PPH interventions

[Bre14]

Any help would be appreciated. Tomorrow is the first day in postpartum. I need 3 nursing interventions to address postpartum hemorrhage.

Assessing BP, assess fundus.?

I'm just a bit lost here, we have had no skills in reference to this rotation and one lecture so far. Anyhow any help would be much appreciated.

Thanks.

[imafostermom]

massage the fundus, if boggy, until firm (do not over massage, this fatigues the muscle).

monitor patient's vital signs every 15 minutes until stable.

prevent bladder distention. bladder distention displaces the uterus and prevents effective uterine contractions.

intervenously fluids administered to increase fluid and blood volume.

oxytocin administration.

methergine/prostin may be administered to stimulate uterine contractions when oxytocin is ineffective.

[gillytook]

Elevate the foot of the bed.

[Daytonite, BSN, RN]

• http://www.brooksidepress.org/Products/Military_OBGYN/Textbook/AbnormalLandD/PPHemorrhage.htm = Postpartum Hemorrhage from the Brookside Press Military Obstetrics & Gynecology Manual
  
• http://www.emedicine.com/med/topic3568.htm - Postpartum Hemorrhage
  
• http://www.fpnotebook.com/OB/Bleed/PstprtmHmrhg.htm - Postpartum Hemorrhage - outline of physician assessment and treatment
  

[Daytonite, BSN, RN]

Therapeutic Management of Postpartum Hemorrhage

(page 331, Foundations of Maternal-Newborn Nursing, 4th Edition, Clinical Companion, by Sharon Smith Murray and Emily Slone McKinney)

• "Massage the uterus while supporting the lower uterine segment. Express clots.
  
• Insert an indwelling catheter to empty the bladder and allow accurate measure of output.
  
• Place the woman in supine position. Avoid Trendelenburg position which may interfere with respiratory and cardiac function.
  
• Maintain IV access and start a second IV with large-bore catheter capable of carrying whole blood.
  
• Administer IV fluids, volume expanders, and blood as directed.
  
• Draw blood (per protocol or orders) for hemoglobin and hematocrit, type and crossmatch, platelets, prothrombin time, activated partial thromboplastin time (aPTT), fibrinogen, fibrin degradation products, and fibrin split products.
  
• Administer prescribed drugs, such as oxytocin, prostaglandins, or methylergonovine maleate.
  
• Apply a pulse oximeter to determine the oxygen saturation; administer oxygen by snug face mask at 8 to 10 L/min or as directed by the physician or facility protocol.
  
• Anticipate further medical interventions (uterine packing, ligation or embolization of uterine, ovarian, or hypogastric arteries, or hysterectomy if other measures fail to control bleeding.
  
• In addition, the nurse will:
  • Monitor the condition of the woman, and communicate with the health care provider.
    
  • Provide explanations and emotional support for the woman and her family.
    
  • Obtain signed consents for specific surgical procedures or blood transfusions."