal.  
4.   Administer  local  anesthesia  (lidocaine)  
 
•   Repair   the   perineal   muscles   using  
interrupted  2-­0  suture  
•   Repair   the   perineal   skin   using  
interrupted   (or   subcuticular)   2-­0  
sutures,   starting   at   the   vaginal  
opening  
 
Advise  the  woman  to  clean  the  genital  area,  
including   the   suture   line,   with   clean   water  
twice  daily  and  always  after  defecation.  
Advise   the   woman   on   danger   signs   and  
when  and  where  to  seek  care  if  they  occur.  
 
 
   

CLAIRE  ALCOBER  
BSN-­‐2A  
  
THREE  TYPES  OF  LACERATION  
 
•   THIRD  DEGREE  LACERATION-­  involves  fourchette  and  superficial  perineal  muscles  and  anal  sphincter  
NURSING  DIAGNOSIS   THERAPEUTIC  MANAGEMENT   OUTCOME  EVALUATION  
Risk  for  Impaired  Skin,  muscle,  and  tissue   •   Repair  of  vaginal  and  perineal  tear   •   Patient  reports  any  altered  sensation  or  
Integrity  related  to  trauma   1.   Review  general  care  principles   pain  at  site  of  tissue  impairment.  
2.   Give   a   single   dose   of   prophylactic   •   Patient   demonstrates   understanding   of  
antibiotics  before  beginning  repair   plan  to  heal  tissue  and  prevent  injury.  
3.   Provide   emotional   support   and   •   Patient   describes   measures   to   protect  
encouragement.  Make  sure  there  are  no   and   heal   the   tissue,   including   wound  
known   allergies   to   lidocaine   or   related   care.  
drugs.   •   Patient’s   wound   decreases   in   size   and  
4.   Administer  local  anesthesia  (lidocaine)   has  increased  granulation  tissue.  
Polyglycolic   sutures   are   preferred   over  
chromic   catgut   for   their   tensile   strength,  
non-­   allergenic   properties   and   lower  
probability   of   infectious   complications.  
Chromic  catgut  is  an  acceptable  alternative,  
but  it  is  not  ideal.  
 
•   Repair   the   rectum  using   interrupted  
3-­0   or   4-­0   sutures   0.5   cm   apart   to  
bring  together  the  mucosa  
•   Repair   the   perineal   muscles   using  
interrupted  2-­0  suture  
•   Repair   the   perineal   skin   using  
interrupted   (or   subcuticular)   2-­0  
sutures,   starting   at   the   vaginal  
opening  
 
Advise  the  woman  to  clean  the  genital  area,  
including   the   suture   line,   with   clean   water  
twice  daily  and  always  after  defecation.  
Advise   the   woman   on   danger   signs   and  
when  and  where  to  seek  care  if  they  occur.  
CLAIRE  ALCOBER  
BSN-­‐2A  
  
 
 
 
PUERPERAL  INFECTION  
 
 
NURSING  DIAGNOSIS   THERAPEUTIC  MANAGEMENT   OUTCOME  EVALUATION  
Acute   pain   related   to   body   response   to   Ensure   adequate   fluid   volume   and   to   •   Patient   will   identify/use   individually  
infective  agent  evidenced  by  verbalization,   prevent  sepsis  and  shock.     appropriate  comfort  measures.  
restlessness,  and  guarding  behavior     •   Patient  will  report  decreased  level  of  
Provide   aggressive   fluid   management,   pain/discomfort.  
begin   cardiac   monitoring,   and   administer  
oxygen.  
 
Antibiotics   are   the   mainstay   of   treatment.  
Pain   medications   also   are   important,  
because  patients  often  have  discomfort.    
 
Patients  with  septic  pelvic  thrombophlebitis  
must  undergo  anticoagulation  therapy,  and  
they   should   receive   broad-­spectrum  
antibiotics.  
 
 
   

CLAIRE  ALCOBER  
BSN-­‐2A  
ENDOMETRITIS  
 
 

NURSING  DIAGNOSIS   THERAPEUTIC  MANAGEMENT   OUTCOME  EVALUATION  

Risk  for  infection  related  to    high  vascularity   The   physician   should   promptly   initiate   Improvement   will   be   noted   within   48-­72  
of  involved  area   broad-­spectrum  antibiotics.     hours  in  nearly  90%  of  women  treated  with  
  an  approved  regimen.  
For   mild   cases   following   vaginal   delivery,    
oral  antibiotics  in  an  outpatient  setting  may    
be  adequate.  
 
Surgical   management   is   not   usually  
necessary   in   acute   endometritis   in   the  
obstetric  population.  Dilation  and  curettage  
may   be   advised   for   retained   products   of  
conception,   however.   In   rare   instances   of  
overwhelming   infection   nonresponsive   to  
conservative  therapy,  hysterectomy  may  be  
necessary  as  a  life-­saving  intervention.  
 
 
 
 
 

CLAIRE  ALCOBER  
BSN-­‐2A