Desperately need help coming up with a fetal diagnosis

[stargirl018]

Hi everyone, so I am currently in the middle of my careplan and I have been pulling my hair out the entire day because i cannot make a suitable diagnosis for my patient's fetus. My instructor was two diagnoses for the mom and one for the baby. The baby's diagnosis has to be based in utero, NOT POSTPARTUM- making it super hard because mom had a c-section with nothing unremarkable. Mom has history of HPV and a current UTI, but thats all I could think that could remotely put baby at risk for infection.

During the procedure, I did notice the doctors using a vacuum suction times two to get the baby out and afterwards there were two big red marks on the baby's head with the head a little bit swollen. This leads me to think of risk for injury related to usage of vacuum suctioning during cesarean, but what do you all think? I would love for some feedback, this is my first maternal careplan and so far all of my mother diagnoses are good, its just the baby. Thank you!

[klone, MSN, RN]

A diagnosis involving the vacuum would be postpartum, not in utero. To get an antenatal diagnosis, you would heed to look at the picture during the pregnancy, not during the birth.

[Okami_CCRN, BSN, RN]

I agree with Klone, you mentioned some important health history that would definitely affect the baby in uteru, think back to how HPV and a UTI could possibly affect the growing baby. Also think about some of the mother's activities while pregnant; did she smoke, excessive exercise, late prenatal care, etc.

[stargirl018]

thats definitely true, i was just getting way too frustrated and sought for the most obvious. would risk for infection related to exposure of mother's ruptured membrane work out? at the moment she did not have any active lesions, but a pap smear concluded that she had abnormal cells around her cervix. Since hpv is transmitted through bodily fluids and mucous membranes, could this predispose baby to an infection as well?

im also thinking that maybe infection can predispose a mother to preterm labor.. but this mother was at 39 weeks-full term and had one contraction every 10 minutes, and the FHR was all within normal limits!

this is rackin' my brain!

[Okami_CCRN, BSN, RN]

Your professor may want you to think about things that could affect the baby in uteru by asking you to come up with a diagnosis like that.

Remember that a nursing diagnosis is what you conclude after your assessment. So risk for infection is definitely plausible if the mother had a UTI while in labor. Think about how you would word that nursing diagnosis.

[stargirl018]

hm, well here's my take: Risk for infection related to mother's current urinary tract infection during labor as evidenced by mother's elevated white blood cell count 13.4

I just read something in my book that says that a mother with a current uti can predispose an baby to another uti or possible sepsis, but i feel like that too is still post partum.

[Okami_CCRN, BSN, RN]

you may want your nursing diagnosis to be a little more specific try using "secondary to" risk for infection related to maternal urinary tract infect secondary to ruptured membranes as evidenced by WBC 13.4, positive urine culture for e.coli Something like that.

You are telling me she has a UTI but only mention an elevated WBC you have to be more specific. You are correct that a maternal UTI can lead to infection and sepsis in the newborn but it can also happen in uteru if the client has ruptured membranes and has a long labor where the infection could ascend into the uterus. So because this client had an active infection you must continually assess the newborn for s/s of infection.

[cayenne06, MSN, CNM]

What was the indication for c/s? That might give you some useful clues for a fetal care plan.