CONCEPT MAP WORKSHEET
DESCRIBE DISEASE PROCESS AFFECTING PATIENT (INCLUDE PATHOPHYSIOLOGY OF DISEASE PROCESS)
Postpartum hemorrhage is considered to occur if the client loses more than 500ml of blood after a vaginal bi
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CONCEPT MAP WORKSHEET
DESCRIBE DISEASE PROCESS AFFECTING PATIENT (INCLUDE PATHOPHYSIOLOGY OF DISEASE PROCESS)
Postpartum hemorrhage is considered to occur if the client loses more than 500ml of blood after a vaginal birth or more than 1,000ml of blood after a cesarean birth. Two complications that can occur following a postpartum hemorrhage include hypovolemic shock and anemia.” (Holman et al., 2019) “With uterine atony, the relaxed muscles allow rapid bleeding from the endometrial arteries at the placental site. Bleeding continues until the uterine muscle fibers contract to stop the flow of blood.” (McKinney, James, Murray, Nelson, & Ashwill, 2018)
DIAGNOSTIC TESTS (REASON & RESULTS) PATIENT INFORMATION EXPECTED PHYSICAL FINDINGS
• Hgb and Hct – test to see how much blood has been loss.
• Coagulation profile (CP)- test clotting factors.
• Blood type and crossmatch- If the
patient needs a blood transfusion from the amount of blood loss it is important to know their blood type. Fatime Sanogo (F) DOB 7/8/1996 (23y)
Height 160 cm
Weight 71 kg
Adm DX Induction of labor secondary to postdates Allergies NKA • “A uterus that does not contract or does not remain contracted.”
• “Large gush or slow, steady trickle, ooze, or dribble of blood from the vagina.”
• “Saturation of one peripad per 15 minutes.”
• “Severe, unrelieved perineal or rectal pain.”
• Tachycardia
(McKinney, James, Murray, Nelson, &
Ashwill, 2018)
• “Uterine atony (hypotonic or bloggy)”
• “Blood clots larger than a quarter”
• “Constant oozing, trickling, or flank flow of bright red blood from the
vagina.”
• “Pallor of skin and mucus membranes; cold and clammy with loss of turgor.”
• Oliguria
(Holman et al., 2019)
ANTICIPATED NURSING INTERVENTIONS
• “Firmly massage the uterine fundus.”
• “Monitor vital signs.”
• Assess for source of bleeding:
o “Assess fundus for height, firmness, and position. If uterus is boggy, massage fundus to increase
muscle contractions.”
o “Assess lochia for color, quantity, and clots.”
o “Assess for clinical findings of bleeding from lacerations, episiotomy site, or hematomas.”
• “Assess bladder for distention. Insert an indwelling urinary catheter to assess kidney function and obtain an accurate measurement of urinary output.”
• “Maintain or initiate IV fluids to replace fluid volume loss with IV isotonic solutions, such as lactated Ringer’s or 0.9% sodium chloride; colloid volume expanders, such as albumin; and blood products (packed RBCs and fresh frozen plasma).”
• “Provide Oxygen at 2 to 3 L/min per nasal cannula, and monitor oxygen saturation.”
INTRODUCTION
Your name, position (RN), unit you are working on Student Nurse, Mother and baby unit
SITUATION
Patient’s name, age, specific reason for visit Fatime Sanogo is a 23-year-old female who just gave vaginal delivery one hour ago. She was admitted yesterday at 0600 for oxytocin induction of labor secondary to postdates. She declined any pain medication during labor. Dr. Schultz delivered her placenta manually at 0635 and then bleeding was controlled by a fundal massage. She has an infusion of oxytocin which is running at 20 mL/hr. and there is approximately 100 mL left in the bag.
BACKGROUND
Patient’s primary diagnosis, date of admission, current orders for patient Fatime Sanogo was admitted on July 8, 2020 with an admissions diagnosis of induction to labor secondary to postdates. Fatime is on a regular diet and we are encouraging PO fluids. She is ambulating with assistance until she is able to bear weight. She may shower when she is able to ambulate without assistance. Her vital signs are taken Q 4 hours then Q 8 hours thereafter if vital signs are within normal ranges. A fundal, bladder, lochia and perineal check should be performed Q 4 hours for the first 24 hours then 8 Q hours. She is on Ibuprofen, morphine, Oxytocin and Misoprostol.
Assessment
Current pertinent assessment data using head to toe approach, pertinent diagnostics, VS An assessment was performed 20 minutes ago on Fatime Sanogo with the following findings. She is breathing at 19 breaths per/min, HR 109, pulse: present. Blood pressure is 98/50, SpO2 97% and Temperature is
98.6. The patient stated she was in pain so 5mg of morphine was given through her IV at 0710. Breath sounds are clear and equal bilaterally. There were regular heart sounds without murmurs and her bowel sounds were heard. I assessed the patient’s perineum and there was minimal redness, minimal edema, no ecchymosis, and no discharge from the repair, and it was well approximated. A lot of blood and lochia was seen in the vaginal. She was bleeding at a moderate rate. I checked the bed for blood, lochia and fluid and changed the bed pads. The weight of the bed pads suggests that approximately 1240 mL of lochia was on the pads. The last time the pad was changed suggested a bleeding rate of approximately 1980 mL/hr.
RECOMMENDATION
Any orders or recommendations you may have for this patient I recommend her vital signs are taken Q 4 hours until bleeding is under control and until her vital signs are consistently in normal ranges. Keep checking her bed pads for bleeding regularly and weighing the amount found. The patient is in pain so making sure pain medication is working effectively to control that pain. Also try to get the patient moving when possible and encourage PO fluids.
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