09.01 Postpartum Hematoma

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

Reference Links

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  • Question 1 of 9

Your patient is a 31 year old female who just delivered a healthy 7lb 8 oz baby boy. The delivery was assisted by forceps. Which of the following statements by the mother in the postpartum period is most concerning?

  • Question 2 of 9

A nurse is caring for a postpartum client who underwent a vacuum assisted delivery. Which of the following findings would be the most concerning?

  • Question 3 of 9

A nurse is caring for a postpartum mother who delivered a baby 3 days ago. On the first day following delivery, the provider ordered a hemoglobin level for the client. The result was 9.9 g/dL. The provider did not list any other orders in the client’s chart since that time. Which response of the nurse is most appropriate?

  • Question 4 of 9

A nurse has received report on 4 postpartum clients. Which of the following clients should be seen first?

  • Question 5 of 9

A nurse is performing a postpartum assessment and notes bulging in the perineum, the patient reports a feeling of pressure in the area. Which intervention is the most appropriate?

  • Question 6 of 9

A nurse is assessing a postpartum client who delivered a baby four hours ago. The client had a complicated delivery and suffered a third degree perineal laceration. The nurse notes that the client has a contracted uterus with excessive, bright red lochia. Which of the following actions is appropriate for the nurse to take?

  • Question 7 of 9

A nurse is assessing a postpartum client. Findings include a temperature of 100°F, a feeling of pressure in her vagina, and a pulse of 100. Which of the following conditions is the most likely cause of these findings?

  • Question 8 of 9

A nurse is caring for a postpartum client with a hematoma. What would be the most concerning development?

  • Question 9 of 9

A nurse is working on a postpartum unit and is starting the day shift. The nurse is caring for the following clients. Which of the following clients should the nurse see first?

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