Case study 2

A CASE STUDY ON POSTPARTUM HEMORRHAGE

(PPH)

PREPARED BY : SEIF SAID KHALFAN

• Postpartum hemorrhage (PPH) is the second
leading cause of maternal mortality worldwide
with a prevalence rate of approximately 6%;
 Africa has the highest prevalence rate of about
10.5%.

• In Africa and Asia, where most maternal deaths

occur, PPH accounts for more than 30% of all
maternal deaths

• Each year, almost 7,900 mothers die due to

childbirth and pregnancy related complications
 in Tanzania. According to Muhimbili National
Hospital postpartum deaths in a year 2011 –
2014 is of an average of 14.9% of all direct
causes of maternal deaths.
• In Zanzibar data obtained from the Muembe
Ladu Hospital shows the incidence of
 postpartum hemorrhage for the years 2013 –
2015 are
14.76%, 18.01% and 16.17% respectively.

• PPH is defined as blood loss of greater than 500

mL after vaginal delivery and greater than 1000
mL after cesarean delivery.

DEMOGRAPHIC DATA
• Patient name: H. A. N
• Address: Chukwani
• Age: 33 years
• occupation: Housewife
• Sex: Female
• Marital status: Married
• Hospital: Mnazi Mmoja
• Date of admission: march 04, 2016
Medical history

• In 2013, she diagnosed with peptic ulcer

disease, which resolved after three months on
cimetidine. She describes no history of cancer,
lung disease or previous heart disease. She also
has allergy with Penicillin; experienced rash and
hives in 2008.
Present history

• The patient has been admitted at Mnazi Mmoja

Hospital since March 04, 2016. She was in her
usual state of good health until one day prior to
admission. Weight of patient is 65kg. She
complains of labour pain which started at
04:30am
Current diagnosis
• Postpartum hemorrhage (PPH)
• Patient vital signs on admission are:-

BP = 130/90, Pulse Rate = 78 bpm,

Temperature = 36.4 0C, Resp. rate = 20r/m.

• Patient vital signs after delivery ( during PPH )

BP = 92/47, Pulse rate = 102bpm,

Temperature = 36.1 0C, Resp. rate = 30r/m

Treatment
Non-pharmacological treatment
• Resuscitation with intravenous fluid e.g. ringer
lactate
• Uterine massage every 15 minutes for the first
two hours
Pharmacological treatment
• Oxytocin 40 I.U via I.V in ringer lactate
Test results
 • HB – 8.4mls

• Blood group - O+

• PMTCT - 2

• Bleeding time (BT) – Normal

• Clotting time (CT) – Normal

Nursing observation on mental state of the patient

• Language: patient able to express by speech of signs

• Orientation: well oriented to person, time and place
• Attention: able to concentrate
• Level of consciousness: she is conscious (awake)

NURSING CARE PLAN

NURSING EXPECTED NURSING INTERVENTION EVALUATION
DIAGNOSIS OUTCOME

Fluid volume deficit After 2 – 5 days I/: Advise patients to sleep with After 2 days the
related to uterine will be Prevented feet higher, while the body client’s body
from remained supine. fluid volume
atony as evidenced
dysfunctional R/: With feet higher will increase improved
by excessive
bleeding and the venous return, and allowing
vaginal blood loss.
improve fluid the blood to the brain and other
volume. organs.
I/: Monitor vital signs.
R/: Changes in vital signs when
bleeding occurs more intense.
I/: Monitor intake and output
every 15 minutes.
R/: Change the output is a sign of
impaired renal function.
NURSING EXPECTED INTERVENTION EVALUATIO
DIAGNOSIS OUTCOME N

Ineffective tissue After 2 – 3 days vital I/: Monitor vital signs every 5- After 2 days
perfusion related to signs and blood gases 10 minutes. patient’s vital
vaginal bleeding as will be within normal R/: Changes in tissue perfusion signs were at
evidenced by limits. causing changes in vital signs. normal range.
fluctuation of vital I/: Monitor blood gas levels
signs and pH
R/: Changes in blood gases and
pH levels are a sign of tissue
hypoxia
I/: Give oxygen therapy
R/: Oxygen transport is needed
to maximize circulation to
tissue.
NURSING EXPECTED INTERVENTION EVALUATION
DIAGNOSIS OUTCOME

Body weakness • Verbalize I/: Discuss with patient the need for The patient can
activity. Plan schedule with patient
related to altered increase in and identify activities that lead to perform some
body chemistry energy level. fatigue. activities
R/: Education may provide
(insufficient motivation to increase activity level
electrolytes) as • Display even though patient may feel too
weak initially.
evidenced by improved ability
inability to to participate I/: Increase patient participation in
ADLs as tolerated.
maintain usual in desired R/: It can increases confidence level,
routines. activities. self-esteem and tolerance.

I/: Alternate activity with periods of

rest and uninterrupted sleep.
R/: It can prevent excessive fatigue.
 NURSING EXPECTED INTERVENTION EVALUATION
DIAGNOSIS OUTCOME

Anxiety related to The client can I/: Assess the client's psychological Client said
response to the post- childbirth anxiety is
knowledge deficit verbalize bleeding. reduced.
regarding anxiety and said R/: Perceptions of client influence the
intensity of anxiety.
procedures, anxiety is
management and reduced or lost. I/: Treat the patient
calm, empathetic and supportive
disease condition attitude.
as evidenced by R/: Provide emotional support.

patient asks many I/: Provide information about care and

questions about treatment.
R/: Accurate information can reduce
the disease. the anxiety and fear of the unknown.

I/: Help clients identify a sense of

anxiety.
z R/: The expression can reduce feelings
of anxiety.
NURSING EXPECTED INTERVENTION EVALUATION
DIAGNOSIS OUTCOME

Sleeping pattern Falls asleep I/: Assess for new onset of depression: After 2 days the
disturbance without depressed mood state, statement of patient falls
related to acute difficulty hopelessness and poor appetite asleep without
pain as R/: It can help to understand which difficulty
evidenced by psychological therapy can help the patient
verbal report of
I/: Provide pain relief shortly before
difficult falling
bedtime
asleep.
R/: Help to keep the body not to suffer
from pain at that time.

I/: Keep environment quit

R/: This can reduce anxiety and lead to
peace of mind
NURSING EXPECTED INTERVENTION EVALUATION
DIAGNOSIS OUTCOME

Risk for To keep I/: Note the changes in vital signs. After 5 days the
infection patient free R/: Changes in vital signs (temperature) is patient was free
related to from indicative of infection. from infection
infection
excessive
I/: Note the signs of fatigue, chills, anorexia,
blood loss and uterine contractions were flabby and
and exposed pelvic pain.
placental R/: The signs are an indication of the
attachment occurrence of bacteremia, shock is not
site and detected.
lacerations.
I/: Consider the possibility of infection in
other places, such as respiratory infections,
mastitis and urinary tract.
R/: Infection elsewhere worsens the situation.

I/: Give antibiotics

R/: Antibiotics are necessary for the proper
state of infection.