HELP~~ L & D CarePlan

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I had a 36 year-old pt. with scheduled repeat C-section. Nothing in particular for her medical history. No allergies. G2 T1 P2 A0 L1. Gestation by date was 38 weeks and 6 days. Has a heart-shaped uterus. Spinal was given for analgesia. pitocin and cefoxitin was given in the OR. Baby was thought to be breeched, but turned out to be normal (head down) when uterus was opened. VSS post-op, very very minor bleeding.

I need a L & D nursing diagnosis for this pt. but couldn't think of any. Pain (more of a postpartum Dx), anxiety (she didn't really have any coz it wasn't her first time doing it), risk for miscarriage r/t the heart-shaped uterus and breech (doesn't really apply coz she had a C-section + it was scheduled).

Suppose the careplan was developed before I saw the delivery + I didn't know that the baby wasn't breeched, what would be a good Dx??!?!?!

Someone please help me. :crying2: It's due very soon.....

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Specializes in geriatrics,emergency,hospice.

Hey...

I know you said very little bleeding, but you could probably use Deficient knowledge r/t effects of bleeding on self, pregnancy, and fetus...

Acute pain r/t uterine cramping

Deficient knowledge r/t purpose and potential side effects of prescribed medications

Caregiver role strain r/t significant other needing to providr not only for the patient but also possibly for other children

Risk for infection r/t incision

Fear r/t potential complications

Without knowing her hx, this is what I can come up with. I hope it helps.

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It seems to me that the heart-shaped uterus was what really stands out. Is there a nursing Dx that somehow relate to the heart-shaped uterus of my pt.? My instructor hates general Dx that applies to almost all pt.

Thanks for your input.

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Specializes in geriatrics,emergency,hospice.

ok... how about

fear r/t real or imagined threat to fetus or own well being AEB bicornuate uterus??

Low self esteem r/t unmet expectations for childbirth AEB inabiltiy to deliver lady partslly?

You just got to be creative, I guess...lol :bugeyes:

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Specializes in geriatrics,emergency,hospice.

The most common problem associated with bicornuate uterus is premature labor or incompetent cervix (premature dilation of the cervix). So, there are alot that will work, just use bicornuate uterus as your r/t.

My instructors say the best diagnosis include something subjective the patient says...

Fear r/t bicornuate uterus AEB patient verbalizing " Im scared about the complications" ( this is just an example)

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Specializes in med/surg, telemetry, IV therapy, mgmt.

first of all, there are no "l & d nursing diagnoses". there are only 3 diagnoses that are specific to women and those all have to do with breastfeeding. all other diagnoses are fair game to be used for all patients. this is why you need to know that care planning is a problem solving process and is why you need to know the steps of the nursing process and how to use them in helping you with care planning.

secondly, what about this patient is similar to med/surg patients that you have taken care of already? she had a surgical procedure, got spinal anesthesia, has an incision that needs care. there are nursing diagnoses that you probably already worked with for surgical patients that apply here. does she have an incision? what needs to be done for it? is there any drainage? is there a risk for infection, do you think? what does the puncture site for the spinal anesthesia look like? is it important that the care plan include that it be monitored? what are the complications of spinal anesthesia? should you monitor for them? is she having any incisional pain? is she getting something for this discomfort, or is she suffering? how about her ability to move around--is she running around the halls or walking like a bent over little old lady? does she need help walking, dressing, and getting to the bathroom? these are self-care deficits.

third, even though she was a planned c-section, her uterus still is recovering from pregnancy. what is normally happening during this recovery time? is the fundus being monitored? why? what complication is she at risk for postoperatively if the fundus does not remain firm? that is a fluid problem if it is present. is she breastfeeding? id so, use one of the breastfeeding diagnoses.

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Specializes in OB.
It seems to me that the heart-shaped uterus was what really stands out. Is there a nursing Dx that somehow relate to the heart-shaped uterus of my pt.? My instructor hates general Dx that applies to almost all pt.

Thanks for your input.

women with heart shaped uterus can deliver vag. that is not the issue. Issue was thought of breech baby, thats why csection

so you have.. risk for infection,(surgical and also from foley cath),DVT d/t immobility, postpartum depression,knowledge def (r/t incision care) some possible psych/soc issues (could she feel like she "failed" to give birth lady partslly, risk for constipation d/t narcotic meds prescribed for pain, will need teaching as to activity restrictions when going home, s/s of infection, incisional care

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Specializes in Have a niche for pysch.

How about decreased cardiac output r/t depressing effects if analgesia? Doesn't this put her at risk for hypotension or bradycardia? Incisional pain may also cause alterations in breathing patterns, just as in would in other post-op patients. Look at the big picture and don't forget your ABCs!

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:yeah:APPLAUSE!!!!!:yeah:

Thanks so much everyone!! :bow:

You couldn't believe how much I've learned from asking this one question.

TOTALLY GOT IT!:)

(excuse me if I got too excited... new user here~~)

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