Hemorrhage Maternal Newborn

1.Perform hand hygiene.
2.Verify correct patient using two identifiers.
3.Call for help and notify additional personnel.
4.Perform hand hygiene and apply clean gloves.
5.Attempt to identify the source of bleeding.
6.If blood is dark, assess for superficial lacerations.
7.If blood is bright red, assess for deep lacerations (i.e., cervix).
8.If blood spurts and clots, assess the patient for uterine atony or placental separation.
9.If blood does not clot, assess for coagulopathies such as DIC.
10.Establish two large bore IV accesses, if not already present, and begin IV fluids.
11.Obtain specimens for necessary laboratory values as ordered.
12.Assess vital signs at least every 5 minutes, including oxygen saturation.
13.Perform interventions specific to source of bleeding.
14.Assess the patient for boggy fundus.
15.Perform fundal massage.
16.Once the uterus is firm, express clots by applying firm but gently pressure on the fundus in the direction of the vagina.
17.Administer oxytocin or other uterotonics as ordered.
18.Ensure the patient's bladder is empty. If bladder is distended, catheterize if needed.
19.Assess the patient for cervical or vaginal lacerations or hematoma.
20.Apply pressure to the lacerations, if visible, with a sterile 4×4 gauze until the practitioner arrives.
21.Assist with repair of lacerations.
22.Assess the patient for retained placenta.
23.Notify anesthesia.
24.Administer tocolytics as ordered.
25.Assist the practitioner with removal of placenta as needed.
26.Administer oxytocin or other uterotonics as ordered once the placenta is removed.
27.Assess the patient for coagulopathy.
28.Attempt to identify cause.
29.Administer oxytocin or other uterotonics as ordered.
30.Obtain specimens for further laboratory values as ordered.
31.Assess for signs of DIC and laboratory abnormalities of DIC.
32.Administer interventions as ordered for specific causes of coagulopathy.
33.Administer oxygen as ordered.
34.Administer IV fluids and blood products as ordered to replace lost fluid and blood volume.
35.Insert Foley catheter and maintain strict intake and output monitoring.
36.Prepare patient for surgery as needed. Provide ongoing reassurance to patient and family.
37.Discard used supplies, remove gloves, and perform hand hygiene.
38.Document the procedure in the patient's record.
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