INTRODUCTION

My self Bithika Pal M .Sc Nursing 1st Year student Tripura Institute of
Paramedical Science. I was posted in IGM Hospital, post natal ward. Here I got a
patient who is suffering from massive blood loss, passing large clots, dizziness,
decreased blood pressure, swelling and pain in the vaginal and perineal area. I
have taken this case for my care plan.

DEMOGRAPHIC DATA
Name of the mother: Rita Sarkar
Age of the mother: 17 years
Diagnosis: Postpartum hemorrhage (PPH)
Last menstrual period: 4/9/23
Expected date of delivery: 11/06/24
Gestational age (on admission):39 weeks 6 days
Date of admission: 10/06/24
Date of delivery: 11/09/23
Mode of delivery: normal veginal delivery
Ward: Postnatal ward
Name of the husband: Raju Sarkar
Age of the husband: 35 years
Language spoken: bengali
Religion: hindu
IP number: 3459881

SOCIO ECONOMIC HISTORY—

Types of family: neuclear
Family member:4
No of adults :3
Total monthly income of family: 7,000 per month
Earning member of family:1
No .of children:1

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Socio economic class: lower class
Education: 10th pass
Occupation: house wife

FAMILY HISTORY— There is no family history

key
FAMILY TREE—

Male

Female
Mr. Raju Sarkar Mrs. Rita Sarkar

client

Baby of Mrs. Rita Sarkar

PERSONAL HISTORY—
Nutrition- adequate
Education- 10th pass
Rest and sleep-adequate and proper. She slept for 8 hours per day
Activity – dull
Hobbies- cooking
Hygiene- maintained

Menstrual history-
Menarche: 12 years
Amount: normal
Interval: 28 days
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 Marital history- married
Contraception history- nothing significant
Drug history- nothing significant
Elimination history- she passed urine 6 times and stool 2 times in a day

PAST MEDICAL HISTORY— she had no past medical history except common cold and
cough.
PAST SURGICAL HISTORY—she had no past surgical history
PRESENT MEDICAL HISTORY— mother was having massive blood loss, passing large
clots, dizziness, decreased blood pressure, swelling and pain in the vaginal and perineal.

PRESENT SURGICAL HISTORY— She has not undergone any surgical history

OBSTETRICAL HISTORY—
SI MOTHER
NO
YEAR GRAVIDA PERINA FULL ABORTION MODE OF REMARKS
TAL TERM DELIVERY
PERIOD
2024 1 39 weeks term no SVD unhealthy
6 days

LMP- 4/09/23
EDD- 11/06/24
Model of delivery: SVD
Gestational age– 39 weeks 6 days
1st trimester- nausea, vomiting
2nd trimester- nothing significant
3rd trimester- abdominal pain
 Date and time of onset of labour pain: 9.6.24 at 7pm
 Date and time of full dilatation: 6.30 am on 10.06.24
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  Date and time of birth: 10.6.24 at 8.50 am
 Date and time of placenta examination: 10.6.24 at 9.05 am
 Total stage of 1st stage: 12 hours 30 min
 2nd stage: 1 hour 50 min
 3rd stage: 15 min

PHYSICAL EXAMINATION—
VITAL SIGNS-
Temperature- 96.6 f
Pulse- 65bpm
Respiration- 24 bpm
B.P.- 100/70 mmhg
ANTHROPOMETRIC MEASUREMENTS—
Weight- 53 kg
Height- 152 cm
HEAD TO FOOT EXAMINATION—
General appearance-
Head- no infection, no dandruff, no pedicuolosis is present
Eyes- no edema, no redness, no anemia is present
Nose- no discharge, clean nostrils.
Ears-symmetrical, no discharge is present
Mouth- no gingivitis, no somatitis is present
Neck- no enlargement is present
Chest- no abnormal sound is present
Back- normal
Extremities- nothing significant
Genitalia- discharge is present

OBSTETRIC EXAMINATION—
ABDOMEN-
Inspection- linea nigra,stria albicans is present

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 Palpation- fundal hight is 13 cm , uterous is bulky

BREAST EXAMINATION-
Inspection- primary and secondary areola is present, discharge is present
Palpation- nothing significant

VAGINAL EXAMINATION-
External- discharge is present.
Lochia: red in colour
Episiotomy:
Redness: absent
Edema: absent
Ecchymosis: absent
Discharge: present
Approximation: healing

INVESTIGATION-
Date Investigation Mothers value NormalValue Remarks
BLOOD
Rh-grouping B positive
21/11/23 Hb 11.2 gm/dl 11-16 gm/dl Normal
RBS 139 mg/dl >140 mg/dl Normal
HIV/HBSAG - - Negative
URINE
Albumin 3.7 g/dl 3.4 -5.4 g/dl Normal
Sugar 21 mg/dl Upto 25 mg/dl normal

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NURSING DIAGNOSIS:

1. Fluid volume deficit related to excessive bleeding as evidenced by hypotension

2. Impaired physical mobility related weakness due increased blood pressure as evidenced by
patient feels restlessness.

3. Anxiety related to blood loss as evidenced by frequent question.

4. Impaired gas exchange related to decrease oxygen delivery as evidenced by shortness of
breath.
5. Activity intolerance related to continuous bleeding as evidenced by not performing daily
works

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NURSING MANAGEMENT:-
Nursing theorists and their work have a significant impact on nurse education and clinical
practice. They can be applied both in theoretical research and used practically in diverse interventions
aimed at the improvement of patient care quality and patient outcomes. One of the theories most
commonly employed in practice is Dorothea Orem’s Self-Care Deficit Theory of Nursing. Orem
received her nursing diploma in the 1930s and started her career at Providence Hospital School of
Nursing in Washington (Berbiglia&Banfield, 2014). In the following decades, she received her BS
and MS degrees in Nursing Education. She worked throughout the country following her goal to
improve nursing in general hospitals.

Theory application
Mrs. Rita Sarkar admitted in the hospital. She was having labour pain, so she can’t do care
herself due to his condition. He needs support from others to perform daily living activities.
So, I applied Dorothea Orem’s Self-Care Deficit Theory for my patient while caring him to
improve his health status by setting the goals with both the nurse and the patient’s mutual
understanding.

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According to Dorothea Orem the conceptual framework is

SELF CARE

SELF CARE SELF CARE

AGENCY DEMANDS

NURSING
AGENCY

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In my patient’s condition the framework are as following

SELF CARE

SELF CARE CAPABILITIES Therapeutic Self

1.Poor Activity level Care demand
2.Poor Nutrition 1.Activity
3.Anorexia 2.Communication
4.Nausea,weekness 3.Self Care
5.Self care deficit 4.Nutrition
6.Risk for Bed sore 5.Skin care

NURSING CAPABILITIES
1.Improve Activity level
2.Improve Appetite,reduce nausea and
vomitting
3.Reduce Risk for bed sore

CARE PLAN:
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Assessment Nsg goal Planning Implementat Evaluati
diagnosis ion on

SUBJECTIVE Fluid volume To Assess the mothers Mother Fluid

DATA: maint condition condition was volume
Deficit
mother said i ain assessed will be
am having related Fluid maintained
dizziness volum Assess the skin texure Skin texure and
To excessive
e turgor is
Bleeding as Level checked by
pinching the
Evidenced by
skin of mother
Hypotension
Assess vital sign Vital signs was
assessed.
OBJECTIVE Tem: 98.8 F
DATA: Pulse: 67 bpm
Hypote- Blood pressure:
Nsion. 100/70 mmhg
Bp 1oo/50
mmhg
Encourage the fluid Fluid intake is
intake encouraged.
Encourage to
take 3-4 l water
per day

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Assessment Nsg goal Planning Implementat Evaluati
diagnosis ion on

Subjective Impaired To -Speak slowly, with -Spoke slowly, Patient

data: physical make patient through using with patient activity is
mother says mobility impro visual cues and through using little bit
that she is related ve the gestures, be visual cues and increased
feeling restless weakness due mobili consistent, so that she gestures, be to some
increased ty of can understand consistent, and extent.
objective blood the clearly. repeat as
data: pressure as mothe necessary.
mother facial evidenced by r
expression is patient feels -Made the
dull restlessness. -Make the mother do mother do
active and passive active and
exercises being in her passive
comfortable position. exercises being
in her
comfortable
position
-Adviced the
mother to be in
-Advice the mother to bed rest.
be in bed rest.

-Given plenty
-Give plenty of water, of water,
psychological support psychological
and proper position. support and left
lateral position
is given.

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assessment Nsg goal Planning Implementat Evaluati
diagnosis ion on

Subjective Anxiety To Assess the anxiety Assessed the Anxiety

data: reduc level of the patient.
related to anxiety level of level of
Mother says e
that she is blood loss as anxiet the patient with the patient
feeling scared y
evidenced by the help of scale is reduced
due to loss of level
blood frequent of the anxiety
patien
question.
Objective t Provide the
Feeling of the
data:
psychological support patient are
Mother is
explored
asking to the patient.
frequent
question
Provided the
- Provide the counseling to
counseling to the the patient
regarding
patient regarding complication of
complication of PPH PPH

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assessment Nsg goal Planning Implementat Evaluati
ion on
diagnosis

Subjective .Impaired gas To Assess the breathing Breathing Gas

data: maint pattern pattern was exchange
exchange
mother says I ain assessed is
cannt breath related to gas maintained
Provide fowlers or
decrease
excha semi fowlers position Fowlers
oxygen nge position was
provided
delivery as
Provide humidified
evidenced by oxygenation
Humidified
shortness of
oxygen was
breath. Provide well provided
ventilation room

Objective Well ventilation

data: room is
shortness of provided
breath

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assessment Nsg Goal Planning Implementat Evaluati
ion on
diagnosis

Subjective Activity To Assess mother activity Mothers Activity

data: impro level activity level level is
intolerance
mother says ve was assessed improved.
that ‘I cannot related to activit Assess the cause of
perform daily y activity intolerance Cause of
continuous
works level activity
bleeding as intolerance was
Help other to perform assessed
evidenced by
small work
not Mother was
helped to
performing
Never leave mother perform small
daily works alone work

Assist mother in daily Mother was not

works left alone
Objective
data: Mother was
Cannt perform assisted in daily
daily works works

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Health education:

Diet:
 Take green leafy vegetables
 Take high caloric diet
 Take iron rich food

Medication:
 Take medicine by doctors provided
 Check the expirery date of medicine
 Don’t skip the medicine

Exercise:
 Do free hand exercise
 Take proper rest between exercises

Follow up:
 Go for follow up regularly
 If any complication will arise than immediately go for checkup

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CONCLUSION
It would appear that we have interfered with normal labour since the 16th century that we have,
in fact, ob- structed the normal mechanism by clamping the cord. thereby creating complications
such as retained placenta. postpartum haemorrhage and rhesus iso-immunization.
As retraction of uterine muscle is enhanced by oxyto-cics, it is suggested that the third stage
should be managed as follows:
1. Give Syntometrine at the birth of the anterior shoulder.
2. After delivery of the infant the cord is severed and allowed to bleed from the placental end.
3. When there is no more bleeding from the cord end. the placenta is removed by the Brandt-
Andrews manoeuvre during the next contraction.

BIBLIOGRAPHY

 Boback M Irene & Jenson Margaret" Maternity & Gynaecologic Care, mosby company

(5th edition) page no;96-98

 DC Dutta (2004)" text book of obstetrics" 9th th edition 2018, jaypee brothers medical

publication,page no: 33-44.

 Myles (2003) text book for midwifes" 15th edition, Philadelphia: Churchill livingstone

publishers, page no:25-65

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