Cry for help - well mother/baby nursing diagnoses!

JustBeachyNurse, LPN · Nov 6, 2013

*Sigh* So I'm doing my careplan for mother-baby. It's intense. I want to check in with you lovely folks and see how some of these diagnoses look. Background: Mom is healthy and had no complications during this birth, multipara/gravida. This is their third child. Baby is very healthy and all assessment findings are normal. The only thing is that she was ever-so-slightly early at 37 weeks and 1 day gestation. She has been a little sleepy and needs to be woken up to participate in breastfeeding. Mom also has developed a little tenderness around one nipple. For mother, I have: -Risk for infection r/t excess milk stored in breast tissue from infrequent infant feedings -Readiness for enhanced self-care r/t exercise aeb seeking information about safe activity levels during PP period and management of s/s indicating PP hemorrhage -Risk for infection r/t 2[sUP']nd[/sUP] degree perineal laceration -Readiness for enhanced comfort aeb prophylactic use of NSAIDs and mild ratings of pain in 24 hrs PP -Readiness for enhanced family processes r/t to integration of third child into family aeb parents support of one another and planning in preparation for discharge For baby, I have: -Risk for imbalanced nutrition: less than body requirements r/t insufficient caloric intake -Readiness for enhanced knowledge r/t birth of third child aeb parents expressed interest in enhancing their care of the newborn (I found something similar to this on a website, but I think it applies more to the parents, so I'm hesitant about using it) -Risk for neonatal jaundice related to early gestational age of 37 weeks 1 day? -Risk for Sudden Infant Death Syndrome r/t seasonality Suggestions for both mom and baby diagnoses would be helpful, but I especially need to work on my baby diagnoses. Any ideas/feedback would be appreciated!

Do you have a NANDA-I book?

There are specific risk factors for each diagnosis

For maternal risk for infection: The milk retention is questionable but 2nd degree laceration could fall under invasive procedures, trauma or broken skin.

If it is not listed in current NANDA-I, it is not a valid nursing diagnosis. There are specific defining characteristics, risk factors and related factors.

If you do not have one it's relatively low cost investment from B&N, Amazon, etc. including reduced cost versions for nook or kindle. this is the ONLY source for all of the acceptable NANDA information. Other texts are only permitted to post certain aspects such as a list of diagnoses.

Ineffective infant feeding pattern might be applicable if infant meets the defining characteristics and related factors. (Inability to stay awake for feedings is neither a defining characteristic nor related factor )

But know that risk for imbalanced nutrition less than body requirements is not a valid nursing diagnosis (only risk for imbalanced nutrition: more than body requirements is a current diagnosis

Risk for neonatal jaundice based upon 37weeks one day is not as accurate as "neonate aged 1-7 days" and "feeding pattern not well established" risk factors (and yes , more than one risk factor is acceptable)

I wouldn't rely on a random website sample care plan.

Sit tight in sure GrnTea and Esme will be around soon.

Esme12, ASN, BSN, RN · Nov 6, 2013

I am not an expert in Mother baby.....This is from AN contributor Daytonite...(rip)

Ok think of this.....close your eyes for a second and try to visualize a front seat view of a 7-pound baby coming through the birth canal. What's happening to those tissues in that mother's body! While birthing may be a "normal" process...... all that stretching and tearing of those tissues is not! Those are injured tissues. what do you know about the pathophysiology of cell and tissue injury? It sets off the inflammatory response. You are not necessarily going to see the resulting signs and symptoms (redness, heat, swelling, pain) because these tissues are deep in the body, but i guarantee they are occurring. You need to think about the effect this has on the mother's body and surrounding organ structures.

There are also complications of birthing and any procedures that were done to assist the birth that need to be taken into consideration:

infection due to
episiotomy
multiple lady partsl examinations
labor lasting more than 24 hours
prolonged time between rupture of membranes and birth
manual extraction of the placenta by the doctor
diabetes
urinary catheterization
[*]pain of the lady partsl tissues
[*]bladder distension or inability to urinate
[*]infection in the uterus
[*]hemorrhoids occur during the pushing of labor
[*]hemorrhage risk
if this is mom's 6th or more child
prolonged labor
retained placenta
induced labor
if tocolytics were given to stop contractions
c-section
forceps delivery or vacuum extraction of the baby

Here are possible nursing problems (which you would need to turn into nursing diagnoses) that you would determine from abnormal assessment information that you had gathered:

women experience afterpains, perineal trauma, their breasts are often engorged with milk and many have hemorrhoids. Was there an order for tylenol or motrin?
if you had gone through 10 or 20 hours of labor how would you be feeling after it was all over? tired, perhaps? drained of energy? need some sleep and rest? hungry? thirsty? need some fluid replacement?
there are 3 nursing diagnoses for breastfeeding: effective, ineffective and interrupted breastfeeding the baby can also have this diagnosis with its own nursing interventions.
when the baby comes through the lady partsl canal the bladder suffers a temporary loss of sensation for a period of time and there is also a decreased muscle tone to the bladder. this can result in urinating problems.
some mothers experience orthostatic hypotension as a result of vertigo after childbirth sometimes because of blood loss or dehydration. they could fall and injure themselves.
many new mothers need teaching regarding care of their episiotomies, prevention of complications and their own health maintenance. some need complete information about baby care, the baby's needs and their normal behaviors.

or the baby:Think about what you know about the assessment findings of a normal newborn compared to an adult. what's different

Newborns can't regulate their body temperature which is why we don't leave them exposed to the room atmosphere for very long with just a diaper covering them....... ineffective thermoregulation r/t immature compensation for changes in environmental temperature. Some newborns just have a few difficulties with excessive secretions in the respiratory track (the big hint here is that the nurses will keep a bulb syringe nearby the baby) so ineffective airway clearance can be used. Babies also have a stump from the umbilical cord hanging off their future belly button. Are they treating this cord stump? if it's inflamed or there are umbilical cord problems there is risk for infection, so you can use risk for infection r/t break in skin integrity at umbilical cord site. If the baby is a male and has been circumcised that is another reason for a risk of infection. is this baby breastfeeding? if so, use effective breastfeeding. Some babies just don't start feeding well at first by breast or bottle--it happens. these kids are imbalanced nutrition: less than body requirements r/t poor infant feeding behaviors

nurseprnRN, BSN, RN · Nov 6, 2013

Loveloveloved Daytonite, may she rest in peace, and recommend that you look in your current NANDA-I 2012-2014 ($29 and free two day shipping for students from Amazon, or $25 for your Kindle) for the current growth and developmental diagnoses and the ones on breast milk supply / nutrition. They are some changed since we lost Daytonite.

Esme12, ASN, BSN, RN · Nov 7, 2013

She was awesome.....sigh.

Katie71275 · Nov 8, 2013

Think about your hierarchy of needs. You have some good options, but I'd prioritize risk of hemorrhage over infection. You also have Safety....ever ambulated a new mom? They can be pretty shaky after delivery esp if they had an epidural...so fall risk right there as well. Is there one for bonding?

JustBeachyNurse, LPN · Nov 8, 2013

Risk for imbalanced nutrition-less than is not a valid NANDA-I nursing diagnosis.