POSTPARTUM HEMORRHAGE
I. INTRODUCTION
The postpartum period or puerperium refers to the 6-week period after
childbirth. Many physiologic and psychological changes occur during this period,
enabling nurses to play major roles in assessment, comfort promotion and education.
Protecting a woman’s health as these changes occur is important in preserving her future
childbearing function and for ensuring that she is physically well enough to incorporate
her new child into her family.
Although the puerperium is usually a period of health, complications like
hemorrhage, particularly, uterine atony, (which was the case of my patient) can occur,
when they do, immediate intervention is essential to prevent long-term disability and
interference with parent-child relationships.
For this case study, we aim that: 1.) we will have better understanding of
postpartum hemorrhage by reading books, articles and journals that are related with the
disease; 2.) understand clearly the pathophysiology of the disease, risk factors,
manifestations and treatment and modalities of the disease; and 3.) equip ourselves with
skills and health teachings that are appropriate for the care of patients with postpartum
hemorrhage, particularly uterine atony.
II. NURSING ASSESSMENT
A.PERSONAL DATA
The patient is Mrs. X. She was 21 years old, born on October 27, 1986 from San
Jose, Sta. Rita, Pampanga. She is a Filipino, married and a Roman Catholic.
SOCIO-DEMOGRAPHICPROFILE
~~~~~~~~&@#(*!#1 POSTPARTUM HEMORRHAGE#$*((#&$@@U#$
, MRS.X is a pure blooded Capampangan whose main concern is to make a living
for her family and to save money for her future delivery. She works as a bank teller in
one of the rural bank in Sta.Rita. His husband is a farmer and manages one of the family
businesses.
Mrs. X and her husband are religious—that they see to it they both go to church
every Sunday. They believe that God must be the center of their family. Whenever a
family member gets sick, they adhere to self-medication but if the condition is a bit
serious, they go directly to the nearest hospital.
Mrs. X lifestyle include: working for 8 hours, sleeping for <8 hours, eating
nutritious meals (more fruits and vegetables, less in meat and fatty foods, avoids junk
food and soft drinks) 3 times a day, etc. As a recreational activity, she watches television
as soon as she goes home and do some cross-stitching. She does not smoke nor drink any
alcoholic beverages.
ENVIRONMENTAL FACTORS
Their house is situated in San Jose, Sta. Rita, and a place near the main road. And
in just a meter away from their home is a gasoline station. Jenney’s and tricycle are
usually their means of transport. Their water supply comes from NAWASA.
There are lesser pollutants in the air because their area is rural and that few
vehicles are present.
B. Maternal-Child Health History
Mrs.X got married when she was 20 years old after her graduation. She got
pregnant 3 months later. According to her, she visits her doctor every month for pre natal
check-up and that she took all the vitamins prescribed by her doctor.
Aside from urinary tract infection on her first trimester and 2nd week of the last
trimester, she had never encountered any other problems during the entire course of her
pregnancy. She was screened for hepatitis B, and had several laboratory tests like
complete blood count, blood typing, and fasting blood sugar. She was also given a shot of
tetanus toxoid on her last trimester.
Onset of Menarche: 15 years old
Gravida- 1, Parity- 0/ Term-0, Preterm-0, Abortion-0, Livebirth-0
Family Health Illness History
The different diseases that run in the family of Mrs. X are:
~~~~~~~~&@#(*!#2 POSTPARTUM HEMORRHAGE#$*((#&$@@U#$
, Father Mother
Hypertension, Diabetes Mellitus
Sister Brother Sister
hypertension Pulmonary none
tuberculosis
Mrs.X
Legend:
Parents
None
Siblings
C. .History of Past Illness
According to the patient she was not sure whether she was fully immunized
during her early years, but as far as she remembers, aside from minor illnesses such as
simple fever, coughs and colds, she never had any major disease such as communicable
diseases neither hospitalized. She has no allergy with food or any allergen in the
environment neither to any medicine. She never experienced any serious accidents such
as vehicular accident and fracture.
History of Present Illness
Mrs. X was admitted to the hospital (Rosario Memorial Hospital) last February
19, 2008, at around 4:50 in the morning because of labor pains.
According to the patient, few hours prior to admission, she was asleep and suddenly felt
some abdominal cramping, since the pain is not that really intense, she ignores it and
went back to sleep. At around 3 am she was awakened by abdominal pain which was
accompanied by flank pain and some vaginal discharge. She told this to her husband and
decided to go to the hospital.
~~~~~~~~&@#(*!#3 POSTPARTUM HEMORRHAGE#$*((#&$@@U#$
, Vital signs upon admission: BP- 100/70, PR-90, RR- 20, TEMP-36.8deg.cel.
She was assessed by the resident on duty and found out she is already in labor. Internal
examination was made and the results were: 6cm, 50% effaced. (+) BOW, FHT-140
beats/minute. Her attending physician was then notified and orders the following; NPO,
IVF: D5LRS 1L + 1 ampule syntocinon, 1 ampule buscopan IV, Monitor FHT.
In the course of labor induction, the cervix was not able to dilate in spite of
uterine contraction, so the Doctors orders to have the patient under cesarean section. She
was transferred to the operating room from the delivery room. After the delivery of the
baby and placenta, the uterus was noticed to be relaxed and the bleeding did not stop. In
spite of the intervention made, such as bimanual uterine massage, injection of methergine
to the uterine muscle, and uterine artery ligation, nothing happened. The bleeding was not
controlled. So, the doctor opted to have the last resort of intervention which is
hysterectomy.
D. Physical Examination (IPPA- Cephalo-caudal Approach)
The patient was admitted last February 19, 2008 at around 3:50 am. I met the
patient last February 20, 2008; unfortunately, I was not there during the operation on
February 19, 2008. When I visited her, she was already on her 1st day post operative. I
introduced my self, told her that I was assign to take care of her for few days. I stated my
purpose and asked permission to do physical examination. Although she seems tired, in
pain and quite depressed, she consented me in doing physical examination.
GENERAL APPEARANCE
The patient is in lying position; she was approximately 130lbs and
approximately 5 feet and 2 inches tall. She was neat, well groomed and no foul odor. She
grimaces every time she moves. She is slightly pale, seems tired, with labored breathing,
because of pain, quite irritable but cooperative. Vital signs upon assessment are as
follows: BP- 100/70mmHG, PR-105, RR-20, Temp- 37 degree Celsius.
Assessment upon Nursing Assessment
RMH
admission
Assessment
Feb. 20, 2008 Feb.21, 2008 Feb 22, 2008
The skin appears pale,
Skin
warm to touch. The
complexion is fair, slightly
(+) Pallor, good skin (+) Pallor, good skin
dry but with good skin
turgor, warm to touch turgor,
turgor. There is no skin
lesions found
~~~~~~~~&@#(*!#4 POSTPARTUM HEMORRHAGE#$*((#&$@@U#$
I. INTRODUCTION
The postpartum period or puerperium refers to the 6-week period after
childbirth. Many physiologic and psychological changes occur during this period,
enabling nurses to play major roles in assessment, comfort promotion and education.
Protecting a woman’s health as these changes occur is important in preserving her future
childbearing function and for ensuring that she is physically well enough to incorporate
her new child into her family.
Although the puerperium is usually a period of health, complications like
hemorrhage, particularly, uterine atony, (which was the case of my patient) can occur,
when they do, immediate intervention is essential to prevent long-term disability and
interference with parent-child relationships.
For this case study, we aim that: 1.) we will have better understanding of
postpartum hemorrhage by reading books, articles and journals that are related with the
disease; 2.) understand clearly the pathophysiology of the disease, risk factors,
manifestations and treatment and modalities of the disease; and 3.) equip ourselves with
skills and health teachings that are appropriate for the care of patients with postpartum
hemorrhage, particularly uterine atony.
II. NURSING ASSESSMENT
A.PERSONAL DATA
The patient is Mrs. X. She was 21 years old, born on October 27, 1986 from San
Jose, Sta. Rita, Pampanga. She is a Filipino, married and a Roman Catholic.
SOCIO-DEMOGRAPHICPROFILE
~~~~~~~~&@#(*!#1 POSTPARTUM HEMORRHAGE#$*((#&$@@U#$
, MRS.X is a pure blooded Capampangan whose main concern is to make a living
for her family and to save money for her future delivery. She works as a bank teller in
one of the rural bank in Sta.Rita. His husband is a farmer and manages one of the family
businesses.
Mrs. X and her husband are religious—that they see to it they both go to church
every Sunday. They believe that God must be the center of their family. Whenever a
family member gets sick, they adhere to self-medication but if the condition is a bit
serious, they go directly to the nearest hospital.
Mrs. X lifestyle include: working for 8 hours, sleeping for <8 hours, eating
nutritious meals (more fruits and vegetables, less in meat and fatty foods, avoids junk
food and soft drinks) 3 times a day, etc. As a recreational activity, she watches television
as soon as she goes home and do some cross-stitching. She does not smoke nor drink any
alcoholic beverages.
ENVIRONMENTAL FACTORS
Their house is situated in San Jose, Sta. Rita, and a place near the main road. And
in just a meter away from their home is a gasoline station. Jenney’s and tricycle are
usually their means of transport. Their water supply comes from NAWASA.
There are lesser pollutants in the air because their area is rural and that few
vehicles are present.
B. Maternal-Child Health History
Mrs.X got married when she was 20 years old after her graduation. She got
pregnant 3 months later. According to her, she visits her doctor every month for pre natal
check-up and that she took all the vitamins prescribed by her doctor.
Aside from urinary tract infection on her first trimester and 2nd week of the last
trimester, she had never encountered any other problems during the entire course of her
pregnancy. She was screened for hepatitis B, and had several laboratory tests like
complete blood count, blood typing, and fasting blood sugar. She was also given a shot of
tetanus toxoid on her last trimester.
Onset of Menarche: 15 years old
Gravida- 1, Parity- 0/ Term-0, Preterm-0, Abortion-0, Livebirth-0
Family Health Illness History
The different diseases that run in the family of Mrs. X are:
~~~~~~~~&@#(*!#2 POSTPARTUM HEMORRHAGE#$*((#&$@@U#$
, Father Mother
Hypertension, Diabetes Mellitus
Sister Brother Sister
hypertension Pulmonary none
tuberculosis
Mrs.X
Legend:
Parents
None
Siblings
C. .History of Past Illness
According to the patient she was not sure whether she was fully immunized
during her early years, but as far as she remembers, aside from minor illnesses such as
simple fever, coughs and colds, she never had any major disease such as communicable
diseases neither hospitalized. She has no allergy with food or any allergen in the
environment neither to any medicine. She never experienced any serious accidents such
as vehicular accident and fracture.
History of Present Illness
Mrs. X was admitted to the hospital (Rosario Memorial Hospital) last February
19, 2008, at around 4:50 in the morning because of labor pains.
According to the patient, few hours prior to admission, she was asleep and suddenly felt
some abdominal cramping, since the pain is not that really intense, she ignores it and
went back to sleep. At around 3 am she was awakened by abdominal pain which was
accompanied by flank pain and some vaginal discharge. She told this to her husband and
decided to go to the hospital.
~~~~~~~~&@#(*!#3 POSTPARTUM HEMORRHAGE#$*((#&$@@U#$
, Vital signs upon admission: BP- 100/70, PR-90, RR- 20, TEMP-36.8deg.cel.
She was assessed by the resident on duty and found out she is already in labor. Internal
examination was made and the results were: 6cm, 50% effaced. (+) BOW, FHT-140
beats/minute. Her attending physician was then notified and orders the following; NPO,
IVF: D5LRS 1L + 1 ampule syntocinon, 1 ampule buscopan IV, Monitor FHT.
In the course of labor induction, the cervix was not able to dilate in spite of
uterine contraction, so the Doctors orders to have the patient under cesarean section. She
was transferred to the operating room from the delivery room. After the delivery of the
baby and placenta, the uterus was noticed to be relaxed and the bleeding did not stop. In
spite of the intervention made, such as bimanual uterine massage, injection of methergine
to the uterine muscle, and uterine artery ligation, nothing happened. The bleeding was not
controlled. So, the doctor opted to have the last resort of intervention which is
hysterectomy.
D. Physical Examination (IPPA- Cephalo-caudal Approach)
The patient was admitted last February 19, 2008 at around 3:50 am. I met the
patient last February 20, 2008; unfortunately, I was not there during the operation on
February 19, 2008. When I visited her, she was already on her 1st day post operative. I
introduced my self, told her that I was assign to take care of her for few days. I stated my
purpose and asked permission to do physical examination. Although she seems tired, in
pain and quite depressed, she consented me in doing physical examination.
GENERAL APPEARANCE
The patient is in lying position; she was approximately 130lbs and
approximately 5 feet and 2 inches tall. She was neat, well groomed and no foul odor. She
grimaces every time she moves. She is slightly pale, seems tired, with labored breathing,
because of pain, quite irritable but cooperative. Vital signs upon assessment are as
follows: BP- 100/70mmHG, PR-105, RR-20, Temp- 37 degree Celsius.
Assessment upon Nursing Assessment
RMH
admission
Assessment
Feb. 20, 2008 Feb.21, 2008 Feb 22, 2008
The skin appears pale,
Skin
warm to touch. The
complexion is fair, slightly
(+) Pallor, good skin (+) Pallor, good skin
dry but with good skin
turgor, warm to touch turgor,
turgor. There is no skin
lesions found
~~~~~~~~&@#(*!#4 POSTPARTUM HEMORRHAGE#$*((#&$@@U#$
