PST Partum Hemorrhage

IDENTIFICATION DATA
 Client Name : Krishna sharma
 Age : 26 year
 Gender : female
 Address : tilak nagar bhilwara
 Education : secondary education
 Occupation : house wife
 Religion : hindu
 Date Of Admission : 12-06-2019
 Diagnosis : Meconium aspiration syndrome
 Ward : female ward
 Marital Status : married
 Gravida : G1T0P0A0L1
 Duration Of Marriage : 3 YEAR

HISTORY COLLECTION
 Present Chief Complains :

 Illness
 Bluish color skin
 Low blood pressure
 Altered blood pressure
 Family History :
28 year 26 year
fetus
 History Of Illness :
A. Present Medical History :
Patient comes the hospital with low blood pressure and bluish skin color
B. Past Medical History :
Patient has no past medical history of illness.
 Obstetrical History : G1T0P0A0L1
 Menstrual History
 Age of menses – 18 year
 L.M.P. – December 2018
 Interval of delivery – irregular
 Duration – 29 days
 Personal history :
 Smoking – no
 Alcohol – no history of alcohol
 Bath – daily
 Skin – normal
 Elimination – normal
 Exercise – not habitual
 Rest & sleep – normal sleep pattern is about 8 hour per day
GENERAL PHYSICAL EXAMINATION
A ) Vital Sign :-
S.N. Vital Sign Pt. value Normal value Remark

1 Temperature 98.6 oF 98.6 oF normal
2 Pulse 80 beats/min 72 beats/min normal
3 Respiration 21breath/min 20-24breath/min normal
4 Blood pressure 110/70 mmhg 120/80 mmhg normal
B) Head : size & shape is normal

C) Eye : vision – normal & no glasses
D) Ear : no discharge, normal hearing process
E) Nose : normal
F) Throat : normal
SYSTEMIC EXAMINATION
1) Respiratory System
 Respiratory rate : 21 breath/min

 Dyspnea : absent
 Lung sound : normal
 Thoracic cage : symmetrical
 Movement : normal
2) G.I. system
 Bowel sound : abnormal

 Abdomen pain : moderate to severe
 Appetite : decrease
3) Cardiovascular system
 Heart rate : 81 beats/min

 Heart sound : normal
4) Musculoskeletal system
 Range of motion : abnormal

 Contracture : absent
 Dyspnea : present
 Movement : normal
 Appetite : decreased
 Abdominal pain : moderate to severe
5) Integumentry System
 Skin integrity : normal

 Edema : present
6) Genitourinary system
 Color of urine : blood sustained

 Nature of urine : alkaline
 Dysuria : absent
 Incontinence : present
7) Reproductive system
 Position of uterus : ante version

 Amenorrhea : last two and half month
 Uterine dysfunction : presence of bleeding
 Vulva veginal : vaginal bleeding present
DISEASE DISCRIPTION
DEFINITION
Meconium is a dark green fecal material produced in the intestines of a fetus before birth.
After delivery, your newborn will pass meconium stools for the first few days of life.
Stress that your baby experiences before or during birth may cause your baby to pass
meconium stool while still in the uterus. The meconium stool then mixes with the amniotic
fluid that surrounds the fetus.
Your baby may then breathe the meconium and amniotic fluid mixture into their lungs
shortly before, during, or right after birth. This is known as meconium aspiration or
meconium aspiration syndrome (MAS).
Although MAS is often not life-threatening, it can cause significant health complications
for your newborn. And, if MAS is severe or untreated, it can be fatal.
ETIOLOGY
MAS may occur when your baby experiences stress. Stress often results when the amount
of oxygen available to the fetus is reduced. Common causes of fetal stress include:
 a pregnancy that goes past the due date (more than 40 weeks)
 difficult or long labor
 certain health issues experienced by the mother, including hypertension (high blood
pressure) or diabetes
 an infection
The fetus doesn’t begin to produce meconium until later in pregnancy, so as a pregnancy
goes past its due date, the fetus has the potential to be exposed to meconium for a longer
period of time.
As pregnancy progresses to term and beyond, the amount of amniotic fluid is also
decreased, which concentrates the meconium. As a result, MAS is more common in
overdue newborns as compared to term newborns. MAS is rare in preterm newborns.
SYMPTOMS
Respiratory distress is the most prominent symptom of MAS. Your infant may breathe
rapidly or grunt during breathing. Some newborns may stop breathing if their airways are
blocked by meconium.
Your baby may also exhibit the following symptoms:
 a bluish skin color, which is called cyanosis

 limpness
 low blood pressure
PATHOPHYSIOLOGY
(a) airway obstruction, lung atelectasis causing hypoxia and increased pulmonary
vascular resistance (PVR)
(b) chemical pneumonitis
(c) pulmonary inflammation due to release of cytokines. This causes airway
edema and hypoxia
(d) surfactant dysfunction and
(e) development of persistent pulmonary hypertension (PPHN).
Not all the infants with meconium aspiration will develop MAS. Features of respiratory
distress develop immediately after birth in only 5–10% infants.
The infant manifests with tachypnea, nasal flaring, intercostal retractions and cyanosis.
DIAGNOSIS
(f) Aspiration of meconium from the trachea at birth

(g) Signs of respiratory distress
(h) Radiologically hyperinflated lung fields, flattened diaphragm with coarse and
patchy infiltration
(i) Cyanosis.
MANAGEMENT
Proper intrapartum monitoring and care

 Amnio infusion in oligohydramnios—may reduce cord compression, grasping and
intrapartum aspiration
 Maintenance of
(a) Thermoneutral environment
(b) Minimum handling
(c) To correct metabolic abnormalities
(d) Circulatory support (N. Saline or whole blood)
(e) Airway and oral suctioning may be needed
 Liberal oxygen supply
 Antibiotic coverage, as meconium invites infection
 In a severe case arterial blood gas analysis should be done
 Inhaled nitric oxide or surfactant therapy may be beneficial
 General management includes correction of hypoxia, acidosis, hypoglycemia and
hypocalcemia. Mechanical ventilation is required where PO2 is less than 50 mm Hg
and PCO2 is above 50 mm of Hg. Complications like airleak (pneumothorax),
PPHN, bronchopulmonary dysplasia or chronic lung diseases are common. New
modalities of therapy have reduced mortality to < 5%.
NURSING DIAGNOSIS
1. Pain related to the invasive procedure.

2. Risk of infection related to the bleeding and open wound
3. Knowledge deficit related to the disease condition.
4. Fluid and electrolyte imbalanced related to the hemorrhage.
5. Nutrition imbalance less than body requirement related to the disease condition
IMPLEMENTAT-
NURSING
ASSESMENT GOAL ION WITH EVALUATION
DIAGNOSIS
RATIONAL
IMPLEMENTAT-
NURSING
DIAGNOSIS
RATIONAL
Sub .data- Pain related To reduce the -To assess the general The pain have
to the pain condition of the been reduced
Patient invasive patient
complain that procedure
abdominal pain -To provide the
comfortable position
Obj. data- of the patient
We assess the -To administer the

irritation of analgesic medication
patient that prescribe by the
physician
-To provide the

psychological therapy
of the patient to
divert the mind of the
patient.
IMPLEMENTAT-
NURSING
DIAGNOSIS
RATIONAL
Sub. Data- Risk of For reduce the -To assess the The risk of
infection risk of infection general condition of infection have
related to the the patient been reduced
Patient vaginal and
complain wound
vaginal bleeding -To regular clean of
bleeding the wound
Obj. data –
-To administer
We observe the antibiotic medication
consistency of that prescribe by the
the bleeding physician.
-To use the sterilized

equipment when
procedure is done
+
NURSING IMPLEMENTAT-ION
ASSESMENT GOAL EVALUATION
DIAGNOSIS WITH RATIONAL
Fluid and to improve The fluid and
electrolyte and maintain To assess the general of electrolyte level
Obj. data imbalance the fluid and the patient have been
related to the electrolyte improved and
hemorrhage level maintain.
Patient -to infuse the iv fluid
complain that level.
vertigo -to minimize the
weakness bleeding transfusion if
needed
-to encourage the
Obj. data patient to drink plenty
of fluid for maintain the
We observe the fluid level
weakness
bluish
discoloration
of the skin.
HEALTH EDUCATION
 To educate the patient to take medicine at right time and right time and right does.
 To educate the patient to regular exercise.
 To educate the patient to daily bath.
 To educate the patient to maintain the personal to reduce the chance of infection.
 To educate the patient to regular health check up periodically.
 To educate the patient to follow the instruction that are give by the doctor.
 To educate the patient to drink the plenty of fluid to prevent the constipation and
Improve the fluid level.
BIBLIOGRAPHY
S.N. Book name Author Edition Page no.

1 Internet - - -
2 OBSTETRICS D.C. Dutta’ s 8th 474-484

PST Partum Hemorrhage

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IDENTIFICATION DATA

 Client Name : Krishna sharma

 Address : tilak nagar bhilwara

 Education : secondary education

 Occupation : house wife

 Date Of Admission : 12-06-2019

 Diagnosis : Meconium aspiration syndrome

 Ward : female ward

 Marital Status : married

 Duration Of Marriage : 3 YEAR

 Present Chief Complains :

S.N. Vital Sign Pt. value Normal value Remark

B) Head : size & shape is normal

 Respiratory rate : 21 breath/min

 Bowel sound : abnormal

 Heart rate : 81 beats/min

 Range of motion : abnormal

 Skin integrity : normal

 Color of urine : blood sustained

 Position of uterus : ante version

 a bluish skin color, which is called cyanosis

(f) Aspiration of meconium from the trachea at birth

Proper intrapartum monitoring and care

1. Pain related to the invasive procedure.

We assess the -To administer the

-To provide the

-To use the sterilized

S.N. Book name Author Edition Page no.

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