Primary Nursing Diagnosis

Fluid volume deficit related to blood loss OUTCOMES. Fluid balance; Hydration; Circulation status

INTERVENTIONS. Bleeding reduction; Blood product administration; Intravenous therapy; Shock management


The goal of treatment is to correct the cause and replace the fluid loss. Patients should have nothing by mouth until hemostasis is established. Expedient diagnosis and treatment of the cause reduce the likelihood of a blood transfusion. Treatment for uterine atony involves performing frequent fundal massage, sometimes bimanual massage (by the medical clinician only), and pharmacologic therapy. Fluid replacement with normal saline solution, lactated Ringer's injection, volume expanders, or whole blood may be necessary. Multiple venous access sites, 100% oxygen, and a Foley catheter are often needed. If uterine atony is not corrected quickly, a life-saving hysterectomy is indicated.

Monitor the hematocrit and hemoglobin to determine the success of fluid replacement and the patient's intake and output. If an infection is the cause of the atony, the physician prescribes

Postpartum Hemorrhage 757

antibiotics. PPH caused by trauma requires surgical repair with aseptic technique. Hematomas may absorb on their own; however, if they are large, an incision, evacuation of clots, and ligation of the bleeding vessel are necessary. Administer analgesics for perineal pain. If retained fragments are suspected at the time of delivery, the uterine cavity should be explored. If manual removal or expression of clots/placental fragments is unsuccessful, cervical dilation and curet-tage is indicated to remove retained fragments.



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