Hematomas in OB Nursing: Causes, Symptoms, and Nursing Care
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Study Tools For Hematomas in OB Nursing: Causes, Symptoms, and Nursing Care
Episiotomy – Evaluation of Healing (Mnemonic)
Vacuum Assisted Delivery (Image)
Forceps Assisted Delivery (Image)
Episiotomy (Image)
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Outline
Overview
- Solid swelling of clotted blood within tissues – NOT where it is supposed to be
- Rarely life-threatening
Nursing Points
General
- As it relates to OB – blood that escapes into areas of mother’s tissues after delivery has occurred
- Vagina
- Surgical site post c-section
- Most commonly associated with assisted delivery (forceps, vacuum) or episiotomy, and injured blood vessels
Assessment
- Perineal pressure (“I gotta poop!”) from the hematoma
- Edematous and sensitive perineal area
- Shock signs / changes in hemodynamics
- Severe pain
- Unable to releave with medications
- Cannot void
Therapeutic Management
- Monitor appropriately for shock and infection (VS, I&O, CBC)
- Treat pain
- Restore fluids
- Administer blood products as indicated
- Administered antibiotics; infection risk increased with hematoma
- May need hematoma evacuation if large enough
Nursing Concepts
- Perfusion
- Clotting
- Skin Integrity
Patient Education
- Notify if unresolved pain
- Perineal care after episiotomy
- Cold packs or ice pads to reduce hematoma and swelling for first 24 hours.
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Transcript
In this lesson I will explain what a hematoma is and how you should provide care for this patient
A hematoma is a collection of blood under the skin. It is caused by trauma so this could be from a vaginal delivery or c-section. In a vaginal delivery trauma to the tissue could be caused by forceps, vacuum or an episiotomy. Any of these can cause trauma to the tissue and cause the vessels to rupture and bleed. In a c-section there could be surgical trauma caused that will cause a hematoma to form because of the bleeding between the tissue. This will cause pain. We have blood where it should not be. The hematoma could resolve on its own with monitoring or it might need to be surgically removed or drained.
Let’s now talk about symptoms for when a patient has a hematoma. The patient might feel a lot of pressure because of the blood filled tissue in the vagina. The pressure discomfort could make them feel like they have to poop because there is pressure on the rectum from this fluid filled sac in the vagina. The patient will have pain that is unresolved with pain medication. Blood is collecting where is shouldn’t be. Tachycardia occurs because the patient is losing blood so the heart is pumping hard to move the low volume. symptoms will involve pain and possibly hemorrhagic symptoms if the bleeding is excessive.There is low blood pressure because of the blood loss and low volume. The hemoglobin is low because the patient is bleeding into a space where it shouldn’t be so the patient is losing red blood cells.
Our management for this patient will be to monitor her for shock and infection. So we need to watch her vital signs, intake and output, and CBC. We need to treat pain as best we can from the hematoma or from surgical removal of the hematoma. Fluids will need to be restored so either blood products of IV fluids will be needed. The patient may need hematoma evacuation if large enough or causing problems. If an evacuation happens of the hematoma then antibiotics might need to be given because it puts the patient at an increased risk of infection since now there is a wound that has been opened.
The patient should be instructed to notify if there is unresolved pain. This will alert nursing to really check for a hematoma. The patient should be taught how to get perineal care after an episiotomy which will include cold packs or ice pads to help reduce the swelling and hematoma. This should be done for the first 24 hours. In this image you can see how trauma can easily be caused by the delivery of the baby. You can see the locations of where an episiotomy would be cut. These spots will be at risk for infection because an instrument has been used to make the cut and trauma occurs which can cause a hematoma at this site. So if a hematoma develops then there will be a collection of blood in this location that would cause the pressure feeling.
A patient with a hematoma will have nursing concepts of perfusion, clotting, and skin integrity.
The key points to really focus on are that hematomas are a collection of blood under the skin. Blood is where it shouldn’t be. Trauma of the tissue is the cause. This trauma could be from forceps, vacuum, episiotomy, or instruments from a c-section caused. Patients will have pain and pressure that goes unresolved with medication and also shock symptoms. Shock symptoms are the hemodynamic changes so low blood pressure and tachycardia. The patient might need to have it surgically removed.
Make sure you check out the resources and images attached to this lesson Now, go out and be your best selves today. And, as always, happy nursing.
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Study Plan Lessons
Abdomen (Abdominal) Assessment
ABG (Arterial Blood Gas) Interpretation-The Basics
ABG (Arterial Blood Gas) Oxygenation
ABGs Nursing Normal Lab Values
ABGs Tic-Tac-Toe interpretation Method
Acetaminophen (Tylenol) Nursing Considerations
Acute Bronchitis
Acute Otitis Media (AOM)
Airborne Precaution Diseases Nursing Mnemonic (MTV)
Albuterol (Ventolin) Nursing Considerations
Alveoli & Atelectasis
Amoxicillin (Amoxil) Nursing Considerations
Anti-Infective – Antivirals
Anti-Infective – Macrolides
Anti-Infective – Penicillins and Cephalosporins
Anti-Infective – Fluoroquinolones
Appendicitis
Appendicitis – Assessment Nursing Mnemonic (PAINS)
Appendicitis Case Study (Peds) (30 min)
Appendicitis for Certified Emergency Nursing (CEN)
Assessment of a Burn Nursing Mnemonic (SCALD)
Asthma
Asthma Concept Map
Asthma management Nursing Mnemonic (ASTHMA)
Attention Deficit Hyperactivity Disorder (ADHD)
Autism Spectrum Disorders
Base Excess & Deficit
Bisacodyl (Dulcolax) Nursing Considerations
Blood Brain Barrier (BBB)
Blood Type O Nursing Mnemonic (Universally Odd)
Bronchiolitis and Respiratory Syncytial Virus (RSV)
Bronchodilators
Bupropion (Wellbutrin) Nursing Considerations
Burn Injuries
Burn Injury Case Study (60 min)
Burns for Certified Emergency Nursing (CEN)
Cardiac Glycosides
Care of the Pediatric Patient
Casting & Splinting
Cefaclor (Ceclor) Nursing Considerations
Celiac Disease
Cerebral Palsy (CP)
Cimetidine (Tagamet) Nursing Considerations
Ciprofloxacin (Cipro) Nursing Considerations
Cleft Lip and Palate
Cleft Lip Repair – Post Op Care Nursing Mnemonic (CLEFT LIP)
Clubfoot
Congenital Heart Defects (CHD)
Conjunctivitis
Constipation and Encopresis (Incontinence)
Corticosteroids
Coumarins
Cyanotic Defects Nursing Mnemonic (The 4 T’s)
Cystic Fibrosis (CF)
Day in the Life of a NICU Nurse
Day in the Life of a Peds (Pediatric) Nurse
Defects of Decreased Pulmonary Blood Flow
Defects of Increased Pulmonary Blood Flow
Dehydration
Diarrhea – Treatment Nursing Mnemonic (BRAT)
Digoxin (Lanoxin) Nursing Considerations
Diphenhydramine (Benadryl) Nursing Considerations
Diphenoxylate-Atropine (Lomotil) Nursing Considerations
Eczema
EENT Assessment
Enuresis
Epiglottitis
Epiglottitis – Signs and Symptoms Nursing Mnemonic (AIR RAID)
Epispadias and Hypospadias
Famotidine (Pepcid) Nursing Considerations
Fever
Fever Case Study (Pediatric) (30 min)
Flu Symptoms Nursing Mnemonic (FACTS)
Fluid Compartments
Fluid Pressures
Fluid Shifts (Ascites) (Pleural Effusion)
Fluid Volume Deficit
Fluticasone (Flonase) Nursing Considerations
Gas Exchange
Gentamicin (Garamycin) Nursing Considerations
Glucose Lab Values
Gluten Free Diet Nursing Mnemonic (BROW)
Guaifenesin (Mucinex) Nursing Considerations
Heart Sounds Nursing Mnemonic (APE To Man – All People Enjoy Time Magazine)
Hematocrit (Hct) Lab Values
Hemoglobin (Hbg) Lab Values
Hemophilia
Hierarchy of O2 Delivery
Hydrocephalus
Hypoxia – Signs and Symptoms (in Pediatrics) Nursing Mnemonic (FINES)
Ibuprofen (Motrin) Nursing Considerations
Immunizations (Vaccinations)
Imperforate Anus
Impetigo
Indomethacin (Indocin) Nursing Considerations
Influenza – Flu
Integumentary (Skin) Assessment
Intussusception
Intussusception for Certified Emergency Nursing (CEN)
Iron Deficiency Anemia
Isolation Precaution Types (PPE)
Isolation Precautions (MRSA, C. Difficile, Meningitis, Pertussis, Tuberculosis, Neutropenia)
Lactulose (Generlac) Nursing Considerations
Leukemia
Levels of Consciousness (LOC)
Levetiracetam (Keppra) Nursing Considerations
Lung Sounds
Marfan Syndrome
Meningitis
Meningitis Assessment Findings Nursing Mnemonic (FAN LIPS)
Meningitis for Certified Emergency Nursing (CEN)
Methylphenidate (Concerta) Nursing Considerations
Mixed (Cardiac) Heart Defects
Mumps
Nephroblastoma
Nephrotic Syndrome
Nephrotic Syndrome Case Study (Peds) (45 min)
Neuro Assessment
NSAIDs
Nursing Care Plan (NCP) for Acute Bronchitis
Nursing Care Plan (NCP) for Appendicitis
Nursing Care Plan (NCP) for Asthma
Nursing Care Plan (NCP) for Asthma / Childhood Asthma
Nursing Care Plan (NCP) for Attention Deficit Hyperactivity Disorder (ADHD)
Nursing Care Plan (NCP) for Bronchiolitis / Respiratory Syncytial Virus (RSV)
Nursing Care Plan (NCP) for Burn Injury (First, Second, Third degree)
Nursing Care Plan (NCP) for Celiac Disease
Nursing Care Plan (NCP) for Cerebral Palsy (CP)
Nursing Care Plan (NCP) for Cleft Lip / Cleft Palate
Nursing Care Plan (NCP) for Clubfoot
Nursing Care Plan (NCP) for Congenital Heart Defects
Nursing Care Plan (NCP) for Constipation / Encopresis
Nursing Care Plan (NCP) for Cystic Fibrosis
Nursing Care Plan (NCP) for Decreased Cardiac Output
Nursing Care Plan (NCP) for Dehydration & Fever
Nursing Care Plan (NCP) for Eczema (Infantile or Childhood) / Atopic Dermatitis
Nursing Care Plan (NCP) for Enuresis / Bedwetting
Nursing Care Plan (NCP) for Epiglottitis
Nursing Care Plan (NCP) for Fluid Volume Deficit
Nursing Care Plan (NCP) for Hemophilia
Nursing Care Plan (NCP) for Hydrocephalus
Nursing Care Plan (NCP) for Impaired Gas Exchange
Nursing Care Plan (NCP) for Imperforate Anus
Nursing Care Plan (NCP) for Impetigo
Nursing Care Plan (NCP) for Infective Conjunctivitis / Pink Eye
Nursing Care Plan (NCP) for Influenza
Nursing Care Plan (NCP) for Intussusception
Nursing Care Plan (NCP) for Marfan Syndrome
Nursing Care Plan (NCP) for Meningitis
Nursing Care Plan (NCP) for Mumps
Nursing Care Plan (NCP) for Neural Tube Defect, Spina Bifida
Nursing Care Plan (NCP) for Omphalocele
Nursing Care Plan (NCP) for Otitis Media / Acute Otitis Media (AOM)
Nursing Care Plan (NCP) for Pediculosis Capitis / Head Lice
Nursing Care Plan (NCP) for Pertussis / Whooping Cough
Nursing Care Plan (NCP) for Phenylketonuria (PKU)
Nursing Care Plan (NCP) for Reye’s Syndrome
Nursing Care Plan (NCP) for Rheumatic Fever
Nursing Care Plan (NCP) for Rubeola – Measles
Nursing Care Plan (NCP) for Scoliosis
Nursing Care Plan (NCP) for Sickle Cell Anemia
Nursing Care Plan (NCP) for Tonsillitis
Nursing Care Plan (NCP) for Varicella / Chickenpox
Nursing Care Plan (NCP) for Vomiting / Diarrhea
Nursing Care Plan for (NCP) Autism Spectrum Disorder
Nursing Case Study for Pediatric Asthma
Obstructive Heart (Cardiac) Defects
Ocular Infections (Conjunctivitis, Iritis) for Certified Emergency Nursing (CEN)
Omphalocele
Opioid Analgesics
Pancrelipase (Pancreaze) Nursing Considerations
Pediatric Bronchiolitis Labs
Pediatric Gastrointestinal Dysfunction – Diarrhea
Pediatric Oncology Basics
Pediatrics Course Introduction
Pediculosis Capitis
Pertussis – Whooping Cough
Phenylketonuria
Phenytoin (Dilantin) Nursing Considerations
Platelets (PLT) Lab Values
Pneumonia
Promotion and Evaluation of Normal Elimination Nursing Mnemonic (POOPER SCOOP)
Pulmonary Function Test
Red Blood Cell (RBC) Lab Values
Respiratory Acidosis (interpretation and nursing interventions)
Reye’s Syndrome
Reyes Syndrome Case Study (Peds) (45 min)
Rheumatic Fever
ROME – ABG (Arterial Blood Gas) Interpretation
Rubeola – Measles
Salmeterol (Serevent) Nursing Considerations
Scoliosis
Selegiline (Eldepyrl) Nursing Considerations
Sickle Cell Anemia
Spina Bifida – Neural Tube Defect (NTD)
Steroids – Side Effects Nursing Mnemonic (6 S’s)
Stoma Care (Colostomy bag)
Strabismus
Sudden Infant Death Syndrome (SIDS)
Sympathomimetics (Alpha (Clonodine) & Beta (Albuterol) Agonists)
Thorax and Lungs Assessment
Tonsillitis
Topical Medications
Tracheal Esophageal Fistula – Sign and Symptoms Nursing Mnemonic (The 3 C’s)
Transient Incontinence – Common Causes Nursing Mnemonic (P-DIAPERS)
Treatment of Sickle Cell Nursing Mnemonic (HOP to the hospital)
Umbilical Hernia
Vaccine-Preventable Diseases (Measles, Mumps, Pertussis, Chicken Pox, Diphtheria) for Certified Emergency Nursing (CEN)
Varicella – Chickenpox
Varicella Case Study (Peds) (30 min)
Vitals (VS) and Assessment
Vomiting
White Blood Cell (WBC) Lab Values
X-Ray (Xray)
05.03 Jaundice for CCRN Review
Abortion in Nursing: Spontaneous, Induced, and Missed
Abruptio Placenta for Certified Emergency Nursing (CEN)
Abruptio Placentae (Placental abruption)
Acyclovir (Zovirax) Nursing Considerations
Addicted Newborn
Adult Vital Signs (VS)
Alpha-fetoprotein (AFP) Lab Values
Ampicillin (Omnipen) Nursing Considerations
Anemia in Pregnancy
Antepartum Testing
Antepartum Testing Case Study (45 min)
Anti-Infective – Aminoglycosides
Anti-Infective – Lincosamide
Aspiration for Certified Emergency Nursing (CEN)
Babies by Term
Behind The Red Line – Live Tutoring Archive
Betamethasone and Dexamethasone
Betamethasone and Dexamethasone in Pregnancy
Bicarbonate (HCO3) Lab Values
Blood Cultures
Blood Glucose Monitoring
Blood Transfusions (Administration)
Body System Assessments
Breastfeeding
Butorphanol (Stadol) Nursing Considerations
Cardiac (Heart) Disease in Pregnancy
Causes of Chorioamnionitis Nursing Mnemonic (Pregnancies Are Very Interesting)
Causes of Labor Dystocia Nursing Mnemonic (Having Extremely Frustrating Labor)
Causes of Postpartum Hemorrhage Nursing Mnemonic (4 T’s)
Certified Nurse Midwife
Chorioamnionitis
Clindamycin (Cleocin) Nursing Considerations
Congestive Heart Failure (CHF) Labs
Day in the Life of a Labor Nurse
Day in the Life of a Postpartum Nurse
Dexamethasone (Decadron) Nursing Considerations
Direct Bilirubin (Conjugated) Lab Values
Discomforts of Pregnancy
Disseminated Intravascular Coagulation (DIC)
Diuretics (Loop, Potassium Sparing, Thiazide, Furosemide/Lasix)
Dystocia
Ectopic Pregnancy
Ectopic Pregnancy Case Study (30 min)
Ectopic Pregnancy for Certified Emergency Nursing (CEN)
Emergent Delivery (OB) (30 min)
Emergent Delivery for Certified Emergency Nursing (CEN)
Epidural
Episiotomy – Evaluation of Healing Nursing Mnemonic (REEDA)
Erythroblastosis Fetalis
Eye Prophylaxis for Newborn
Eye Prophylaxis for Newborn (Erythromycin)
Factors That Can Put a Pregnancy at Risk Nursing Mnemonic (RIBCAGE)
Family Planning & Contraception
Family Planning & Signs of Pregnancy – Live Tutoring Archive
Fertilization and Implantation
Fetal Alcohol Syndrome (FAS)
Fetal Circulation
Fetal Development
Fetal Distress Interventions Nursing Mnemonic (Stop MOAN)
Fetal Environment
Fetal Heart Monitoring (FHM)
Fetal Heart Monitoring Like A Pro – Live Tutoring Archive
Fetal Heart Monitoring Like A Pro 2 – Live Tutoring Archive
Fetal Wellbeing Assessment Tests Nursing Mnemonic (ALONE)
Fundal Height Assessment for Nurses
Furosemide (Lasix) Nursing Considerations
Gestation & Nägele’s Rule: Estimating Due Dates
Gestational Diabetes (GDM)
Gestational Diabetes and Why YOU Should Know About It – Live Tutoring Archive
Gestational HTN (Hypertension)
Glucagon Lab Values
Glucose Tolerance Test (GTT) Lab Values
Gravidity and Parity (G&Ps, GTPAL)
HELLP Syndrome
HELLP Syndrome – Signs and Symptoms Nursing Mnemonic (HELLP)
Hematomas in OB Nursing: Causes, Symptoms, and Nursing Care
Hemodynamics
Hemoglobin A1c (HbA1C)
Hemorrhage (Postpartum Bleeding) for Certified Emergency Nursing (CEN)
Hepatitis B Vaccine for Newborns
Homocysteine (HCY) Lab Values
Hydatidiform Mole (Molar pregnancy)
Hydralazine (Apresoline) Nursing Considerations
Hydrochlorothiazide (Hydrodiuril) Nursing Considerations
Hyperbilirubinemia (Jaundice)
Hyperemesis Gravidarum
Hyperemesis Gravidarum for Certified Emergency Nursing (CEN)
Hyperglycemia Management Nursing Mnemonic (Dry and Hot – Insulin Shot)
Hypovolemic Shock Case Study (OB sim) (60 min)
Incompetent Cervix
Infections in Pregnancy
Initial Care of the Newborn (APGAR)
Inserting a Foley (Urinary Catheter) – Female
Intra Uterine Device – Potential Problems Nursing Mnemonic (PAINS)
Isotonic Solutions (IV solutions)
Labor Progression Case Study (45 min)
Leopold Maneuvers
Lung Surfactant
Lung Surfactant for Newborns
Magnesium Sulfate
Magnesium Sulfate
Magnesium Sulfate (MgSO4) Nursing Considerations
Magnesium Sulfate in Pregnancy
Mastitis
Maternal Risk Factors
Mechanisms of Labor
Meconium Aspiration
Meds for Postpartum Hemorrhage (PPH)
Meds for PPH (postpartum hemorrhage)
Menstrual Cycle
Methylergonovine (Methergine) Nursing Considerations
Newborn of HIV+ Mother
Newborn Physical Exam
Newborn Reflexes
Nifedipine (Procardia) Nursing Considerations
Nursing Care Plan (NCP) for Abortion, Spontaneous Abortion, Miscarriage
Nursing Care Plan (NCP) for Abruptio Placentae / Placental abruption
Nursing Care Plan (NCP) for Chorioamnionitis
Nursing Care Plan (NCP) for Diabetes Mellitus (DM)
Nursing Care Plan (NCP) for Dystocia
Nursing Care Plan (NCP) for Ectopic Pregnancy
Nursing Care Plan (NCP) for Gestational Diabetes (GDM)
Nursing Care Plan (NCP) for Gestational Hypertension, Preeclampsia, Eclampsia
Nursing Care Plan (NCP) for Hyperemesis Gravidarum
Nursing Care Plan (NCP) for Hypertension (HTN)
Nursing Care Plan (NCP) for Incompetent Cervix
Nursing Care Plan (NCP) for Mastitis
Nursing Care Plan (NCP) for Maternal-Fetal Dyad Using GTPAL
Nursing Care Plan (NCP) for Meconium Aspiration
Nursing Care Plan (NCP) for Neonatal Jaundice | Hyperbilirubinemia
Nursing Care Plan (NCP) for Newborns
Nursing Care Plan (NCP) for Placenta Previa
Nursing Care Plan (NCP) for Postpartum Hemorrhage (PPH)
Nursing Care Plan (NCP) for Premature Rupture of Membranes (PROM) / Preterm Premature Rupture of Membranes (PPROM)
Nursing Care Plan (NCP) for Preterm Labor / Premature Labor
Nursing Care Plan (NCP) for Process of Labor
Nursing Care Plan (NCP) for Transient Tachypnea of Newborn
Nursing Care Plan for (NCP) Fetal Alcohol Syndrome (FAS)
Nursing Care Plan for Newborn Reflexes
Nursing Case Study for Maternal Newborn
Nutrition Assessments
Nutrition in Pregnancy
Nutritional Requirements
OB (Labor) Nurse Report to OB (Postpartum) Nurses
OB Course Introduction
OB Non-Stress Test Results Nursing Mnemonic (NNN)
OB Pharm and What Drugs You HAVE to Know – Live Tutoring Archive
Obstetric Trauma for Certified Emergency Nursing (CEN)
Obstetrical Procedures
Opioid Analgesics in Pregnancy
Oral Birth Control Pills – Serious Complications Nursing Mnemonic (Aches)
Oxytocin (Pitocin) Nursing Considerations
Pediatric Vital Signs (VS)
Physiological Changes
Phytonadione (Vitamin K)
Phytonadione (Vitamin K) for Newborn
Placenta Previa
Placenta Previa for Certified Emergency Nursing (CEN)
Possible Infections During Pregnancy Nursing Mnemonic (TORCH)
Post-Partum Assessment Nursing Mnemonic (BUBBLE)
Postpartum Discomforts
Postpartum Hematoma
Postpartum Hemorrhage (PPH)
Postpartum Interventions
Postpartum Physiological Maternal Changes
Postpartum Thrombophlebitis
Precipitous Labor
Preeclampsia (45 min)
Preeclampsia, Eclampsia, and HELLP Syndrome for Certified Emergency Nursing (CEN)
Preeclampsia: Signs, Symptoms, Nursing Care, and Magnesium Sulfate
Pregnancy Labs
Pregnancy Outcomes Nursing Mnemonic (GTPAL)
Preload and Afterload
Premature Rupture of the Membranes (PROM)
Preterm Labor
Preterm Labor for Certified Emergency Nursing (CEN)
Probable Signs of Pregnancy Nursing Mnemonic (CHOP BUGS)
Process of Labor
Process of Labor – Mom Nursing Mnemonic (4 P’s)
Process of Labor – Baby Nursing Mnemonic (ALPPPS)
Process of Labor – Live Tutoring Archive
Process of Labor 2 – Live Tutoring Archive
Prolapsed Umbilical Cord
Promethazine (Phenergan) Nursing Considerations
Prostaglandins
Prostaglandins in Pregnancy
Protein (PROT) Lab Values
Retinopathy of Prematurity (ROP)
Rh Immune Globulin (Rhogam)
Rh Immune Globulin in Pregnancy
Signs of Pregnancy – Live Tutoring Archive
Signs of Pregnancy (Presumptive, Probable, Positive)
Spironolactone (Aldactone) Nursing Considerations
Stages of Fetal Development Nursing Mnemonic (Proficiently Expanding Fetus)
Subinvolution
Terbutaline (Brethine) Nursing Considerations
Threatened/Spontaneous Abortion for Certified Emergency Nursing (CEN)
Tips & Advice for Newborns (Neonatal IV Insertion)
Tocolytics
Tocolytics
Top 5 Misunderstood OB Concepts – Live Tutoring Archive
Transient Tachypnea of Newborn
Umbilical Cord Vasculature Nursing Mnemonic (2A1V)
Uterine Stimulants (Oxytocin, Pitocin)
Uterine Stimulants (Oxytocin, Pitocin) Nursing Considerations
VEAL CHOP Nursing Mnemonic (Fetal Accelerations and Decelerations) (VEAL CHOP)
What the Heck is Antepartum Testing? – Live Tutoring Archive