What would be a good Nursing Diagnosis for my Maternity Care Plan?

  1. 1
    So I have to do a nursing care plan (a.k.a., Nursing Process Report/NPR). And I'm still rather unsure how this spiel works out.

    I was on a newborn nursery unit on Tuesday, and I picked out a newborn baby to look at the charting and do my assessment on. But the baby was pretty much normal and A-OK, so I don't even know if I'd have nursing diagnoses that I could do a care plan on.

    (For my class's care plan, by the way, I just have to pick 1 Nursing Diagnosis and do the care plan on that.)

    Anyhoo, I scoured through my data sheet, and the baby DID have a blood glucose test run because he was 9 lbs. 3 ozs., and I think that the hospital's policy is to automatically run a glucose test if the baby's bigger than 9 lbs. The baby's blood glucose was 49, which was one below the minimum 50. Hypoglycemia, eh?

    So I figured I'd find a nursing diagnosis on that.

    I have a maternity-specific care plans book with me. It's called "Maternal Newborn Nursing Care Plans" (2nd ed.) by Carol J. Green. I'm scouring through it to find an appropriate diagnosis for this baby, but I can't find any.

    There's this one Nursing Diagnosis that says "Risk for Impaired Gas Exchange", and right underneath it says "Related Factors: meconium aspiration, polycythemia, hypothermia, and hypoglycemia".

    Oooh! I thought. It says "Hypoglycemia".

    So should I write "Risk for Impaired Gas Exchange r/t hypoglycemia" as my nursing dx?
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  4. 0
    Just my opinion, but I wouldn't use that. I mean is the baby having gas exchange issues? The baby checked out ok and didn't need RT? If not than you are creating something that doesn't exist. My understanding of newborns with low glucose is that the change from being fed by mom and now baby being fed directly sometimes this will happen after the birthing process (energy used) and when baby will get next feeding (especially being larger and having higher metabolic nees than a smaller baby). So I think it needs to have something to do with nutrition and body requirements imbalance...that is what is causing the problem that we already know is there. The impaired gas exchange can be a result of the low glucose after prolonged time without treatment they can present with periods of apnea and can become cyanotic in late stages.
  5. 0
    That's what's making this so hard. Other than that low blood glucose reading, I seriously can't find anything wrong with this baby. But I need to do a care plan! Grrr
  6. 0
    What is a newborn at risk for? Even a healthy infant. How is the infant feeding? Are they latching on? Was this a vag birth? Was the baby full term? What about mom? How is she with the baby? Are they bonding? How does mom feel about the baby? How old is mom? is mom understanding what the diagnosis is indicative of? What learning does mom need to care properly for baby? Is this her first baby?

    thermoregulation in a newborn is a neurological system adaptation to extrauterine life. newborns lose body heat, and lose it rapidly, 4 ways because their neurological systems are not fully developed at birth:
    • conduction (their warm body heat transfers to cooler objects that they come into direct contact with)
    • evaporation from exposure of wet skin surfaces lost to the atmosphere
    • convection (their body heats transfers to the air surrounding them)
    • radiation (their warm body heat transfers to cooler objects around them)

    ineffective thermoregulation in newborns is due to immature compensation (adaptation to) the environmental temperature. in other words, when the newborn encounters conduction, evaporation, convection and/or radiation when they come into this world, hypothermia occurs and they lose body heat and become hypothermic. once body heat is lost in a newborn, their immature system compensates by (here comes the pathophysiology of hypothermia, or ineffective thermoregulation in newborns):
    • increasing their metabolism and increasing use of glucose and oxygen (to generate more heat)
    • this causes their respiratory rate to increase leading to respiratory distress
    • leads to hypoglycemia
    • leads to metabolic acidosis
    • leads to vasoconstriction (as the body attempts to retain heat)
    • increasing cold leads to the production of fatty acids that interferes with bilirubin transport and can lead to jaundice

    Think about what is important to watch for in a newborn. The biggies with newborns are temperature (which you rightly picked) and feeding. If there are problems with either of these (or baby has a diabetic mom), blood sugar will also be a concern. Low temp and inadequate intake can use up blood sugar as the body uses it for fuel. Diabetic moms have kids who are used to insulin bringing the blood sugar down. After birth, that insulin keeps on pumping for a little while and can send blood sugar plummeting. One other thing to keep an eye on is jaundice from hyperbilirubinemia.

    So think (risk) thermo-regulation R/T immature thermo-regulation for environment, imbalanced nutrition R/T (actual) poor feeding, thermo-regulation, diabetic Mom AEB hypoglycemia

    http://allnurses.com/nursing-student...an-290606.html
    http://allnurses.com/nursing-student...is-760113.html

    Do you see where I'm going?
  7. 0
  8. 0
    Like I said, the baby's doing just fine. I saw the baby with the mother, and the bonding was perfectly fine. The baby *was* slightly macrosomic, obviously due to the weight, and was born at 40.5 weeks. Mom's 38 by the way. I couldn't use "Ineffective thermoregulation" because I've got zero evidence for this nursing diagnosis anyway. Other than that low blood glucose, everything is WNL. In fact, I'm not even sure if a nursing intervention would BE warranted because everything's just fine. Why intervene when there's no risks or problems?
  9. 0
    Another few I can think of are:

    risk for impaired maternal-child bonding if mom's gotta worry about her diabetes as well
    risk for ineffective tissue perfusion (going back to the cold stress)
    risk for aspiration (was this baby post term? was the amniotic fluid meconium stained?)
    knowledge deficit r/t newborn care (look at other aspects of the mother- how well does she understand how to do the
    simple things like bathing, feeding. etc.)

    Also look at psychosocial factors- is there an intact family structure? Does the mother speak English? Does she have access to
    health care and financially be able to take care of the newborn? Does she have a supportive partner? These will all
    affect the newborn's development as well.
  10. 0
    But the mom doesn't have a diagnosis of diabetes (I looked in her chart). I couldn't find any of the psychosocial stuff in the chart (the binder's THIS THICK!), but I didn't see anything in the chart that would indicate that the baby's mom was doing poorly. And the whole ineffective tissue perfusion-slash-cold stress is moot because obviously the newborn's in a warmer. I didn't even have the maternity care plan book until after I got out of my clinicals, so it's not like I could retrospectively go back and try to fish out a nursing diagnosis-related problem from the mother.
  11. 0
    Oh, check this out!
    Image - TinyPic - Free Image Hosting, Photo Sharing & Video Hosting

    Why don't I just say "Risk for Birth Trauma secondary to Macrosomia"? I looked in the index and it's the ONLY thing I could find for macrosomia.
  12. 0
    Quote from samianquazi
    Like I said, the baby's doing just fine. I saw the baby with the mother, and the bonding was perfectly fine. The baby *was* slightly macrosomic, obviously due to the weight, and was born at 40.5 weeks. Mom's 38 by the way. I couldn't use "Ineffective thermoregulation" because I've got zero evidence for this nursing diagnosis anyway. Other than that low blood glucose, everything is WNL. In fact, I'm not even sure if a nursing intervention would BE warranted because everything's just fine. Why intervene when there's no risks or problems?
    You are falling into the same hole that trips most new students. You find your diagnosis and then try to retrofit the patient into the diagnosis. Let the patient/patient assessment drive your diagnosis. Do not try to fit the patient to the diagnosis you found first. You need to know the pathophysiology of your disease process. You need to assess your patient, collect data then find a diagnosis. Let the patient data drive the diagnosis.

    Could the babies low glucose be due to ineffective thermoregulation (one of the signs of ineffective thermoregulation)? All babies are at risk for thermoregulation issues.....it's because they are new born. A big concern for all babies is to keep them warm and don't let them overheat. Since this baby is macrosomic (slightly by weight)....what is one of the symptoms of macrosomia?

    Let the information you have drive the diagnosis....you have a big newborn with a low glucose. Is this a male baby? what about circumcision? Is the baby breast fed? What about the umbilical site?
    thermoregulation in a newborn is a neurological system adaptation to extrauterine life. newborns lose body heat, and lose it rapidly, 4 ways because their neurological systems are not fully developed at birth:
    • conduction (their warm body heat transfers to cooler objects that they come into direct contact with)
    • evaporation from exposure of wet skin surfaces lost to the atmosphere
    • convection (their body heats transfers to the air surrounding them)
    • radiation (their warm body heat transfers to cooler objects around them)

    ineffective thermoregulation in newborns is due to immature compensation (adaptation to) the environmental temperature. in other words, when the newborn encounters conduction, evaporation, convection and/or radiation when they come into this world, hypothermia occurs and they lose body heat and become hypothermic. once body heat is lost in a newborn, their immature system compensates by (here comes the pathophysiology of hypothermia, or ineffective thermoregulation in newborns):
    • increasing their metabolism and increasing use of glucose and oxygen (to generate more heat)
    • this causes their respiratory rate to increase leading to respiratory distress
    • leads to hypoglycemia
    • leads to metabolic acidosis
    • leads to vasoconstriction (as the body attempts to retain heat)
    • increasing cold leads to the production of fatty acids that interferes with bilirubin transport and can lead to jaundice
    Last edit by Esme12 on Sep 30, '12


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