Help with a postpartum hemorrhage care plan

  1. Hello,

    I am worried that my care plan for a postpartum hemorrhage is not sounding correct. The pt is a 2 day post op c-section. I really appreciate any comments. Thank you very much in advance.

    Nursing Diagnosis: Risk for late postpartum hemorrhage related to macrosomnia
    (since she is a 2 day post op c-section is it considered a late postpartum hemorrhage?

    (subjective and objective)

    Uterine Overdistention:
    10lb. 12 oz. infant

    Prolonged Labor:
    29 hours

    EBL during C-section:
    1,000 ML

    " It seems like I am not bleeding as heavy as I was before"

    Patient Outcome
    (measurable goal/s)
    Pt will not experience a late postpartum hemorrhage

    Assess pt's, blood pressure, pulse and respirations. IF PT IS 48 HOURS POST-OP HOW OFTEN SHOULD THIS BE DONE DURING A SHIFT?
    Assessment will provide information regarding any excessive blood loss with a decreased BP and increased P and R.
    At the end of shift the pt's vitals all remained steady and within the range of normal limits. BP 120/78, R 16, P 74

    Assess fundus, perineum and bleeding. Evaluate blood loss by weighing peri pads. IF PT IS 48 HOURS POST-OP HOW OFTEN SHOULD THIS BE DONE DURING A SHIFT? Notify healthcare provider of any increased blood loss.
    Assessment gives information about uterine tone and position, hematoma development and extent of blood loss.
    At two days post-op, fundus was firm and at the level of the umbilicus and blood loss was decreased and no evidence of hematomas or increased blood, at the end of shift.

    Assess pt for abdominal pain, rigidity, increasing abdominal girth, vulvar or vulvovaginal hematomas.
    Assesment will provide information regarding a possible uterine rupture or hematoma formation or hidden bleeding.
    Pt had no complaints of abdominal pain or rigidity. No evidence of increased abdominal girth, vulvar or vulvovaginal hematomas.
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