Postpartum Hemorrhage Nursing Care Plan Diagnosis: Comprehensive Guide for Nurses

Postpartum Hemorrhage (PPH) stands as a critical obstetric emergency, demanding immediate recognition and intervention by healthcare professionals. Defined by the American College of Obstetricians and Gynecologists (ACOG) as a blood loss exceeding 1,000 mL, accompanied by hypovolemia signs, PPH complicates 1-5% of births. It is categorized into primary PPH, occurring within 24 hours of delivery, and secondary PPH, which can manifest from 24 hours to 12 weeks postpartum. Uterine atony, the failure of the uterus to contract after placental delivery, is the primary culprit, leading to excessive blood loss and potentially life-threatening consequences such as shock and maternal death. Globally, PPH is responsible for a staggering 25% of maternal mortality cases, underscoring the urgency and importance of effective nursing care.

Nurses, especially those in labor and delivery and postpartum units, play a pivotal role in managing PPH. Their expertise in early detection, prompt intervention, and patient education is crucial for improving maternal outcomes. This article delves into a comprehensive nursing care plan diagnosis for postpartum hemorrhage, aiming to equip nurses with the knowledge and skills necessary to provide optimal care. We will explore the nursing process, encompassing assessment, interventions, and detailed nursing care plans designed to address the multifaceted needs of patients experiencing PPH.

Nursing Process in Postpartum Hemorrhage

The nursing process forms the bedrock of effective patient care, particularly in managing complex conditions like postpartum hemorrhage. It involves a systematic approach to patient care, encompassing assessment, diagnosis, planning, implementation, and evaluation. For PPH, a meticulous application of the nursing process is vital for timely intervention and positive patient outcomes.

Nursing Assessment for Postpartum Hemorrhage

The initial step in the nursing process is a thorough assessment. This involves gathering subjective and objective data to understand the patient’s condition comprehensively. In the context of postpartum hemorrhage, assessment is continuous and vigilant, focusing on early signs and risk factors.

Review of Health History

A detailed health history is paramount in identifying women at risk for PPH and understanding the current clinical picture.

1. Identifying Acute Postpartum Bleeding Symptoms: Recognizing the signs of acute bleeding is the first crucial step. Symptoms may be subtle initially but can rapidly escalate.

• General Symptoms: Patients may report generalized weakness, feeling faint upon standing (orthostatic hypotension), unexplained chills, and restlessness indicative of hypovolemia.
• Central Nervous System (CNS) Changes: Dizziness and syncope (loss of consciousness) are significant neurological signs reflecting reduced cerebral perfusion due to blood loss.
• Cardiovascular Indicators: Palpitations and tachycardia (rapid heart rate) are compensatory mechanisms to maintain cardiac output. Hypotension (decreased blood pressure) is a later and more ominous sign of significant blood loss.
• Respiratory Distress: Tachypnea (rapid breathing) may occur as the body attempts to compensate for decreased oxygen-carrying capacity.
• Integumentary Manifestations: Diaphoresis (excessive sweating) and pallor (pale skin) are classic signs of hypovolemia and shock.
• Genitourinary Impact: Oliguria (decreased urine output) or anuria (absent urine output) reflects reduced renal perfusion and is a critical sign of hypovolemic shock.

2. Detailed Medical History Review: A thorough review of the patient’s medical records can reveal pre-existing conditions that elevate PPH risk.

• Pre-existing Hypertension and Preeclampsia/Eclampsia: These conditions are associated with coagulopathies and uterine atony, increasing PPH risk.
• Infections: Current or recent infections, including chorioamnionitis or endometritis, can contribute to uterine atony and bleeding.
• Blood Clotting Disorders: Pre-existing conditions like Disseminated Intravascular Coagulation (DIC) or other bleeding disorders significantly increase the risk of PPH and complicate management.
• Anemia: Pre-existing anemia reduces the patient’s tolerance to blood loss, making PPH more dangerous.
• Obesity: Obesity is linked to an increased risk of several pregnancy complications, including PPH, possibly due to uterine atony and cesarean deliveries.
• Advanced Maternal Age: Older mothers have a higher incidence of conditions like uterine fibroids and preeclampsia, which are PPH risk factors.

3. Obstetric History Examination: Past obstetric events can significantly predict the likelihood of PPH in the current delivery.

• Placental Anomalies: Conditions like placenta accreta, placenta previa, and placental abruption are major risk factors for PPH due to abnormal placental separation or implantation.
• Retained Placenta: Incomplete expulsion of the placenta can lead to uterine atony and secondary PPH.
• Multiparity (≥ 5 Pregnancies): Grand multiparity is associated with uterine atony due to overstretching of the uterine muscle.
• Multiple Gestation (Twins, Triplets, etc.): Similar to multiparity, multiple gestations can overdistend the uterus, increasing atony risk.
• Fetal Macrosomia (Baby > 9 pounds): Large babies can also lead to uterine overdistension and atony, as well as increased risk of lacerations during delivery.
• Polyhydramnios (Excessive Amniotic Fluid): Excessive amniotic fluid can overstretch the uterus, predisposing to atony.

4. Medication Review: Certain medications can predispose patients to bleeding or interfere with clotting mechanisms.

• Anticoagulants: Medications like heparin and aspirin inhibit clot formation, increasing bleeding risk.
• Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Drugs like diclofenac and ibuprofen can affect platelet function.
• Oral Steroids: Long-term use of steroids like dexamethasone and prednisone can, in some cases, affect coagulation.
• Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs): These antidepressants, including citalopram, fluoxetine, desvenlafaxine, and duloxetine, have been associated with a slightly increased risk of postpartum bleeding.

Physical Assessment

Physical examination is crucial for identifying the immediate signs of PPH and its potential causes.

1. Vital Signs and Vaginal Blood Loss Monitoring: Close monitoring of vital signs is essential.

• Tachycardia and Hypotension: These are cardinal signs of hypovolemia. Tachycardia often precedes hypotension. Changes in heart rate and blood pressure should be carefully tracked as indicators of blood volume loss. Significant blood volume loss (more than 25%) will manifest in marked vital sign changes.

2. Genitalia Examination: A thorough examination of the perineum, vagina, and cervix is necessary to identify sources of bleeding.

• Lacerations, Hematomas, and Uterine Rupture: Inspect for perineal and vaginal lacerations, which are common causes of PPH. Assess for hematomas in the vulvar or vaginal areas. In rare cases, uterine rupture may be suspected, especially in women with prior uterine scars. Palpate the cervix and vagina post-vaginal delivery to assess for trauma.

3. Placental Tissue Assessment: Ensuring complete placental expulsion is critical.

• Retained Placental Tissue: Verify that the placenta is delivered intact within 30 minutes of the baby’s birth. Inspect the placenta for completeness. Retained placental fragments are a common cause of late PPH, potentially causing fever, foul-smelling discharge, persistent bleeding, and pelvic pain.

4. Uterine Tone and Size Palpation: Assessing uterine tone is paramount as uterine atony is the leading cause of PPH.

• Uterine Atony: Palpate the fundus to assess uterine tone. Atony is characterized by a soft, “boggy,” or non-contracted uterus. A non-contracted uterus cannot effectively compress blood vessels at the placental site, leading to ongoing bleeding.

5. Disseminated Intravascular Coagulation (DIC) Assessment: DIC is a severe complication of PPH.

• Signs of DIC: Observe for signs of DIC, a disruption in the body’s clotting mechanism leading to widespread bleeding. Symptoms include bleeding from multiple sites (nosebleeds, gum bleeding, IV sites), easy bruising, hypotension, dyspnea (shortness of breath), and confusion.

6. Lochia Observation: Assessing the quantity and quality of lochia (postpartum vaginal discharge) is crucial.

• Abnormal Lochia: Lochia in the initial postpartum days is normally rubra (red) and may resemble a heavy menstrual flow. However, saturating more than one perineal pad per hour or passing large blood clots is abnormal and necessitates immediate intervention.

Diagnostic Procedures

Diagnostic tests aid in confirming the diagnosis of PPH, assessing its severity, and guiding management.

1. Laboratory Tests: Blood tests provide crucial information about the patient’s hematological status.

• Complete Blood Count (CBC): Monitor hemoglobin, hematocrit, and platelet levels. Serial CBCs are essential to track blood loss and guide transfusion needs.
• Blood Typing and Screening: Essential for preparing for potential blood transfusions. Crossmatching is necessary if transfusion is likely.

2. Coagulation Studies: Initial coagulation tests might be normal but are important to monitor, especially in certain risk conditions.

• Coagulation Profile: Prothrombin Time (PT), Partial Thromboplastin Time (PTT), fibrinogen levels, and D-dimer may be ordered, particularly if DIC is suspected or in conditions like abruptio placenta, HELLP syndrome, fatty liver of pregnancy, intrauterine fetal death, embolic events, or septicemia. These conditions can disrupt coagulation pathways.

3. Investigating Elevated INR and aPTT: If INR (International Normalized Ratio) and aPTT (activated Partial Thromboplastin Time) are elevated, further investigation is needed.

• Further Coagulation Tests: If INR and aPTT are abnormal, further tests may include fibrinogen levels, thrombin time, D-dimer, and blood film to assess for coagulopathies and guide specific treatments.

4. Ultrasound: Bedside ultrasound can be a rapid and useful tool.

• Point-of-Care Ultrasound (POCUS): Ultrasound can help identify retained placental tissue or uterine clots, guiding further management decisions such as manual uterine exploration or dilation and curettage (D&C).

Nursing Interventions for Postpartum Hemorrhage

Prompt and effective nursing interventions are critical in managing PPH and preventing severe complications. Interventions are focused on stopping the bleeding, restoring hemodynamic stability, and addressing the underlying cause.

Managing Active Bleeding

The primary goal in managing active PPH is to stop the hemorrhage and stabilize the patient.

1. Treat Causative Factors: Addressing the underlying cause is fundamental to PPH management.

• Etiology-Based Treatment: Treatment strategies are tailored to the cause of PPH. For uterine atony, interventions focus on uterine contraction. For lacerations or hematomas, repair is necessary. For retained placenta, removal is essential.

2. Ensure Continuous Organ Perfusion: Maintaining hemodynamic stability is paramount to preserve vital organ function.

• Hemodynamic Support: Ensure patent large-bore intravenous (IV) access (at least two IV lines). Elevate the patient’s legs to promote venous return and improve blood flow to vital organs. Administer supplemental oxygen to optimize oxygenation.

3. Intravenous Fluid Resuscitation: Rapid fluid replacement is crucial to counteract hypovolemia.

• Crystalloid Infusion: Initiate rapid infusion of crystalloid solutions, such as normal saline or Lactated Ringer’s, to restore circulating volume and maintain blood pressure.

4. Blood Transfusion Initiation: Blood product transfusion may be necessary in cases of significant blood loss or coagulopathy.

• Blood Product Administration: Early administration of blood products, including packed red blood cells, fresh frozen plasma (for clotting factors), and platelets (if thrombocytopenic or with coagulopathy), should be prioritized. Closely monitor cumulative blood loss to guide transfusion requirements.

5. Vital Signs and Urine Output Monitoring: Continuous monitoring of vital signs and urine output is essential to assess treatment effectiveness and perfusion status.

• Perfusion Assessment: Continuously monitor blood pressure, heart rate, oxygen saturation, and urine output. Urine output is a sensitive indicator of renal perfusion and overall hemodynamic status.

6. Trauma Repair: Surgical intervention is necessary to address bleeding from trauma.

• Surgical Procedures: Immediate surgical procedures may include exploration of the uterus for rupture, repair of perineal, vaginal, or cervical lacerations, and correction of uterine inversion.

7. Uterine Atony Management: Specific measures are taken to address uterine atony, the most common cause of PPH.

• Uterotonic Agents and Mechanical Interventions: Treatment options for uterine atony include bimanual uterine massage, uterine tamponade (using a balloon catheter), pelvic artery embolization (in severe cases), surgical management (uterine compression sutures or hysterectomy as last resort), and uterotonic medications such as oxytocin, methylergonovine, carboprost, and misoprostol.

8. Retained Tissue Removal: Removal of retained placental tissue is crucial for resolving PPH caused by this factor.

• Manual or Surgical Removal: Manual removal of retained placental fragments or dilation and curettage (D&C) may be necessary to remove any remaining tissue and allow the uterus to contract effectively.

9. Surgical Procedure Preparation: Prepare for surgical interventions if bleeding persists or recurs.

• Arterial Ligation or Hysterectomy: When bleeding is recurrent or uncontrollable in a stable patient, ligation of bleeding arteries (uterine or hypogastric artery ligation) may be required. Uterine rupture may necessitate laparotomy and potentially hysterectomy if uterine repair is not feasible.

Preventing Further Bleeding

Prevention is always better than cure. Identifying risk factors and implementing preventative measures can significantly reduce PPH incidence and severity.

1. Bleeding Risk Identification: Proactive risk assessment is key to preventing PPH-related morbidity and mortality.

• Risk Stratification: Identify patients at high risk for PPH prior to delivery through detailed history taking and antenatal assessments. Ultrasound evaluation can help identify conditions like placenta previa or accreta, guiding delivery planning.

2. Iron Supplementation: Addressing pre-existing anemia is crucial.

• Anemia Management: Treat anemic patients with oral or parenteral iron supplements, especially if hematocrit is less than 30%, to improve iron stores and reduce the impact of potential blood loss.

3. Erythropoietin-Stimulating Agents: In select high-risk patients, these agents may be considered.

• For High-Risk Anemia: In high-risk patients, particularly those who decline blood transfusion, erythropoietin-stimulating agents may be considered, along with hematological consultation, to stimulate red blood cell production pre-delivery.

4. Healthcare Provider Collaboration: Collaborative care is essential for optimal patient management during labor and delivery.

• Multidisciplinary Approach: Close collaboration with obstetricians and other healthcare providers during labor and delivery is vital. Consider factors that increase bleeding risk when planning delivery management, such as the mode of delivery (cesarean section increases risk), need for general anesthesia, potential for prolonged labor, presence of infection, and history of PPH in previous pregnancies.

5. Early Breastfeeding Initiation: Breastfeeding has physiological benefits in preventing PPH.

• Oxytocin Release: Encourage breastfeeding immediately after delivery. Breastfeeding stimulates the release of natural oxytocin, which promotes uterine contractions and helps control postpartum bleeding.

6. Secondary PPH Education: Patient education is crucial for early detection of late PPH.

• Discharge Education: Educate patients about the signs and symptoms of secondary PPH, which can occur up to 12 weeks postpartum. Instruct them to monitor for changes in lochia (increased bleeding, return to bright red bleeding after it had lightened), severe abdominal cramping, fever, or dizziness, and to seek immediate medical attention if these symptoms occur. Reinforce that treatment principles for secondary PPH are similar to those for primary PPH.

Postpartum Hemorrhage Nursing Care Plans: Diagnoses and Goals

Nursing care plans are structured frameworks that guide nursing care, outlining diagnoses, expected outcomes, and interventions. For PPH, care plans are essential for prioritizing and organizing care delivery. Here are examples of nursing care plans for common nursing diagnoses associated with postpartum hemorrhage.

Acute Pain

Acute pain is a common issue in PPH, often related to perineal trauma, lacerations, or uterine interventions.

Nursing Diagnosis: Acute Pain

Related to: Tissue damage (perineal lacerations, episiotomy), hematoma formation, surgical interventions, uterine atony and associated cramping.

As evidenced by: Patient reports of pain intensity (using pain scales), diaphoresis, expressive pain behaviors (grimacing, moaning), guarding behavior, protective positioning, abdominal cramping, pelvic pain, and sensations of heaviness.

Expected Outcomes:

• Patient will verbalize a decrease in pain intensity within a specified timeframe (e.g., within 1 hour of intervention).
• Patient will demonstrate effective use of pain relief measures, both pharmacological and non-pharmacological.
• Patient will report satisfactory pain control that allows for rest and comfort.

Assessments:

1. Comprehensive Pain Assessment: Conduct a detailed pain assessment including location, character, onset, duration, exacerbating and relieving factors, and pain intensity using a standardized pain scale. Uterine atony can manifest as lower back pain. Internal bleeding may cause generalized abdominal pain or tenderness.
2. Perineal Trauma Assessment: Assess the perineum for lacerations, episiotomy, edema, and hematoma formation. Perineal and vaginal lacerations are significant sources of postpartum pain. Increased perineal pressure and discomfort without visible trauma may indicate hematoma development.
3. Fundal Height and Tenderness Assessment: Assess fundal height and tenderness. Persistent pain or heaviness accompanied by postpartum bleeding can suggest subinvolution of the uterus, a less common cause of PPH.

Interventions:

1. Non-pharmacological Pain Relief Techniques: Encourage and teach relaxation techniques such as deep breathing exercises, guided imagery, meditation, and provide comfort measures like back rubs. Diversional activities can help distract from pain.
2. Pharmacological Pain Management: Administer pain medications as prescribed, considering the type and severity of pain. Analgesics may range from NSAIDs to opioids, depending on pain intensity and patient needs.
3. Local Comfort Measures: Encourage the use of cold compresses to the perineum in the immediate postpartum period to reduce hematoma formation and provide pain relief. Later, warm sitz baths can promote perineal healing, reduce episiotomy pain, and enhance relaxation.
4. Prepare for or Assist with Surgical Interventions: Be prepared to assist with surgical interventions as indicated by the cause of pain and bleeding. Pain may be a symptom indicating the need for surgical repair of lacerations, laparotomy for uterine rupture repair or cesarean incision, artery ligation, or incision and drainage of hematomas.

Anxiety

The experience of PPH can be traumatic, leading to significant anxiety and fear.

Nursing Diagnosis: Anxiety

Related to: Traumatic delivery experience, perceived or actual threat to life, fear of complications, unfamiliarity with medical procedures.

As evidenced by: Patient expressing feelings of fear, sense of impending doom, heightened awareness of physiological symptoms (palpitations, shortness of breath), expressions of helplessness, restlessness, and overall distress.

Expected Outcomes:

• Patient will report a reduction in anxiety levels and an increased sense of control over the situation.
• Patient will verbalize feelings and concerns related to the PPH experience.
• Patient will demonstrate at least two coping strategies to manage anxiety effectively.

Assessments:

1. Differentiate Physiological vs. Psychological Symptoms: Distinguish between anxiety symptoms and PPH symptoms, as some overlap (e.g., restlessness, tachypnea, tachycardia). Differentiating is crucial for appropriate diagnosis and intervention.
2. Assess Thoughts and Feelings: Encourage the patient to express their thoughts, feelings, and perceptions about the PPH event. Provide a safe and supportive environment for verbalization. Clarify any misinformation or misconceptions to reduce panic and anxiety.

Interventions:

1. Clear and Empathetic Communication: Maintain clear, consistent, and empathetic communication. Explain all procedures and interventions in understandable terms. Provide reassurance and calm support to reduce anxiety.
2. Involve Support System: Involve the patient’s partner, family members, or support persons in education and care, as appropriate. Support systems can offer emotional support and reinforce the treatment plan.
3. Maintain Mother-Baby Dyad: Keep the baby and mother together whenever medically feasible to promote bonding and reduce maternal anxiety associated with separation. If the mother is being treated in her room, keeping the newborn nearby can be reassuring.
4. Provide Resources for Psychological Support: Offer information about therapy resources and counseling services. Acknowledge that experiencing a life-threatening event like PPH can lead to long-term stress, anxiety, and potentially postpartum post-traumatic stress disorder (PTSD). Early access to counseling can aid coping and recovery. Also, be aware that postpartum depression risk may be elevated after PPH.

Deficient Fluid Volume

Fluid volume deficit is a direct consequence of blood loss in PPH, threatening organ perfusion.

Nursing Diagnosis: Deficient Fluid Volume

Related to: Excessive blood loss secondary to postpartum hemorrhage.

As evidenced by: Changes in mental status (confusion, lethargy), hypotension, tachycardia, decreased urine output (oliguria), decreased hemoglobin and hematocrit levels.

Expected Outcomes:

• Patient will maintain a blood pressure within acceptable parameters (e.g., systolic BP > 90 mm Hg, diastolic BP > 60 mm Hg) adequate for vital organ perfusion.
• Patient will exhibit urine output of at least 30 mL/hour, indicating adequate renal perfusion.
• Patient will demonstrate stable hemoglobin levels within acceptable limits for postpartum status.
• Patient will not experience further signs or symptoms of hypovolemia.

Assessments:

1. Monitor Vital Signs and Level of Consciousness (LOC): Closely monitor vital signs (blood pressure, heart rate, respiratory rate, oxygen saturation) and LOC frequently. Hypotension, tachycardia, confusion, faintness, and weakness are key indicators of hypovolemia and impending hypovolemic shock.
2. Assess Uterine Status: Determine the source of bleeding. Assess uterine tone; a soft or “boggy” uterus is indicative of atony. Evaluate for uterine inversion, lacerations, or uterine rupture, which may require internal examination.
3. Review Laboratory Values: Monitor trends in laboratory values, particularly hemoglobin, hematocrit, and coagulation studies. Low hemoglobin is expected in PPH, and platelet counts and coagulation profiles may be abnormal depending on the cause and severity of bleeding.
4. Monitor Lochia Characteristics: Assess the amount, color, and consistency of lochia. Persistent heavy bleeding, saturation of perineal pads rapidly, and passage of large clots are signs of ongoing hemorrhage.

Interventions:

1. Uterine Massage: Perform fundal massage immediately after delivery and as needed to promote uterine contraction and reduce bleeding caused by atony.
2. Administer Uterotonic Medications: Administer uterotonic medications (oxytocin, methylergonovine, carboprost, misoprostol) as ordered to promote uterine contraction and control bleeding. Oxytocin is typically administered prophylactically and therapeutically.
3. Promote Bed Rest with Leg Elevation: Maintain patient on bed rest to prevent orthostatic hypotension and reduce the risk of falls associated with hypovolemia. Elevate legs to enhance venous return.
4. Administer IV Fluids: Initiate rapid intravenous fluid resuscitation with crystalloid solutions (normal saline, Lactated Ringer’s) to expand intravascular volume.
5. Administer Blood Products: Prepare for and administer blood products (packed red blood cells, plasma, platelets) as ordered to replace blood loss and correct coagulopathies.
6. Prepare for Surgical or Invasive Procedures: Prepare the patient for potential surgical or other invasive interventions if hemorrhage is due to lacerations, hematoma, uterine rupture, trauma, or retained placental tissue.

Deficient Knowledge

Lack of understanding about PPH and postpartum recovery can increase anxiety and hinder self-care.

Nursing Diagnosis: Deficient Knowledge

Related to: Lack of prior information about postpartum hemorrhage, unfamiliarity with postpartum complications, information misinterpretation, cognitive limitations due to stress or anxiety.

As evidenced by: Expressed concerns or questions about postpartum bleeding, exaggerated behaviors related to perceived risks, seeking information constantly, statements reflecting misconceptions about PPH, and potentially, development of PPH complications due to delayed recognition or action.

Expected Outcomes:

• Patient will verbalize understanding of postpartum hemorrhage, its causes, risk factors, and management.
• Patient will accurately describe signs and symptoms of PPH that require prompt medical attention.
• Patient will actively participate in the plan of care to prevent or manage PPH complications.
• Patient will demonstrate appropriate self-care behaviors related to postpartum recovery and monitoring for PPH signs.

Assessments:

1. Identify Risk Factors and Patient’s Awareness: Assess the patient’s specific risk factors for PPH (e.g., history of PPH, multiple gestation, placenta previa). Determine the patient’s current level of understanding about PPH and postpartum recovery.
2. Assess Understanding of Warning Signs: Evaluate the patient’s understanding of normal postpartum changes versus warning signs of complications, particularly PPH. Identify any misconceptions or knowledge gaps.

Interventions:

1. Provide Comprehensive Discharge Education: Provide detailed discharge instructions regarding normal postpartum lochia changes versus abnormal bleeding patterns. Educate about signs of PPH, including saturating a pad in an hour, passing large clots, dizziness, fatigue, new or worsening abdominal pain, fever, and foul-smelling discharge. Emphasize the importance of promptly contacting their healthcare provider if any of these symptoms occur, even up to 12 weeks postpartum.
2. Emphasize Early Breastfeeding Benefits: Reinforce the benefits of immediate breastfeeding for uterine contraction and bleeding control. Educate and support the mother in initiating breastfeeding soon after delivery, if desired.
3. Review Follow-Up Care Plan: Explain the follow-up care plan, which may include repeat lab testing to monitor blood counts and iron levels, especially if anemia is present. Discuss recommendations for iron supplementation or dietary modifications to increase iron intake.
4. Provide Written Materials and Resources: Offer written materials, websites, or support group information related to postpartum recovery and PPH, reinforcing verbal education and providing accessible resources for later review.

Imbalanced Nutrition: Less Than Body Requirements

Blood loss in PPH can lead to iron deficiency and nutritional imbalances.

Nursing Diagnosis: Imbalanced Nutrition: Less Than Body Requirements

Related to: Blood loss resulting in iron deficiency anemia, inadequate food intake due to fatigue, pain, nausea, or altered taste perception, increased metabolic demands postpartum.

As evidenced by: Laboratory evidence of anemia (decreased hemoglobin, hematocrit, ferritin), reported fatigue, pallor, lightheadedness, delayed wound healing, poor appetite, and potentially hypoglycemia.

Expected Outcomes:

• Patient will verbalize understanding of nutritional needs postpartum, including iron-rich food sources.
• Patient will demonstrate dietary intake that meets nutritional requirements for postpartum recovery and lactation (if breastfeeding).
• Patient will exhibit improvement in laboratory values (RBC count, hemoglobin, iron levels) towards normal limits.
• Patient will report increased energy levels and reduced symptoms of anemia.

Assessments:

1. Assess Laboratory Values: Review CBC, iron studies (serum iron, ferritin, transferrin saturation) to assess for anemia and iron deficiency. Monitor trends in these values.
2. Assess Fluid and Electrolyte Status: Evaluate fluid balance and electrolyte levels, as PPH and fluid resuscitation can impact electrolyte balance. Assess for dehydration signs and monitor intake and output.
3. Assess for Anemia Signs and Symptoms: Assess for clinical signs of anemia such as fatigue, pallor, weakness, shortness of breath, and dizziness.
4. Assess Nutritional Intake and Appetite: Evaluate the patient’s appetite, dietary intake, and any factors affecting nutritional intake, such as pain, nausea, depression, or lack of knowledge about postpartum nutritional needs.

Interventions:

1. Encourage Adequate Fluid Intake: Promote adequate oral fluid intake to maintain hydration, support organ function, and aid in nutrient delivery. If oral intake is insufficient, IV fluids may be necessary.
2. Educate on Iron-Rich Food Sources: Provide education on dietary sources of iron, emphasizing heme iron (lean meats, seafood) and non-heme iron (beans, lentils, fortified grains, dark green leafy vegetables). Advise on combining non-heme iron sources with vitamin C-rich foods to enhance absorption.
3. Educate on Iron Supplementation: If iron supplements are prescribed, provide detailed instructions on proper administration:
   • Take iron supplements with vitamin C (e.g., orange juice) to improve absorption.
   • Avoid taking iron with calcium-rich foods or antacids, as calcium can inhibit iron absorption.
   • Advise taking iron supplements at least one hour before bedtime to minimize gastrointestinal side effects.
   • Avoid consuming tea or coffee within one hour of taking iron supplements, as tannins and caffeine can interfere with iron absorption.
4. Refer to a Dietitian: Consider referral to a registered dietitian for individualized meal planning and nutritional counseling, especially for patients with significant anemia, dietary restrictions, or breastfeeding mothers with increased nutritional needs.

This comprehensive postpartum hemorrhage nursing care plan diagnosis guide provides a framework for nurses to effectively manage and care for patients experiencing this critical obstetric complication. By utilizing a systematic nursing process, focusing on early assessment, implementing timely interventions, and providing thorough patient education, nurses can significantly improve outcomes and ensure the well-being of postpartum mothers.

References

American College of Obstetricians and Gynecologists (ACOG)
NurseTogether – Labor and Delivery Nursing
NurseTogether – Postpartum Nursing
NurseTogether – Nursing Diagnosis Guide
NurseTogether – Nursing Care Plans