Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Breastfeeding promotion wikipedia , lookup
Prenatal testing wikipedia , lookup
Maternal physiological changes in pregnancy wikipedia , lookup
Breech birth wikipedia , lookup
Women's medicine in antiquity wikipedia , lookup
Breastfeeding wikipedia , lookup
Fetal origins hypothesis wikipedia , lookup
Prenatal nutrition wikipedia , lookup
Neonatal intensive care unit wikipedia , lookup
Maternal health wikipedia , lookup
THE CARE OF A MOTHER AND HER NEWBORN By: Brittany Wisener & Katelyn Branney INTRODUCTION & DEMOGRAPHICS Patient: K.W., Caucasian and 19 years of age. Unemployed with high school diploma. Needs financial assistances, such as food stamps, cash assistance, and WIC (Women, Infants, & Children Program). No religious or cultural beliefs that would affect her care. Engaged, but not present during delivery due to serving in the National Guard. Her fiancé's income is the primary support and he has ownership of their current home. Lives alone when he is not present, and does the cooking and shopping. Gravida 1, Para 1: Delivered, vaginally, to a baby boy on November 7, 2010 at 1:37 a.m. He weighed 8lbs 13.2 oz. Gestational age 40 weeks and 2 days. Cared for at 40 weeks and 3 days, the first post partum day. ANTENATAL HISTORY oPrimipara oDid not have many healthy habits during her prenatal care. oPregnancy was due to an oral contraceptive failure. oUnaware of her pregnancy because of her irregular menses until April, 2010. She had her first prenatal visit on April 15, 2010. During this time period she consumed alcohol and periodically smoked. She also had poor eating habits. oPrenatal vitamins were not taken until August 25, 2010 oShe did not have any complications during this period; however, during placentation she developed two placentas. oNo history of allergies, sexually transmitted infections, GYN disorders, or surgeries. oAll of the prenatal labs were within normal limits. oMother is O+, baby is B+. This raises concern about ABO incompatibility. INTRAPARTAL PERIOD: CONTRACTIONS Admitted for spontaneous labor Onset of labor took place on November 6, 2010 at 2:00 p.m. During labor she was given LR at 125mL/hr, pitocin was added to the LR 7 min. after the delivery. Contractions began to be monitored at 4:26 p.m. Latent Phase: Contractions were approx. 4-6 min. apart & lasted 70-80 sec. long Active Phase: Contractions 2-3 min. apart & approx 90 sec. long. Transitional Phase: Contractions 1-2 min. apart & lasting approx. 60-80 sec. long. Contractions became increasingly more intense & were dangerously close together, which caused a non-reassuring fetal heart rate. Brethine 0.25mg, subQ was administered to relax the contractions to keep the fetus safe. INTRAPARTAL PERIOD: CERVICAL EXAMS First Stage of Labor: 11 hours & 21 min. Second Stage of Labor: 16 min. Third Stage of Labor: 7 min. Total: 11 hours & 44 min. Exam #1: 4:26 p.m. 3cm dilated, 70% effaced, -3 station. FHR approx. 120 bpm with moderate, variable accelerations. Exam #2: 9:16 p.m. 4cm dilated, 80% effaced, -3 station. Amniotomy performed at 9:17 p.m. Shortly after an epidural was administered. Two attempts were made to insert the catheter, this caused CSF leakage. Exam #3: 11:02 p.m. 7cm dilated, 100% effaced, -1 station. FHR 120 bpm with moderate variable accelerations. Exam #4: K.W. felt rectal pressure, 10 cm dilated, 100% effaced, & 0 station. FHR was120 bpm with moderate, variable accelerations. At 1:37 a.m. on November 7, 2010 a male neonate was delivered vaginally with no assisted devices, but K.W. acquired a second degree laceration. Intrapartal labs were all what to be expected during a delivery. MATERNAL POSTPARTUM ASSESSMENT Throughout the day vital signs were all within normal range. Appetite was normal Appearance morning: tired & skin was pale & warm. Breasts were soft & non-tender Uterus was at umbilicus, firm, & midline. Bowel sounds were in all 4 quadrants, abdomen was round, soft & no pain to touch. Bladder was not distended Lochia was rubra & a moderate amount. Perineal area was swollen & well approximated. Edema was +2 on her ankles & legs, but reported no signs of pain, tingling, or numbness. Hemorrhoids were not present. Emotionally was concerned about her body image & was upset that her fiancé was not present. Bonding, she bonded well with her infant. She enjoyed holding, cuddling, & talking to him. MATERNAL POSTPARTUM ASSESSMENT Postpartum labs (Hgb & Hematocrit low) Chief Complaint: Pain, due to CSF leak upon administration of the epidural. Headache, upper back pain, & shoulder pain. Administered Motrin, Vicodin, & IV Caffeine Sodium Benzoate to control pain. Consent for Blood Patch was signed. NEWBORN POSTPARTUM ASSESSMENT At delivery weighed 8lbs 13.2 oz (4004 g) & lost 5.1 % of his body weight. Currently, weighing 8lbs 3.6 oz (3799.79g). Throughout the day all vital signs were within normal range. His anterior and posterior fontanels were soft, open, and normal to touch. N.S.’s reflexes were all within normal limits (blinking, pupillary, babinski, palmar, moro, sucking, & rooting). No facial abnormalities, skin was pink and warm. Lungs were clear upon auscultation and respirations were regular. Abdomen was soft, round, and there were bowel sounds in all four quadrants. There were few scratches on his abdomen from his sharp finger nails. His umbilicus was intact, but drying appropriately. All pulses were within normal limits and equal bilaterally. Circumcised in the morning, checks were performed, and showed no complications. He was voiding adequately, but he has not yet passed his first stool. Mother is breastfeeding, but newborn is having difficulties latching. NURSING DIAGNOSIS Risk for impaired situational low self-esteem r/t pregnancy weight gain AEB expressing concerns about excessive weight gain and impressing her fiancé. -Use motivational interventions, such as motivating K.W., verbally, with positive encouragement when she expresses concerns about body image and losing weight, prn. -Refer K.W. to a nutritional specialist to come up with a diet plan that will work best with K.W.’s needs, stat. -Educate and provide written information to K.W. on different exercises that she can perform, stat. -Encourage behavioral interventions, such as improving hygiene (showering, shaving, brushing teeth, and getting dressed), prn. Acute pain r/t a cerebral spinal fluid leak secondary to epidural administration AEB c/o severe, constant headaches. -Encourage K.W. to achieve adequate uninterrupted sleep in flat supine position, prn. -Administer ordered analgesics (Motrin & Vicodin), prn and assess pain level before and after administration of medication. -Encourage oral hydration of 6-8 (8oz) glasses of preferably water each day, prn. -Institute comfort measures, such as applying a heating pad on the upper back and shoulders, and providing an ice wash cloth over the eyes or forehead, prn. NURSING DIAGNOSES CONT.. Knowledge deficit r/t being new to parenthood and its stresses AEB being a young new mom with a lack of support. -Encourage and stress the importance to K.W. that parent and child interaction is vital for normal psychological development, prn. -Educate K.W. that it is important for the infant to have the father actively involved in N.S.’s life prn. -Give K.W. written information that includes parenting tips and resources for parenting support groups stat. -Educate K.W. on the signs and symptoms of depression stat. Risk for imbalanced nutrition r/t infants inability to correctly latch on and transfer milk AEB having hesitancy when latching on and by needing nursing staff to assist the baby to latch on affectively. -Use self-attached breastfeeding, prn. -Help K.W. establish different holding techniques that work best for her newborn and herself when breastfeeding. -Keep breastfeeding environment free from distraction and ideally a dim, quiet, warm setting, prn. -Instruct K.W. to look for pre-feeding behaviors, such as, searching, rooting, and mouthing before attempting to feed, stat. CONCLUSION Concerns: How strong her & her fiancé's relationship is. Lack of support Leading to depression, stress, & sleepless nights, which may affect the care of her new baby. Self-esteem deteriorating, due to her body image never meeting her expectations. Lack of prenatal care, puts a high concern for not getting the routinely care that an infant should receive after birth (Doctor appointments & getting immunized). The possibility of retained placenta fragments. By having two placentas it will increase the likelihood of fragments retaining in the uterus. This is a high concern because this could lead to postpartum hemorrhage & this may become life threatening.