Maternity Nursing: Postpartum Q 2
A nurse is caring for a PP woman who has received epidural anesthesia and is monitoring the woman for the presence of a vulva hematoma. Which of the following assessment findings would best indicate the presence of a hematoma?
A. Complaints of a tearing sensation.
B. Complaints of intense pain.
C. Changes in vital signs.
D. Signs of heavy bruising.
Correct Answer: C. Changes in vital signs.
Changes in vitals indicate hypovolemia in the anesthetized PP woman with vulvar hematoma. There may also be intermittent bleeding. Depending on the size and location of the vulvar hematoma, urological or neurological signs and symptoms may be present.
Option A: A hematoma is described as a collection of blood beneath an intact epidermis that presents as a swollen fluctuant lump. It can be extremely tender on palpation. Due to its rich blood supply, the vulva is highly vulnerable and prone to hematoma formation. Although venous bleeding is possible, arterial bleeds mainly originate from one of the branches of the pudendal artery. Vulvar hematoma, rarely, might be secondary to operative laparoscopy (especially adnexal surgery), spontaneous rupture of the internal iliac artery, or spontaneous rupture of a pseudoaneurysm of the pudendal artery.
Option B: Because the woman has had epidural anesthesia and is anesthetized, she cannot feel pain, pressure, or a tearing sensation. Due to mechanical urethral obstruction, patients may present with urinary retention or micturition difficulties. In severe cases, the patient can be hemodynamically unstable and will require urgent fluid resuscitation or blood transfusion. Symptoms usually develop within a few hours to days of delivery, depending on the severity of the condition.
Option D: Heavy bruising may be visualized, but vital sign changes indicate hematoma caused by blood collection in the perineal tissues. As bleeding into the vulva is largely restricted only by the Colles fascia and the urogenital diaphragm, a hematoma in this area will be visible on physical examination. This is seen as a tender fluctuant lump of variable size. Since the Colles fascia exerts little resistance, vulvar hematomas can grow to become 15cm in diameter or more. The observation of a lump or swelling in the groin may be offered by the patient if asked during the consultation. Although there is no anatomical explanation, it is discovered that the right side appears to be more commonly affected.