The concept Haemoraghi Post Partum (HPP)
Haemoraghi Post Partum (HPP) Definition of bleeding that occurs after childbirth glittering 24 hours of more than 500-600 cc.
Incidents In the case of developing countries reached 5-15% of the total number of births that occur.
Etiology
Atonic uterus (50-60%).
Retained placenta (16-17%).
The rest of the placenta (23-24%).
Lacerations of the birth canal (4-5%).
Blood disorders (0.5-0.8%).
Predisposition
Age (who are too old or too young at the time of birth), parity (or the Multi grandemulti), obstructed labor, obstetric oprastif and narcotics, and big too tense uterus, abnormalities in the uterus (myoma uteri), Socio-Economic less which can lead to malnutrition .
Diagnosis
Palpation: uterine contractions and the SFH.
Inspection: Uri, amniotic (complete or not), there is a tear in the vagina aapakah or the presence of varicose veins.
Exploration of the uterine cavity: residual uri and membranes, tearing the uterus, placenta suksenturiata.
Laboratory examination: DL (Hb), Physiology of hemostasis, Clot observastion test (COT).
Ultrasound examination if necessary.
Symptom
Bleeding more than 500-600 cc, weak uterine contractions, uterine mushy (Boggy), Sub involution (fundus rose), face pale / anemic.
Prognosis
The maternal mortality rate of 7.9% (Mochtar. R), and according Wignyosastro maternal mortality rate reached 1.8 to 4.5% of cases.
Management
In general, for the case of bleeding are:
Stop the bleeding.
Help prevent syock.
Replace blood lost.
Special Treatment:
Phase I (bleeding that is not too much): Give uterotonic, massage / massage the uterus, attach the octopus.
Phase II (more bleeding): Do the replacement fluid (transfusion or infusion), Prasat or maneuver (Zangemeister, frits), bimanual compression, aortic compression, uterovaginal tamponade, uterine artery clamping.
If all the above measures do not help: hypogastric artery ligation, histerekstomi.
Nursing diagnoses that may appear high risk of infection associated with impaired formation of white blood cells.
Objectives:
Infection did not occur during the period of treatment with the following criteria:
There are no signs of infection (tumor, ruborm calor, dolor and fungsiolaesa).
Vital signs within normal limits (blood pressure, temperature, pulse and respiration).
Results of laboratory tests (DL) within normal limits.
Plan:
Explain to the client about the signs of infection.
R / adequate knowledge enables clients cooperatively to nursing actions.
Observations of the amount of bleeding.
R / bleeding that causes many of the body's defense spending fell as a result of excessive leukocytes.
Motivation clients to maintain personal hygiene.
R / humid environment is a good medium for the growth of bacteria that increase the risk of infection.
Collaboration with physicians in the administration of antibiotics.
R / specific antibiotics can help to prevent the growth of bacteria that rely more progressive.
Observation for signs of infection and TTV (blood pressure, temperature, pulse and respiration).
R / Increased to reflect the occurrence of TTV infection.
The risk of anemia associated with the effects of bleeding.
Objectives:
Anemia did not occur during the period of treatment with the following criteria:
Hb> 10 g%.
The conjunctiva was not anemic.
Mucosa was not pale.
Plan:
Identification of patients' knowledge about anemia and explain the cause of the anemia.
R / Knowledge sufficient to facilitate cooperative patients to nursing actions.
Instruct the patient to bed rest.
R / activity will slightly reduce the metabolism so that the burden of oxygen supply to the tissues would be better.
Collaboration in the provision of adequate nutrition (diet TKTP).
R / Nutrition is especially Hb-forming materials as iron.
Collaboration with physicians in:
Giving koagulantia and roburantia.
Transfusion.
DL examinations periodically.
KU observation of patients, the conjunctiva and the patient's complaint.
The risk of bleeding associated with hypovolemic syock that occur continuously.
Objectives:
Shock does not occur during the period of treatment with the following criteria:
No loss of consciousness occurs.
Vital signs within normal limits.
Good skin turgor.
Good peripheral perfusion (akral warm, dry and red).
Fluid balance in the body.
Plan:
Instruct the patient to drink more.
R / Increasing fluid intake can increase the volume intrvaskuler which can increase tissue perfusion.
Observation of vital signs every 4 hours.
R / TTV changes to an early indicator of dehydration.
Observation for signs of dehydration.
R / Dehydration is the beginning of the syock when hands are not properly hydrated.
Observation of fluid intake and output.
R / adequate fluid intake to compensate for the excessive discharge.
Collaboration in:
Intravenous fluids or transfusions.
Giving koagulantia and uterotonic.
CVP custom installation.
Plasma BJ examination.
The risk of metabolic acidosis associated with a decreased amount of blood in the capillaries.
Objectives:
Metabolic acidosis did not occur during the period of treatment with the following criteria:
BGA results within normal limits.
Vital signs within normal limits.
Plan:
Observation of vital signs within normal limits.
R / TTV Change detection is an early sign of acidosis.
Instruct the patient and the motivation to drink sweet.
R / Reduce protein breakdown and excess fat to meet metabolic needs.
Collaboration in:
BGA Inspection.
Intravenous fluid administration.
Self care deficit related to physical weakness
Objectives:
During the treatment period of daily activity needs are met.
Plan:
Explain to patients about the importance of maintaining personal hygiene.
R / adequate knowledge enables clients cooperatively towards maintenance actions performed.
Assist clients in meeting the nutritional needs (eating and drinking).
R / weakness of the body requires to help clients meet the needs of others.
Assist clients in meeting personal hygiene needs.
R / weakness of the body that occurs can lead to an inability to meet the needs of individual hygiene.
Fulfillment observation of daily activities.
R / Improved ability to fulfill daily needs may reflect reduced body weakness.
Haemoraghi Post Partum (HPP) Definition of bleeding that occurs after childbirth glittering 24 hours of more than 500-600 cc.
Incidents In the case of developing countries reached 5-15% of the total number of births that occur.
Etiology
Atonic uterus (50-60%).
Retained placenta (16-17%).
The rest of the placenta (23-24%).
Lacerations of the birth canal (4-5%).
Blood disorders (0.5-0.8%).
Predisposition
Age (who are too old or too young at the time of birth), parity (or the Multi grandemulti), obstructed labor, obstetric oprastif and narcotics, and big too tense uterus, abnormalities in the uterus (myoma uteri), Socio-Economic less which can lead to malnutrition .
Diagnosis
Palpation: uterine contractions and the SFH.
Inspection: Uri, amniotic (complete or not), there is a tear in the vagina aapakah or the presence of varicose veins.
Exploration of the uterine cavity: residual uri and membranes, tearing the uterus, placenta suksenturiata.
Laboratory examination: DL (Hb), Physiology of hemostasis, Clot observastion test (COT).
Ultrasound examination if necessary.
Symptom
Bleeding more than 500-600 cc, weak uterine contractions, uterine mushy (Boggy), Sub involution (fundus rose), face pale / anemic.
Prognosis
The maternal mortality rate of 7.9% (Mochtar. R), and according Wignyosastro maternal mortality rate reached 1.8 to 4.5% of cases.
Management
In general, for the case of bleeding are:
Stop the bleeding.
Help prevent syock.
Replace blood lost.
Special Treatment:
Phase I (bleeding that is not too much): Give uterotonic, massage / massage the uterus, attach the octopus.
Phase II (more bleeding): Do the replacement fluid (transfusion or infusion), Prasat or maneuver (Zangemeister, frits), bimanual compression, aortic compression, uterovaginal tamponade, uterine artery clamping.
If all the above measures do not help: hypogastric artery ligation, histerekstomi.
Nursing diagnoses that may appear high risk of infection associated with impaired formation of white blood cells.
Objectives:
Infection did not occur during the period of treatment with the following criteria:
There are no signs of infection (tumor, ruborm calor, dolor and fungsiolaesa).
Vital signs within normal limits (blood pressure, temperature, pulse and respiration).
Results of laboratory tests (DL) within normal limits.
Plan:
Explain to the client about the signs of infection.
R / adequate knowledge enables clients cooperatively to nursing actions.
Observations of the amount of bleeding.
R / bleeding that causes many of the body's defense spending fell as a result of excessive leukocytes.
Motivation clients to maintain personal hygiene.
R / humid environment is a good medium for the growth of bacteria that increase the risk of infection.
Collaboration with physicians in the administration of antibiotics.
R / specific antibiotics can help to prevent the growth of bacteria that rely more progressive.
Observation for signs of infection and TTV (blood pressure, temperature, pulse and respiration).
R / Increased to reflect the occurrence of TTV infection.
The risk of anemia associated with the effects of bleeding.
Objectives:
Anemia did not occur during the period of treatment with the following criteria:
Hb> 10 g%.
The conjunctiva was not anemic.
Mucosa was not pale.
Plan:
Identification of patients' knowledge about anemia and explain the cause of the anemia.
R / Knowledge sufficient to facilitate cooperative patients to nursing actions.
Instruct the patient to bed rest.
R / activity will slightly reduce the metabolism so that the burden of oxygen supply to the tissues would be better.
Collaboration in the provision of adequate nutrition (diet TKTP).
R / Nutrition is especially Hb-forming materials as iron.
Collaboration with physicians in:
Giving koagulantia and roburantia.
Transfusion.
DL examinations periodically.
KU observation of patients, the conjunctiva and the patient's complaint.
The risk of bleeding associated with hypovolemic syock that occur continuously.
Objectives:
Shock does not occur during the period of treatment with the following criteria:
No loss of consciousness occurs.
Vital signs within normal limits.
Good skin turgor.
Good peripheral perfusion (akral warm, dry and red).
Fluid balance in the body.
Plan:
Instruct the patient to drink more.
R / Increasing fluid intake can increase the volume intrvaskuler which can increase tissue perfusion.
Observation of vital signs every 4 hours.
R / TTV changes to an early indicator of dehydration.
Observation for signs of dehydration.
R / Dehydration is the beginning of the syock when hands are not properly hydrated.
Observation of fluid intake and output.
R / adequate fluid intake to compensate for the excessive discharge.
Collaboration in:
Intravenous fluids or transfusions.
Giving koagulantia and uterotonic.
CVP custom installation.
Plasma BJ examination.
The risk of metabolic acidosis associated with a decreased amount of blood in the capillaries.
Objectives:
Metabolic acidosis did not occur during the period of treatment with the following criteria:
BGA results within normal limits.
Vital signs within normal limits.
Plan:
Observation of vital signs within normal limits.
R / TTV Change detection is an early sign of acidosis.
Instruct the patient and the motivation to drink sweet.
R / Reduce protein breakdown and excess fat to meet metabolic needs.
Collaboration in:
BGA Inspection.
Intravenous fluid administration.
Self care deficit related to physical weakness
Objectives:
During the treatment period of daily activity needs are met.
Plan:
Explain to patients about the importance of maintaining personal hygiene.
R / adequate knowledge enables clients cooperatively towards maintenance actions performed.
Assist clients in meeting the nutritional needs (eating and drinking).
R / weakness of the body requires to help clients meet the needs of others.
Assist clients in meeting personal hygiene needs.
R / weakness of the body that occurs can lead to an inability to meet the needs of individual hygiene.
Fulfillment observation of daily activities.
R / Improved ability to fulfill daily needs may reflect reduced body weakness.
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