POSTPARTUM HEMORRHAGE I. INTRODUCTIONThe postpartum period or puerperium refers to the 6-week period after c h i l d b i r t h .

M a n y p h y s i o l o g i c a n d p s y c h o l o g i c a l c h a n g e s o c c u r d u r i n g t h i s p e r i o d , enabling nurses to play major roles in assessment, comfort promotion and education. Protecting a womans health as these changes occur is important in preserving her futurechildbearing function and for ensuring that she is physically well enough to incorporateher new child into her family.Although the puerperium is usually a period of health, complications likehemorrhage, particularly, uterine atony, (which was the case of my patient) can occur,when they do, immediate intervention is essential to prevent long-term disability and interference with parent-child relationships.For this case study, we aim that: 1.) we will have better understanding of postpartum hemorrhage by reading books, articles and journals that are related with thed i s e a s e ; 2 . ) u n d e r s t a n d c l e a r l y t h e p a t h o p h y s i o l o g y o f t h e d i s e a s e , r i s k f a c t o r s , manifestations and treatment and modalities of the disease; and 3.) equip ourselves withskills and health teachings that are appropriate for the care of patients with postpartumhemorrhage, particularly uterine atony.II. NURSING ASSESSMENT A.PERSONAL DATA The patient is Mrs. X. She was 21 years old, born on October 27, 1986 from N H A , K a u s w a g a n , C a g a y a n d e O r o C i t y . S h e i s a F i l i p i n o , m a r r i e d a n d a R o m a n Catholic. SOCIO-DEMOGRAPHICPROFILE MRS.X is a pure blooded visaya, whose main concern is to make a living for her family and to save money for her future delivery. She works as an encoder in a Internetcafe in NHA, Kauswagan. Her husband is a farmer.Mrs. X and her husband are religiousthat they see to it they both go to churchevery Sunday. They believe that God must be the center of their family. Whenever af a m i l y m e m b e r g e t s s i c k , t h e y a d h e r e t o s e l f m e d i c a t i o n b u t i f t h e c o n d i t i o n i s a b i t serious, they go directly to the nearest hospital.M r s . X l i f e s t y l e i n c l u d e : w o r k i n g f o r 8 h o u r s , s l e e p i n g f o r < 8 h o u r s , e a t i n g nutritious meals (more fruits and vegetables, less in meat and fatty foods, avoids junk food and soft drinks) 3 times a day, etc. As a recreational activity, she watches televisionas soon as she goes home and do some cross-stitching. She does not smoke nor drink anyalcoholic beverages. ENVIRONMENTAL FACTORS Their house is situated in NHA, Kauswagan, and a place near the main road. Andin just a meter away from their home is a gasoline station. Their water supply comes from NAWASA.T h e r e a r e l e s s e r p o l l u t a n t s i n t h e a i r b e c a u s e t h e i r a r e a i s r u r a l a n d t h a t f e w vehicles are present. B. Maternal-Child Health History M r s . X g o t m a r r i e d w h e n s h e w a s 2 1 y e a r s o l d a f t e r h e r g r a d u a t i o n . S h e g o t pregnant 3 months later. According to her, she visited her doctor every month for pre-natal check-up and that she took all the vitamins prescribed by her doctor.Aside from urinary tract infection on her first trimester and 2 nd week of the lasttrimester, she had never encountered any other problems during the entire course of her p r e g n a n c y . S h e w a s s c r e e n e d f o r h e p a t i t i s B , a n d h a d s e v e r a l l a b o r a t o r y t e s t s l i k e complet e blood count, blood typing, and fasting blood sugar. She was also given a shot of tetanus toxoid on her last trimester.Onset of Menarche: 15 years oldGravida- 1, Parity- 0/ Term-0, Preterm-0, Abortion-0, Livebirth-0 C. .History of Past Illness According to the patient she was not sure whether she was fully immunizedduring her early years, but as far as she remembers, aside from minor illnesses such assimple fever, coughs and colds, she never had any major disease such as communicabled i s e a s e s n e i t h e r h o s p i t a l i z e d . S h e h a s n o a l l e r g y w i t h f o o d o r a n y a l l e r g e n i n t h e environment neither to any medicine. She never experienced any serious accidents suchas vehicular accident and fracture. History of Present Illness Mrs. X was admitted to the hospital (City Hospital) last August 20, 2010 ataround 4:50 in the morning because of labor pains. According to the patient, few hours prior to admission, she was asleep and suddenly felt some abdominal cramping, since the pain is not that really intense, she ignores it and went back to sleep. At around 3:00 am,she was awakened by abdominal pain which was accompanied by flank pain and somevaginal discharge. She told this to her husband and decided to go to the hospital.Vital signs upon admission: BP100/70, PR-90, RR- 20, TEMP-36.8 deg.cel.She was assessed by the resident on duty and found out she is already in labor. Internalexamination was made and the results were: 6cm, 50% effaced. (+) BOW, FHT-

140 beats/minute. Her attending physician was then notified and orders the following; NPO,IVF: D5LRS 1L + 1 ampule syntocinon, 1 ampule buscopan IV, Monitor FHT.In the course of labor induction, the cervix was not able to dilate in spite of uterine contraction, so the Doctors orders to have the patient under cesarean section. Shewas transferred to the operating room from the delivery room. After the delivery of the baby and placenta, the uterus was noticed to be relaxed and the bleeding did not stop. Inspite of the intervention made, such as bimanual uterine massage, injection of methergineto the uterine muscle, and uterine artery ligation, nothing happened. The bleeding was notc o n t r o l l e d . S o , t h e d o c t o r o p t e d t o h a v e t h e l a s t r e s o r t o f i n t e r v e n t i o n w h i c h i s hysterectomy.

D. Physical Examination (IPPA- Cephalo-caudal Approach) The patient was admitted last August 20, 2010 at around 3:20 am. When I visitedher, she was already on her 1 st day post operative. I introduced my self, told her that I wasassign to take care of her for few days. I stated my purpose and asked permission to do p h y s i c a l e x a m i n a t i o n . A l t h o u g h s h e s e e m s t i r e d , i n p a i n a n d q u i t e d e p r e s s e d , s h e consente d me in doing physical examination.