POSTPARTUM HEMORRHAGE
NURSING DIAGNOSIS THERAPEUTIC MANAGEMENT OUTCOME EVALUATION
Deficient fluid volume related to excessive The use of pharmacological agents (e.g., • Patient will maintain a blood
blood loss after birth as evidenced by tranexamic acid) and clotting factor pressure of at least 100/60 mmHg.
decrease blood pressure concentrates (e.g., fibrinogen concentrates • Patient will maintain a pulse rate
and prothrombin complex concentrates) between 70-90 beats per minute.
which results in improved hemostasis and • Patient will have a balanced 24-hour
decreased bleeding-associated mortality. intake and output.
• Patient will have a cognitive status
within expected range.
• Patient will have a lochia flow of less
than one saturated perineal pad per
hour.
• Patient will demonstrate
improvement in the fluid balance as
evidenced by a good capillary refill,
adequate urine output, and skin
turgor.
CLAIRE ALCOBER
BSN-‐2A
THREE TYPES OF LACERATION
• FIRST DEGREE LACERATION- involves only the fourchette
NURSING DIAGNOSIS THERAPEUTIC MANAGEMENT OUTCOME EVALUATION
Risk for Impaired Skin Integrity related to • Repair of vaginal and perineal tear • Patient reports any altered sensation or
trauma 1. Review general care principles pain at site of tissue impairment.
2. Provide emotional support and • Patient demonstrates understanding of
encouragement. Make sure there are no plan to heal tissue and prevent injury.
known allergies to lidocaine or related • Patient describes measures to protect
drugs. and heal the tissue, including wound
Polyglycolic sutures are preferred over care.
chromic catgut for their tensile strength, • Patient’s wound decreases in size and
non- allergenic properties and lower has increased granulation tissue.
probability of infectious complications.
Chromic catgut is an acceptable alternative,
but it is not ideal.
3. Administer local anesthesia (lidocaine)
• Repair the vaginal mucosa using a
continuous 2-0 suture
Advise the woman to clean the genital area,
including the suture line, with clean water
twice daily and always after defecation.
Advise the woman on danger signs and
when and where to seek care if they occur.
CLAIRE ALCOBER
BSN-‐2A
THREE TYPES OF LACERATION
• SECOND DEGREE LACERATION- involves fourchette and superficial perineal muscles
NURSING DIAGNOSIS THERAPEUTIC MANAGEMENT OUTCOME EVALUATION
Risk for Impaired skin, and muscle Integrity • Repair of vaginal and perineal tear • Patient reports any altered sensation or
related to trauma 1. Review general care principles pain at site of tissue impairment.
2. Provide emotional support and • Patient demonstrates understanding of
encouragement. Make sure there are no plan to heal tissue and prevent injury.
known allergies to lidocaine or related • Patient describes measures to protect
drugs. and heal the tissue, including wound
Polyglycolic sutures are preferred over care.
chromic catgut for their tensile strength, • Patient’s wound decreases in size and
non- allergenic properties and lower has increased granulation tissue.
probability of infectious complications.
Chromic catgut is an acceptable alternative,
but it is not ideal.
4. Administer local anesthesia (lidocaine)
• Repair the perineal muscles using
interrupted 2-0 suture
• Repair the perineal skin using
interrupted (or subcuticular) 2-0
sutures, starting at the vaginal
opening
Advise the woman to clean the genital area,
including the suture line, with clean water
twice daily and always after defecation.
Advise the woman on danger signs and
when and where to seek care if they occur.
CLAIRE ALCOBER
BSN-‐2A
THREE TYPES OF LACERATION
• THIRD DEGREE LACERATION- involves fourchette and superficial perineal muscles and anal sphincter
NURSING DIAGNOSIS THERAPEUTIC MANAGEMENT OUTCOME EVALUATION
Risk for Impaired Skin, muscle, and tissue • Repair of vaginal and perineal tear • Patient reports any altered sensation or
Integrity related to trauma 1. Review general care principles pain at site of tissue impairment.
2. Give a single dose of prophylactic • Patient demonstrates understanding of
antibiotics before beginning repair plan to heal tissue and prevent injury.
3. Provide emotional support and • Patient describes measures to protect
encouragement. Make sure there are no and heal the tissue, including wound
known allergies to lidocaine or related care.
drugs. • Patient’s wound decreases in size and
4. Administer local anesthesia (lidocaine) has increased granulation tissue.
Polyglycolic sutures are preferred over
chromic catgut for their tensile strength,
non- allergenic properties and lower
probability of infectious complications.
Chromic catgut is an acceptable alternative,
but it is not ideal.
• Repair the rectum using interrupted
3-0 or 4-0 sutures 0.5 cm apart to
bring together the mucosa
• Repair the perineal muscles using
interrupted 2-0 suture
• Repair the perineal skin using
interrupted (or subcuticular) 2-0
sutures, starting at the vaginal
opening
Advise the woman to clean the genital area,
including the suture line, with clean water
twice daily and always after defecation.
Advise the woman on danger signs and
when and where to seek care if they occur.
CLAIRE ALCOBER
BSN-‐2A
PUERPERAL INFECTION
NURSING DIAGNOSIS THERAPEUTIC MANAGEMENT OUTCOME EVALUATION
Acute pain related to body response to Ensure adequate fluid volume and to • Patient will identify/use individually
infective agent evidenced by verbalization, prevent sepsis and shock. appropriate comfort measures.
restlessness, and guarding behavior • Patient will report decreased level of
Provide aggressive fluid management, pain/discomfort.
begin cardiac monitoring, and administer
oxygen.
Antibiotics are the mainstay of treatment.
Pain medications also are important,
because patients often have discomfort.
Patients with septic pelvic thrombophlebitis
must undergo anticoagulation therapy, and
they should receive broad-spectrum
antibiotics.
CLAIRE ALCOBER
BSN-‐2A
ENDOMETRITIS
NURSING DIAGNOSIS THERAPEUTIC MANAGEMENT OUTCOME EVALUATION
Risk for infection related to high vascularity The physician should promptly initiate Improvement will be noted within 48-72
of involved area broad-spectrum antibiotics. hours in nearly 90% of women treated with
an approved regimen.
For mild cases following vaginal delivery,
oral antibiotics in an outpatient setting may
be adequate.
Surgical management is not usually
necessary in acute endometritis in the
obstetric population. Dilation and curettage
may be advised for retained products of
conception, however. In rare instances of
overwhelming infection nonresponsive to
conservative therapy, hysterectomy may be
necessary as a life-saving intervention.
CLAIRE ALCOBER
BSN-‐2A
