Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Haemorrhage (original)

23,458 views

Published on

Haemorrhage
Introduction
Types
Categories
Emergency Managment
Nursing Care Plan

Published in: Health & Medicine
  • Login to see the comments

Haemorrhage (original)

  1. 1. CONTENTS  Objectives  Introduction  Definition  Normal Anatomy of Blood Vessels  Composition of Blood  Pathophysiology  Types of Haemorrhage  W.H.O Grading  Classification of Haemorrhage  Causes  Signs & Symptoms  Emergency Management  Nursing Care Plan  Summary  References
  2. 2. OBJECTIVES At the end of this presentation, participants will be able to ;  Gain knowledge about haemorrhage  Define haemorrhage  Describe anatomy of blood vessels & composition of blood  Differentiate different types of haemorrhage  Elaborate classification  Learn about W.H.O grading of haemorrhage  Discuss causes and signs & symptoms of haemorrhage  Manage haemorrhage in emergency
  3. 3. HAEMORRHAGE INTRODUCTION Haemorrhage is the loss of blood escaping from the circulatory system. Bleeding can occur internally, where blood leaks from blood vessels inside the body, or externally, either through a natural opening such as mouth, nose, ear, urethra, vagina or anus, or through a break in the skin. Uncontrolled bleeding can rapidly lead to shock and death.
  4. 4. HAEMORRHAGE DEFINITION The term haemorrhage refers to a large amount of bleeding in a short time. (Thygerson, Gulli & Krohmer 2006; pp:23) An escape of blood from a ruptured blood vessel. ( Weller & Wells 1990; pp:217) Haemorrhage is the loss of blood from a vessel. (Malcolm R. Colmer 1986 ; pp:98)
  5. 5. ANATOMY OF BLOOD VESSELS
  6. 6. B L O O D P L A S M A 55% PROTEINS 7% WATER 91.5% PLATELETS 1,50,000-400,000 OTHER SOLUTES 1.5% WHITE BLOOD CELLS RED BLOOD CELLS 4.8 – 5.4 millions ALBUMIN 54% GLOBULIN 38% FIBRINOGEN 7% ALL OTHERS 1% ELECTROLYTES NUTRIENTS GASES REGULATORY SUBSTANCES WASTE PRODUCTS NEUTROPHILS 60 – 70% LYMPHOCYTES 20 – 25% MONOCYTES 3 – 8% EOSINOPHILS 2 – 4% BASOPHILS 0.5 – 1.0% COMPOSITION OF BLOOD
  7. 7. CLOTTING MECHANISM  Defense mechanism of circulatory system to leakage  Involves complex series of reactions  Adequate amount of calcium and all clotting factors are essential  Clotting factors include; thromboplastin, prothrombin, thrombin and fibrinogen  Clot formed is called fibrin  Platelets and other blood cells also play an important role in clot formation
  8. 8. CLOTTING MECHANISM & SITE OF ACTION OF ANTICOAGULANTS Platelet breakdown Tissue damage Oral anticoagulants Sodium citrate Heparin THROMBOPLASTIN THROMBIN CALCIUM PROTHROMBIN FIBRINOGEN FIBRIN (CLOT)
  9. 9. TYPES OF HAEMORRHAGE
  10. 10. TYPES OF HAEMORRHAGE CAPILLARY  Bleeding oozes steadily but slowly VENOUS  flow steadily under less pressure doesn't spurt ARTERIAL  Bleeding spurts with each heartbeat  Difficult to control due to pressure  Most serious type as large amount of blood may be lost in short time
  11. 11. TYPES (cont) PRIMARY  Occurs immediately  A cut finger or an operation incision REACTIONARY(INTERMEDIATE)  Occurs in first 24-hrs after operation  More severe the operation, more likely it is to occur  Operations on kidney, thyroid and breasts as well as total hysterectomy are more liable to be followed by reactionary haemorrhage SECONDARY  If infection is present, walls of blood vessels may be eroded and may burst, causing what is known as secondary haemorrhage
  12. 12. TYPES (cont) REVEALED OR EXTERNAL  Bleeding can be seen  From an open wound e.g.; abrasion, laceration, avulsion, amputation etc.  Through natural opening like mouth, nose, anus, vagina etc. CONCEALED OR INTERNAL  Bleeding cannot be seen  Occurs in one of the body cavities such as abdomen  Can result from;  Blunt trauma or penetrating injury  Acute or chronic medical illness
  13. 13. W.H.O GRADING
  14. 14. CLASSIFICATION OF HAEMORRHAGE CLASS I CLASS II CLASS III CLASS IV up to 15%(<750ml) of total blood volume 15-30%(500-1500ml) of total blood volume 30-40%(2000ml) of total blood volume >40%(>2000ml) of total blood volume Compensation Early Decompensation Late Decompensation (Early irreversible) Compensation Limited (Irreversible) Normal BP, Pulse, Respirations •Unable to maintain BP •Tachycardia & tachypnea •Decreased pulse strength & narrow pulse pressure •BP 70mmhg or below(systolic) •Weak , thready rapid pulse •Narrowing pulse pressure •Tachypnea •Pulse barely palpable •Respirations : rapid, shallow and ineffective •Vasoconstriction •Release of catecholamine • Epinephrine • Norepinephrine - Anxiety, slightly pale and clammy skin •Significant release of catecholamine - Cool, clammy skin and thirst - Increased anxiety and agitation -Normal renal output •Anxiety and restlessness •Increased LOC & AMS •Pale, cold and clammy skin •Decreased renal output •Lethargic, confused and unresponsive •Extremely pale, cold and clammy skin •Diminished renal output Fluid resuscitation is not usually required -volume resuscitation with crystalloids is all that may be required - Blood transfusion is not usually required fluid resuscitation with crystalloid -blood transfusions are usually required -aggressive resuscitation is required to prevent death
  15. 15. CAUSES OF HAEMORRHAGE  Multiple trauma  Injury to the highly vascular area involving lungs, liver, spleen, or prostate  Any surgical or obstetric emergency  Aneurysms  Hypertension  Septicemia (Gram negative & Meningococcal)  Widespread Carcinomas  Bleeding disorders
  16. 16. SIGNS & SYMPTOMS EARLY SIGNS & SYMPTOMS  Restlessness and anxiety  Coldness ; temp is slightly subnormal  Blood pressure is lowered  Pulse rate is slightly increased  Pallor  Increased thirst SIGNS & SYMPTOMS AFTER SEVERE HAEMORRHAGE  Extreme pallor  Coldness is profound  Air hunger ; respirations are rapid & sighing  Pulse rate is very rapid
  17. 17. SIGNS & SYMPTOMS (cont)  Blood pressure is extremely low  Thirst is extreme  Volume of urine output is diminished SIGNS & SYMPTOMS OF INTERNAL BLEEDING  May appear quickly or take days to appear  Bruising  Painful, tender area  Vomiting or coughing up blood
  18. 18. NURSING MANAGEMENT MEDICAL MANAGEMENT EVALUATION INTERVENTION PLANNING NURSING DIAGNOSIS ASSESSMENT Dependent Independent HISTORY EXAMINATION INVESTIGATION TREATMENT PAST HX PRESENT HX INSPECTION PALPATION AUSCULTATIO N GENERAL SPECIFIC GENERAL SPECIFIC SYMPTOMATIC
  19. 19. ASSESSMENT NURSING DIAGNOSIS PLANNING INTERVENTION EVALUATION Obvious bleeding risk for deficient fluid volume r/t large amount of blood loss evidenced by trauma To stop bleeding INDEPENDENT - Apply pressure bandage - Elevation(limbs - Shift the patient to OT (if needed) DEPENDENT - IV coagulation therapy(tranaxemic acid, vit.k, FFP) Bleeding stopped Restlessness and anxiety SOB Lips cyanotic Delayed or absent capillary refill BP below 70mmhg to unobtainable Ineffective tissue perfusion related to hypotension evidenced by excessive blood loss To make pt relax and comfortable To build systolic BP upto above 90mmhg To get strong peripheral pulses INDEPENDENT - Counseling & psychotherapy - Attach cardiac monitor -O2 inhalation - Monitor SP02 continuously - Monitor patient for signs of shock DEPENDENT - IV fluid replacement according to blood loss Patient is relaxed Breathing comfortable Strong peripheral pulses BP above 90mmhg (systolic) No signs of shock Cold clammy skin Temp below 35dc Hypothermia related to ineffective tissue perfusion evidenced by hypotension To build up body temperature To get skin warm - cover patient with blanket to warm up body _ Monitor skin temperature every 15 mints Skin warm and dry Temp 37dc or above
  20. 20. INVESTIGATIONS GENERAL All baseline investigations SPECIFIC PT, APTT to check clotting profile ABG’s to check perfusion CBC to review Hb, Hct levels, and platelet count RFT’s to review renal profile when urine output is less or diminished
  21. 21.  CONTROL OF EXTERNAL BLEEDING  Place dressing over the wound and apply direct pressure  If patient is bleeding from an arm or leg, elevate the injured area above heart level to reduce blood flow  Apply a pressure bandage (if bleeding is not controlled)  If bleeding still cannot be controlled, apply pressure at a pressure point (artery or vein) while keeping pressure on the wound
  22. 22.  CONTROL OF INTERNAL BLEEDING  For minor internal bleeding (such as bruise on the leg from bumping into the corner of a table), follow the steps of the RICE procedure:  Rest the injured area  Ice or cold pack application over the injury  Compression over injured area by applying an elastic bandage  Elevation of injured arm or leg, if it is not broken  For serious internal bleeding follow these steps  Care for shock by raising legs 6 to 12 inches, and cover the patient to maintain warmth  If vomiting occurs, roll the patient onto his/her side to keep airway clear  Monitor breathing  Identification and correction of underlying problem
  23. 23. SUMMARY Haemorrhage is loss of blood from any blood vessel due to some trauma or injury. It may also occur due to some bleeding disorder or tumors. Bleeding may be external or internal. Signs and symptoms depend on extent of blood loss. It is classified into four classes according to blood loss. W.H.O has set a standard grading schedule to assess level of blood loss. Uncontrolled bleeding can lead to hemorrhagic shock and even death. So immediate measures are taken to control bleeding and blood products and fluids are administered to replace fluid volume. Patient is monitored continuously and assessed to check patient’s response to therapy.
  24. 24. REFERENCES Brunner & Suddhart’s Textbook of Medical Surgical Nursing, vol 2, 12th ed, 2010: pp 2161 – 2163 Colmer ; Moroney’s Surgery for Nurses, 16th ed, 1981 : pp 98 – 106 Howard, Steinmann, Sheehy’s emergency nursing principles & practice, 6th ed, 2003 pp ; Thygerson, Gulli & Krohmer, First Aid, 5th ed, 2006 : pp 23 – 27 http://www.google.com/bleeding-wikipedia http://europepmc.org/abstract/MED/6517266

×