Postpartum Hematoma

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Study Tools For Postpartum Hematoma

Episiotomy – Evaluation of Healing (Mnemonic)
Vacuum Assisted Delivery (Image)
Forceps Assisted Delivery (Image)
Episiotomy (Image)
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Outline

Overview

  1. Localized collection of blood in loose connective tissue beneath the skin of the vagina or c-section incision

Nursing Points

General

  1. Occurs from trauma
  2. Most often in assisted deliveries (vacuum, forceps)

Assessment

  1. Pain, pressure
  2. Cannot void due to hematoma obstructing flow
  3. Apparent bulging area, skin discolored
  4. Decreasing H/H due to bleeding
  5. Signs and symptoms of hypovolemic shock
    1. Hypotension
    2. Tachycardia
    3. Febrile
    4. Pallor

Therapeutic Management

  1. Prepare to administer IVF, pain meds,  blood products
  2. Monitor I&O, vitals
  3. May need to insert foley if urinary obstruction has occurred
  4. Medical management:
    1. Watch and let reabsorb
    2. Surgically drain

Nursing Concepts

  1. Perfusion
  2. Clotting
  3. Skin Integrity

Patient Education

  1. Perineal care after episiotomy
  2. Cold packs to reduce hematoma and swelling
  3. Report pain that doesn’t go away with meds

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Obstetrical Nursing

Concepts Covered:

  • Prenatal Concepts
  • Pregnancy Risks
  • Postpartum Complications
  • Fetal Development
  • Labor and Delivery
  • Labor Complications
  • Postpartum Care
  • Newborn Care
  • Newborn Complications
  • Integumentary Disorders
  • Liver & Gallbladder Disorders
  • Microbiology

Study Plan Lessons

OB Course Introduction
Menstrual Cycle
Family Planning & Contraception
Gestation & Nägele’s Rule: Estimating Due Dates
Gravidity and Parity (G&Ps, GTPAL)
Signs of Pregnancy (Presumptive, Probable, Positive)
Fundal Height Assessment for Nurses
Maternal Risk Factors
Physiological Changes
Discomforts of Pregnancy
Antepartum Testing
Nutrition in Pregnancy
Abortion in Nursing: Spontaneous, Induced, and Missed
Anemia in Pregnancy
Cardiac (Heart) Disease in Pregnancy
Chorioamnionitis
Gestational Diabetes (GDM)
Disseminated Intravascular Coagulation (DIC)
Ectopic Pregnancy
Hematomas in OB Nursing: Causes, Symptoms, and Nursing Care
Hydatidiform Mole (Molar pregnancy)
Hyperemesis Gravidarum
Gestational HTN (Hypertension)
Incompetent Cervix
Infections in Pregnancy
Preeclampsia: Signs, Symptoms, Nursing Care, and Magnesium Sulfate
Fertilization and Implantation
Fetal Development
Fetal Environment
Fetal Circulation
Process of Labor
Mechanisms of Labor
Leopold Maneuvers
Fetal Heart Monitoring (FHM)
Obstetrical Procedures
Premature Rupture of the Membranes (PROM)
Prolapsed Umbilical Cord
Placenta Previa
Abruptio Placentae (Placental abruption)
Preterm Labor
Precipitous Labor
Dystocia
Postpartum Physiological Maternal Changes
Postpartum Interventions
Postpartum Discomforts
Breastfeeding
Postpartum Hematoma
Postpartum Hemorrhage (PPH)
Mastitis
Subinvolution
Postpartum Thrombophlebitis
Initial Care of the Newborn (APGAR)
Newborn Physical Exam
Body System Assessments
Newborn Reflexes
Babies by Term
Meconium Aspiration
Transient Tachypnea of Newborn
Retinopathy of Prematurity (ROP)
Hyperbilirubinemia (Jaundice)
Erythroblastosis Fetalis
Addicted Newborn
Fetal Alcohol Syndrome (FAS)
Newborn of HIV+ Mother
Tocolytics
Betamethasone and Dexamethasone
Magnesium Sulfate
Opioid Analgesics
Prostaglandins
Uterine Stimulants (Oxytocin, Pitocin)
Meds for PPH (postpartum hemorrhage)
Rh Immune Globulin (Rhogam)
Lung Surfactant
Eye Prophylaxis for Newborn (Erythromycin)
Phytonadione (Vitamin K)
Hb (Hepatitis) Vaccine