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Topic:Describe the nursing interventions

appropriate for each class of hemorrhage

Subject: critical care nursing.

Presented to: Sir Mansoor ul haq
People’s nursing school LUMHS
Jamshoro .
Date:18/10/2024
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 Group members;
1)Shah faisal
2)Muhammad bhatti
3)Ramesh kumar
4)Ali muhammad
4)Khan muhammad
6)Ali mujtabah

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 After the end of presentations the students
will be able to;
Define hemorrhage.
Enlist types of hemorrhage.
Describe nursing interventions of each class
of hemorrhage.

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 Hemorrhage
Hemorrhage is the medical term for bleeding either
inside of the body or out side of the body. It can
occur due to various reasons, such as
trauma,medical condition or surgical
complications.
OR
A large flow of blood from a damaged blood
vessel (Definition of hemorrhage from the
Cambridge
Advanced Learner's Dictionary & Thesaurus ©
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Cambridge University Press). 02/02/2025
 Types of hemorrhage
There are two main types of hemorrhage.
1) external hemorrhage:
bleeding visible out side of the
body.
2)internal hemorrhage:
bleeding with in the body.it is
further divided into :
i)intracranial hemorrhage:
bleeding inside the skull(subarachnoid,
intracerebral)
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 ii)Thoracic hemorrhage:
bleeding wit in chest cavity.
iii)Abdominal hemorrhage:
bleeding with in abdominal cavity.
iv)Gastrointestinal hemorrhage:
bleeding with in the digestive tract.
v)Postpartum hemorrhage (PPH): This is severe
vaginal bleeding after childbirth. It’s a serious
condition that can lead to death. It can occur right
after delivery or up to 12 weeks after delivery.

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 Arterial hemorrhage: When bleeding occurs due to
a damaged artery, the blood is bright red and comes
out in spurts, matching the heart's rhythm. Arterial
bleeding can be life-threatening due to rapid blood
loss.

Venous hemorrhage: When a vein is damaged, dark

red blood flows steadily from the affected blood
vessel. Venous bleeding is less severe than arterial
bleeding but can still be significant and requires
prompt treatment.
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 Capillary hemorrhage: Capillary hemorrhage
occurs when capillaries—the smallest blood
vessels—are damaged. Capillary bleeding is
generally slow and oozes or trickles. Though it can
be the most painful, it is the least severe type of
bleeding and often stops on its own.

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 Nursing interventions for external
hemorrhage
1. Apply Direct Pressure:
Place a sterile dressing or clean cloth over the
wound.Press firmly with your hand or have the
patient apply pressure if possible.Maintain
pressure until the bleeding stops or emergency
medical help arrives.

2. Elevate the Affected Area:

If the injury is on a limb, elevate it above the level
of the heart to reduce blood flow to the area.
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 3. Use a Pressure Bandage:
Once direct pressure has controlled the bleeding,
apply a pressure bandage tightly but not so tight
that it cuts off circulation.

4. Tourniquet Application :

If bleeding is uncontrollable with direct pressure
and pressure bandaging, a tourniquet may be
applied above the site of injury.

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 5. Monitor for Signs of Shock:
Keep the patient lying down.Elevate their legs if
there's no head or spinal injury.Cover the patient
with a blanket to maintain body
temperature.Monitor vital signs, such as blood
pressure, heart rate, and level of consciousness.
6. Administer Fluids or Blood:
Start IV fluids if the patient is showing signs of
shock and fluid resuscitation is needed.In a
hospital setting, blood transfusion may be
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necessary for severe blood loss. 02/02/2025
 7. Prepare for Emergency Transport:
Ensure that the patient is transported to a hospital
or emergency care facility as soon as
possible.Continue to monitor the patient’s
condition during transport.

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 Nursing intervention for internal
hemorrhage
Assessment:
Frequent nursing assessment is very
important.
Document the progress and response of the
patient
Assess blood chemistries, blood gas,
oxygen saturation and electrolytes.

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 Assess for the air way breathing and the
circulation.
Identify the bleeding site, amount of blood loss
and nature of injury.
Assess respiratory tract for the clearance, rate of
respiration and auscultation the respiratory sounds
for any abnormality.

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 Improve Oxygenation
Reassure the patient and make him comfortable.
Calm down the patient as anxiety may increase
heart rate further causes complications.
If patient is restless, irritable never give him
opioids as it may further cause hypoxia.
Clear the air way if it is obstructed with blood
clots, blood or some dust particles.
Turn head to one side
Administer oxygen with the help of nasal cannula
at the rate of 4 lit / minutes.

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 Restore and Maintain Adequate Perfusion
Assess the patient for the manifestation of hypoxia.
Avoid hot application to treat hypothermia as it
dilates peripheral blood vessels and pull away blood
from vital organs.
Use modified trend burg position for the patient to
increase cardiac output.
Provide blanket to the patient to prevent
hypothermia.
Check vital signs every 5 minutes specially blood
pressure and pulse.

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 Temperature Monitoring:
Temperature monitoring is very important in
patient with shock.
Check temperature by using rectal thermometer
avoid axillary and oral temperature taking.

Cardiac Monitoring:
Monitor blood pressure of the patient
every 5 minutes till patients systolic
blood pressure comes to 100 mm of Hg.
Monitor patients closely on cardiac
monitors as patients with hemmorhagaic
shock tend to have arrhythmias due to
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severe electrolytes imbalance. 02/02/2025
 Assess Patient For Fluid Overload:
While treating hypovolemia often rigorous fluid
therapy is given which may cause complication
such as pulmonary edema if not done carefully.
Be alert for the signs and symptoms of pulmonary
edema
During fluid therapy assess cardiac as well as
respiratory signs and symptoms which indicate
pulmonary edema.
Inform unfavorable changes immediately.
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 Blood Transfusion:
Check the blood bag for recipient’s details, group, and
expiry.
Tally the name of patient with blood bag.
Monitor the patient throughout for any reaction.
Insure that informed written consent is obtained.
Keep eye on vital signs to detect reaction at early stage.
Use specially designed large bore transfusion set and set
the rate as per order of physician.
If reaction occurs stop the transfusion notify physician
immediately.
Do not live client alone during blood transfusion.
Keep monitoring the patient for any life threatening
reaction.
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
 Nursing intervention for intracranial
hemorrhage
Neurological Assessments:
Conduct frequent assessments using a standardized scale
like the Glasgow Coma Scale (GCS) to monitor for
changes in consciousness and signs of neurological
decline. Regular assessments help identify early
symptoms of increased intracranial pressure (ICP).
Intracranial Pressure Management:
To minimize ICP, the head of the bed is elevated to 30
degrees, and positioning is carefully adjusted to
maintain proper neck alignment, which promotes
venous drainage from the brain.
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 Blood Pressure Control:
Hypertension management is crucial in ICH
patients to reduce the risk of rebleeding. Nurses
may administer prescribed antihypertensives and
monitor blood pressure levels frequently, aiming to
keep values within a targeted range.
Seizure Precautions:
Patients with ICH are at risk for seizures, so nurses
are advised to initiate precautions, such as keeping
side rails up and having anticonvulsant
medications on standby if ordered.
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 Fluid and Electrolyte Balance:
Close monitoring of fluid intake and output is
essential, as well as watching for signs of
electrolyte imbalances that may contribute to
increased ICP.
Support for Patient and Family:
Providing clear information, emotional support, and
reassurance to both patients and families is vital, as
ICH can be distressing and complex.

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 Nursing intervention for post
partum hemorrhage,
Assessment and MonitoringFrequent Vital Signs:
Monitor blood pressure, pulse, and respiratory rate
every 5–15 minutes or as needed
Monitor Bleeding:
Assess lochia (vaginal discharge) for amount,
color, and presence of clots. Estimate blood loss to
determine severity.
Signs of Shock:
Watch for signs of hypovolemic shock, such as low
blood pressure, rapid pulse, pallor, and cold/clammy
skin
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 Fundal Massage
Perform gentle but firm massage on the uterus to
stimulate contraction, which helps reduce bleeding.
Positioning
Keep the patient in a supine position with legs
elevated to maintain circulation and prevent shock.
Fluids and Blood Products:
Start or increase IV fluids to maintain hydration
and replace blood volume. Prepare for blood
transfusions if needed.
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 Emotional Support
Provide reassurance and support to reduce anxiety,
as PPH can be frightening for the patient and
family.

Documentation
Document all assessments, interventions, patient
responses, and any medication or blood products
administered.

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 Case scenerio
1. What is the initial intervention for a patient with
external hemorrhage?
A) Apply a tourniquet immediately
B) Elevate the affected area
C) Apply direct pressure with a sterile dressing
D) Administer IV fluids

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 2) Which of the following is a primary goal of
frequent neurological assessments in patients with
intracranial hemorrhage?
A) To administer pain medication as needed
B) To assess for early signs of increased
intracranial pressure (ICP)
C) To determine the patient’s respiratory status
D) To promote patient relaxation

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 3) Mr gohar khan, a 34-year-old male, has
sustained a deep laceration to his left thigh from a
motor vehicle accident, resulting in significant
external hemorrhage. Despite applying direct
pressure and a pressure bandage, the bleeding
continues, and shows signs of shock. When is the
appropriate time to apply a tourniquet?
A) Immediately upon noticing the bleeding
B) When direct pressure and pressure bandaging
are ineffective
C) Only if IV fluids are not available
D) After elevating the affected limb

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 4) A patient experiencing postpartum hemorrhage
(PPH) is receiving care after childbirth. The nurse
performs fundal massage. What is the primary
purpose of this intervention?
A) To relieve pain
B) To stimulate uterine contraction and reduce
bleeding
C) To improve circulation
D) To assess respiratory function

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 5) A patient is admitted to the emergency
department with suspected internal hemorrhage
following a blunt abdominal injury. The nurse
assesses the patient and initiates nursing
interventions. What is the primary nursing
intervention to manage the patient's condition?
A) Administer analgesics to manage pain
B) Monitor vital signs and assess for signs of
shock
C) Encourage the patient to ambulate to promote
circulation
D) Provide emotional support to the patient and
family
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 References

1)Smeltzer.S.C. etal. (2010) Brunner & Suddhart’s

Textbook of Medical surgical Nursing, vol 1 (ed
12th), pp 2164-2165. Lippincott Williams &
Wilkins. Tokyo.
2)www.google.com

3) Brunner & Suddarth's Textbook of Medical-

Surgical Nursing" (Hinkle & Cheever, 14th
Edition).

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