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Hematoma | 마이메르시 MyMerci
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Hematoma

NCLEX Review Guide: Postpartum Hematoma

Postpartum Hematoma Overview

Definition and Pathophysiology

  • A hematoma is a collection of blood in tissues caused by bleeding from damaged blood vessels during delivery
  • Most commonly occurs within the first 24 hours postpartum due to trauma during vaginal delivery, episiotomy, or operative delivery
  • Can be classified as vulvar, vaginal, or retroperitoneal based on location

Memory Aid: HEMATOMA

  • Heavy bleeding signs
  • Excruciating pain
  • Mass or swelling
  • Anemia symptoms
  • Tachycardia present
  • Obvious discoloration
  • Monitor vital signs
  • Assess fundus regularly

Key Points

  • Hematomas can develop internally without visible external bleeding
  • Size determines severity: small hematomas may resolve spontaneously, large ones require intervention
  • Early recognition prevents hemorrhagic shock

Assessment and Clinical Manifestations

Signs and Symptoms

  • Severe, unrelenting pelvic or perineal pain that is disproportionate to visible trauma
  • Visible or palpable mass with bluish discoloration in the perineal area
  • Signs of hypovolemic shock: tachycardia, hypotension, decreased urine output, restlessness
  • Difficulty voiding or defecating due to pressure from hematoma
CRITICAL ALERT: Pain that doesn't respond to typical postpartum pain management may indicate hematoma formation!

Clinical Scenario

A 28-year-old primigravida delivered vaginally 4 hours ago with a midline episiotomy. She reports severe perineal pain (8/10) despite receiving pain medication. VS: BP 90/60, HR 110, RR 22. Upon inspection, you note a 6cm bluish, tense mass on the right side of her perineum.

Priority Action: Notify the healthcare provider immediately and prepare for possible surgical intervention.

Key Points

  • Pain is often the first and most significant symptom
  • Vital sign changes may indicate internal bleeding and impending shock
  • Assess for urinary retention as hematomas can compress the urethra

Nursing Interventions and Management

Immediate Nursing Actions

  1. Assess vital signs frequently (every 15 minutes initially)
  2. Apply ice packs to small hematomas to reduce swelling and pain
  3. Monitor intake and output closely
  4. Administer prescribed analgesics and monitor effectiveness
  5. Prepare for surgical intervention if hematoma is large (>5cm) or expanding

Small vs. Large Hematoma Management

Small Hematoma (<5cm) Large Hematoma (>5cm)
Conservative management Surgical evacuation required
Ice application Incision and drainage
Pain management Possible packing or suturing
Monitor for expansion Blood transfusion may be needed

Key Points

  • Never massage or apply heat to a hematoma as this increases bleeding
  • Prepare for emergency surgery if patient shows signs of hemorrhagic shock
  • Monitor hemoglobin and hematocrit levels closely

Commonly Confused Points

Hematoma vs. Other Postpartum Complications

Condition Pain Characteristics Bleeding Pattern Key Differentiator
Hematoma Severe, localized, constant Internal, minimal external Visible/palpable mass
Uterine Atony Cramping, intermittent Heavy vaginal bleeding Boggy, soft fundus
Lacerations Sharp, at tear site Bright red, continuous Visible tissue damage

Quick Differentiation Tip

"HEMATOMA = HIDDEN bleeding with HORRIBLE pain"
Remember: The bleeding is often internal and not visible, but the pain is severe and localized.

Study Tips and Memory Aids

Priority Assessment Mnemonic: PAIN

  • Palpate for masses
  • Assess vital signs
  • Inspect perineum
  • Notify provider immediately
Common Pitfalls to Avoid:
  • Don't assume normal vital signs rule out hematoma
  • Don't apply heat to reduce pain - this increases bleeding
  • Don't delay notifying provider for severe pain complaints

NCLEX Success Tips

  • Questions often focus on priority assessments and interventions
  • Remember: Pain management is important, but identifying the cause is priority
  • Know when conservative vs. surgical management is indicated

Quick Check Questions

  • ☐ Can you identify the classic triad: severe pain, mass, and vital sign changes?
  • ☐ Do you know when to apply ice vs. when surgery is needed?
  • ☐ Can you differentiate hematoma from other postpartum bleeding causes?

Remember: You're preparing to be a safe, competent nurse who can recognize and respond to postpartum complications. Trust your assessment skills and prioritize patient safety. You've got this! 💪

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