Care plan for postpartum C-section pt

  1. 0
    sitting here doing my wonderful care plan and now that i have everything set up i am reconsidering my options.
    my "paper patient" is 3 days postpardum from c-section - there was meconium found in the amniotic fluid during the amniotomy prior to the decision to do the c.
    ok, so our instructors want us to include risk for bleeding as our #1 diagnosis.
    so this is where i am at so far.

    #1. risk for bleeding r/t surgical incision and postpartum complications
    #2. acute pain r/t surgical incision d/t cesarean birth a/e/b pt stating pain level of 6/10.
    #3. at risk for impaired gas exchange r/t ventilation perfusion imblanace secondary to cesarean birth and use of opioids for pain managment post op.
    #4. risk for fluid volume deficient r/t maternal blood loss - this is where i am not happy. i know there is a high risk for thrombophlebitis and i want to include this but i am scratching my head as to how to get that in there w/a proper nanda. help.

    #5. risk for ineffective coping r/t inadequate social support created by characteristics of relationships (no father in picture and she's only 20 w/no relationship w/her family)

    i am not a fan of paper patients - and i wanted to get away from the usual risk for infection issues that are always listed -but i am finding the text isn't that great of a help and our nanda books aren't the best for ob ....
    any guidance would be great on this.
    thanks!:redpinkhe
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  3. 8 Comments so far...

  4. 0
    i would switch around 3 and 4. to me that risk for fluid volume deficit would be more of a concern to a postpartum nurse than impaired gas exchange. instead of that i would choose ineffective breathing pattern. also instead of "maternal blood loss" i would just put blood loss from cesarean birth.

    like this..
    #3. risk for fluid volume deficit r/t blood loss from cesarean birth -
    #4. risk for ineffective breathing pattern r/t surgical incision from cesarean birth and use of opioids for pain management post op.
  5. 0
    thanks...actually I ended up revamping it a bit after taking a breather and doing some other stuff around the house to clear my head.
    I ended up going this way as my top 5:

    1. Risk for bleeding r/t surgical incision and postpartum complications
    2. acute pain r/t surgical incision d/t cesarean birth a/e/b pt stating pain level of 6/10.
    3. Risk for infection r/t increased environmental exposure to pathogens d/t surgical incision and vaginal examinations
    4. At risk for impaired Gas exchange r/t ventilation / perfusion imbalance secondary to c-section and use of opioids for pain.
    5. Risk for ineffective coping r/t inadequate social support created by characteristics of relationships.

    I opted out of fluid deficiency do to the fact that blood loss was #1 and it was basically a repeat and I instead looped thrombophlebitis as a possible complication of pain due to the lack of desire to be OOB and ambulating because of the pain. I decided to reinterject the infection b/c of the high complications that this causes...

    hopefully this is fine the way it is. care plans aren't usually an issue for me but they don't change anything up for OB including our sheets so it makes the placement a little bit different and this is a new teacher and who knows what exactly they are looking for.

    Thanks!
  6. 1
    Quote from rockennurse
    thanks...actually I ended up revamping it a bit after taking a breather and doing some other stuff around the house to clear my head.
    I ended up going this way as my top 5:

    1. Risk for bleeding r/t surgical incision and postpartum complications
    2. acute pain r/t surgical incision d/t cesarean birth a/e/b pt stating pain level of 6/10.
    3. Risk for infection r/t increased environmental exposure to pathogens d/t surgical incision and vaginal examinations
    4. At risk for impaired Gas exchange r/t ventilation / perfusion imbalance secondary to c-section and use of opioids for pain.
    5. Risk for ineffective coping r/t inadequate social support created by characteristics of relationships.

    I opted out of fluid deficiency do to the fact that blood loss was #1 and it was basically a repeat and I instead looped thrombophlebitis as a possible complication of pain due to the lack of desire to be OOB and ambulating because of the pain. I decided to reinterject the infection b/c of the high complications that this causes...

    hopefully this is fine the way it is. care plans aren't usually an issue for me but they don't change anything up for OB including our sheets so it makes the placement a little bit different and this is a new teacher and who knows what exactly they are looking for.

    Thanks!

    You need to change your Dx for #4. Impaired gas exchange isn't appropriate. You could use Ineffective breathing pattern instead. Impaired gas exchange is used when there is something actually causing a problem with gas exchange in the alveoli, an example of that would be pulmonary edema, pneumonia, or asthma. Narcotics are going to decrease respiratory rate, so its a breathing pattern issue.

    So, Ineffective breathing pattern r/t V/Q (means ventilation/perfustion) mismatch 2' to use of opioids for pain AEB respiratory rate of X.
    Forever Sunshine likes this.
  7. 0
    I see what you are saying but being that it's an "At Risk for"... it should be ok because it's the risk of the problem - am I right? I could change it to ineffective breathing pattern..... but at this point I am putting it all together and idk if I should break the whiteout out.

    although I admit I am quite tempted...hmmmmm
  8. 0
    If that's the case then what you listed as r/t needs to be changed. It doesn't support the Dx. The easiest is to change the Dx to the correct one. Opiates and cesarean deliveries aren't a contributing factor to impaired gas exchange. You could leave it like you have it, but then it will be an easy target for your instructor to mark wrong.
  9. 0
    gotcha - ok, it really won't take much revamping and I would rather it be 100%. I really appreciate it! thanks so much!
  10. 0
    Abdominal surgery is a risk for ineffective breathing pattern as is opiate use (especially if spinal/epidural morphine was used).

    Since pregnancy causes blood to clot more easily, and a post op patient doesn't move as much, risk of PE is increased.

    Use of epidural/spinal narcotics also can cause problems with voiding as does having a foley cath.

    If your patient is breast feeding, there's another one for you as pain can cause more difficulty in handling the infant, finding a comfortable position, and even let down.

    If she had a prolonged labor before the C/S, she is at increased risk for PPH (especially if she had prolonged rupture of membranes and was possibly starting to get an infection), other reasons she is at risk for increased blood loss, other than just post op.

    When I went to nursing school in the dark ages, there was no such thing as a nursing diagnosis, so I don't know if any of this will be helpful to you or not.
  11. 0
    :heartbeat
    thanks
    I did cover all the thing mentioned so everything should be good - handed it in a week ago but who knows when I will find out the grades.
    and I hear ya on pain after a C/S . . . for my 1st one (I've had 2) I couldn't even hold my son. thankfully the 2nd time around was a better experience


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