ASSESSMENT EXPLANATION OF GOAL/OBJECTIVES IMPLEMENTATION RATIONALE EVALUATION

THE PROBLEM

S> ➢ Postpartum ➢ After 8 hours of Dx: ➢ After 8 hours pf

hemorrhage is nursing nursing intervention,
“Nahihilo ako pag 1. Evaluate the blood - 1. To measure the
defined as a interventions, the the patient was able
katapos ko manganak loss amount amount blood loss.
patient will
tapos nag dudugo ako.” loss of blood in to demonstrate
demonstrate Thx: - 1. To measure and
O> the postpartum adequate perfusion
adequate perfusion Ind> monitor the blood loss
period of more and stable vital
➢ Restlessness and stable vital every 1 hr.
than 500ml. 1. Monitor amount of signs.
➢ Confusion signs.
There is a bleeding by - 2. Early recognition of
-
➢ Irritability greater risk of possible adverse effects
weighing all pads.
➢ Vital Signs taken hemorrhage in - allows for prompt
2. Frequently monitor
as follows: the first 24 intervention.
vital signs.
- BP: 100/70 hours after the - 3. To help expel clots of
3. Massage the uterus.
- R: 24 birth, called blood and it is also used
primary 4. Provide comfort to check the tone of the
postpartum measure like back uterus and ensure that ut
NURSING rubs, deep breathing
hemorrhage. us clamping down to
DIAGNOSIS: and Instruct in prevent excessive
➢ Risk for relaxation or bleeding.
ineffective tissue visualization - 4. Encourages venous
perfusion related exercises. return to facilitate
to hemorrhage. circulation, and prevent
further bleeding and
Ed:
promotes relaxation and
1. Instruct the may enhance patient’s
significant others to coping activities.
report any bleeding
- 1. To early recognition
and unwanted signs
of further risks and
and symptoms
immediate nursing
related to the
intervention.
bleeding and pain.
- 2. To enhance patient’s
2. Encourage the
coping in emotions and
significant others to
activities, and to
give support to the
minimize irritation and
patient.
refocusing patient’s
attention.
-