CAREPLAN OB HELP

Nursing Students Student Assist

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Hello, this is my first care plan for OB and I'm kind of stuck :no:

Patient 46 yo gravida 15 para 10. 39 weeks gestational. She is orthodox jewish. She didn't have any complications during her pregnancy except 3+ pedal edema which is pretty normal.. Didn't have any gestational diabetes or anything of that sort..

I was thinking of doing her dx on her age of 46.

But I'm completely lost!

Im not asking you to write my care plan, I'm just asking for any ideas?

Thank you!!!!!

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

Google advanced maternal age and loo at complications. Did the patient deliver? Care plans are all about what the patient NEEDS and the patient assessment.

what makes you pick the patients age?

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Specializes in Hospice + Palliative.

how were those 10 babies delivered previously? Any complications with those labors? Do you have any current labs? How's her H+H? group B strep status?

She's an elderly grand multip - there's risk for lots of stuff to go belly-up. (here's just two possibilities for your to research: hypotonic uterus, post-partum hemorrhage)

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How about risk for uterine rupture related to multiple caginal births aeb 15 babies

Risk for uterine atony

Risk for delayed maternal development related to age aeb patient age of 45

I just made most up but you can tailor it properly

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Specializes in Complex pedi to LTC/SA & now a manager.
How about risk for uterine rupture related to multiple caginal births aeb 15 babies

Risk for uterine atony

Risk for delayed maternal development related to age aeb patient age of 45

I just made most up but you can tailor it properly

Not one of these suggestions are a valid nursing diagnosis. The first two are medical diagnoses and out of the scope of a nurse. You cannot make up a nursing diagnosis you must use one of the available internationally approved nursing diagnoses in the current NANDA-I. You have risk for impaired parenting d/t high number of pregnancies. Any incontinence issues. There are 4 related to incontinence stress, urge, functional, retention incontinence and risk for...

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Specializes in Complex pedi to LTC/SA & now a manager.
how were those 10 babies delivered previously? Any complications with those labors? Do you have any current labs? How's her H+H? group B strep status?

She's an elderly grand multip - there's risk for lots of stuff to go belly-up. (here's just two possibilities for your to research: hypotonic uterus, post-partum hemorrhage)

Hypotonic uterus is a medical diagnosis as is post partum hemorrhage. You have the fluid balance NDx risk for fluid imbalance, risk for fluid volume deficit, excessive fluid volume,n

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Take it easy. I said I made them up. This was to get her thought process going

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Specializes in SICU, trauma, neuro.
How about risk for uterine rupture related to multiple caginal births aeb 15 babies

Risk for uterine atony

Risk for delayed maternal development related to age aeb patient age of 45

I just made most up but you can tailor it properly

One doesn't see 15 babies (even if she HAD 15 babies--she's para 10) and conclude that she is at risk for uterine rupture. How many cesareans has she had? Is she being induced post cesarean? OP doesn't say. And anyway it's not a nursing dx.

While she may be at risk for uterine atony, it's not a nursing dx.

I don't know what delayed maternal development is, but what about being mid-40s and a very experienced mother is going to delay her maternal development?

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Specializes in SICU, trauma, neuro.

What in your assessment tells you that her age is an issue? Nursing dx are based on the assessment.

How is her support system? Self-care ability? Any difficulties with observing the law post-partum? (I say that because I'm a hugger, and probably would have gone off the deep end if my husband couldn't give me a hug for those first weeks.) Has she delivered yet? If so, how's her pain, bleeding, breastfeeding (if breastfeeding)?

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Specializes in med-surg, mother-baby, teaching, peds.

Breastfeeding on her next baby will be painful as the cramping is worse with each subsequent delivery. So in volition pain will be a very active problem but the risk for diagnosis others mentioned are also possible. Remember to use your NANDA, NIC and NOC websites to help you develop your CP. Altered perfusion is also evident regarding the 3+ edema.

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Specializes in med-surg, mother-baby, teaching, peds.

Regarding uterine atony risk, client's uterine tissue as definitely been affected my multiparty so she does actively have

Altered tissue integrity r/ t excess uterine

or r/t endometrial injury with grand multiparty. Now you will need the AEB portion such as overcompensating UCs,

ineffective labor pattern, etc.

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Specializes in Hospice + Palliative.
Hypotonic uterus is a medical diagnosis as is post partum hemorrhage. You have the fluid balance NDx risk for fluid imbalance, risk for fluid volume deficit, excessive fluid volume,n

I understand that - I wasn't giving nursing diagnoses, I was giving thoughts on things that might be problematic to initially guide the OP's own research. I generally don't make a habit of doing pople's homework for them...I far prefer to offer sparks that will incite the student's own thought process ;) The OP did, in fact ask for "ideas" initially, after all

One doesn't see 15 babies (even if she HAD 15 babies--she's para 10) and conclude that she is at risk for uterine rupture. How many cesareans has she had?

Actually, grand multip (regardless of c/s status) does prompt the conclusion that she is at risk for uterine rupture. Multiparity (especially grand multiparity) is one of the common risk factors in (non-scarred, ie: no previous c/s or other uterine surgery) intrapartum rupture. (see http://www.sciencedirect.com/science/article/pii/S0029784497000732)

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