Help! Maternal Care Plan

Daytonite, BSN, RN · Mar 4, 2008

you need to look up the symptoms of any medical diagnosis. your nursing diagnoses are always based upon the symptoms or behaviors (nanda calls them defining characteristics) that the patient is displaying. any diagnosis whether it is being made by a doctor, nurse, car mechanic or a plumber is based upon the examination of the "patient" (assessment) and consideration of the abnormal symptoms they are seeing. every nursing diagnosis has a list of symptoms. your patient must have at least one of more of the symptoms on that list before you can assign that particular nursing diagnosis to their problem. the nursing diagnosis, as you are using it, is merely a shortened label. the actual nursing problem is more correctly stated in the definition of the nursing diagnosis. you need a nursing diagnosis reference to be able to make these diagnostic assignments correctly and so you can read these definitions of the nursing diagnoses.

what you need to do is look up information on chorioamnionitis, specifically it's signs and symptoms and complications. you might also want to look up the signs and symptoms of an infection, any run of the mill infection. the elevated wbc count is a symptom of this infection. might there be physical manifestations/symptoms connected with an elevated wbc? newborns are not able to control their body temperature very well. you need to compare that information with the assessment information you obtained from the mother and baby to see if there is something you might have missed. then, with the list of symptoms that the mother and baby have, you look for nursing diagnoses that have those symptoms and fit the circumstances.

you do not have your nursing diagnoses prioritized correctly. also, many of your r/t's (related factors) are not etiologies, but symptoms and need to be revised. the related factor is the underlying cause of the problem or the cause of the signs and symptoms that the patient is having. to help you determine a related factor it is often helpful to know the pathophysiology of the medical disease/condition process going on in the patient. to help you in determining a related factor you can ask yourself "is this the cause of the problem (meaning the nursing diagnosis)", or "is this what is ultimately causing the symptoms". "by taking away this factor, will the symptoms go away?"

prob #1:

activity intolerance r/t surgical incision, percocet, tylenol

[page 3,

nanda-i nursing diagnoses: definitions & classification 2007-2008

] definition of

activity intolerance:

insufficient physiological or psychological energy to endure or complete required or desired daily activities.

related factors

include: bed rest, generalized weakness, imbalance between oxygen supply and demand, immobility, sedentary lifestyle. not "surgical incision, perocet, tylenol"!

prob #4:

impaired skin integrity r/t surgical procedure (c-section)

prob #2:

anxiety r/t baby in nicu for chorioamnionitis, client verbalized anxiety about breastfeeding

the related factor here is actually "situational crisis". "client verbalized anxiety about breastfeeding" is a subjective piece of data and should be classified as a symptom, i.e.

anxiety r/t situational crisis aeb client's verbalization of anxiety about breastfeeding while her baby is in nicu.

and, this may be an incorrect nursing diagnosis. there is a nursing diagnosis for

ineffective breastfeeding

whose definition is

dissatisfaction or difficulty a mother, infant or child experiences with the breastfeeding process

(page 24,

nanda-i nursing diagnoses: definitions & classification 2007-2008

) or

interrupted breastfeeding

whose definition is

break in the continuity of the breastfeeding process as a result of inability or inadvisability to put baby to breast for feeding

(page 25,

nanda-i nursing diagnoses: definitions & classification 2007-2008

).

prob #5:

caregiver role strain r/t support person needs to provide not only for the client but also, possibly for the baby in order for client to adhere to treatments

the related factors for this diagnosis are listed on this webpage. they are too numerous for me to type out:

[color=#3366ff]caregiver role strain

however, the way you have worded the related factor does not convey a cause of the problem, but your thought: "support person

needs to provide"

sounds like an intervention or a goal.

prob #6:

risk for ineffective coping r/t/ adjustment in lifestyle to provide an optimal outcome for the newborn

first of all, the definition of

ineffective coping

is

inability to form a valid appraisal of the stressors, inadequate choices of practiced responses, and/or inability to use available resources.

to turn this into a "risk for" diagnosis you need to have a specific problem in mind because your nursing interventions will be to monitor for and allay the symptoms or behaviors of that problem. "to provide an optimal outcome for the newborn" is a goal or outcome statement and doesn't belong in a nursing diagnostic statement.

prob #3:

knowledge deficit r/t first time breastfeeding, "i don't know what types of food to eat."

this diagnosis must be specified:

knowledge deficit (breastfeeding).

the related factors for this diagnosis are: cognitive limitation, information misinterpretation, lack of exposure, lack of interest in learning, lack of recall, unfamiliarity with information resources (page 130,

nanda-i nursing diagnoses: definitions & classification 2007-2008

). in this case, just say "lack of facts". "i don't know what types of food to eat" is subjective data (a symptom), not a related factor.

knowledge deficit (breastfeeding) r/t lack of factual information aeb patient statement of "i don't know what types of food to eat while breastfeeding."

let me just add that the patient's symptoms are a very integral part of the care plan. they are the foundation for the choice of nursing diagnoses. they are what all your nursing interventions and goals are targeting. if you do not have a clear idea of what your patient's symptoms are before you even start looking for nursing diagnoses, your care plan will suffer the consequences. this all goes back to what i told you in a previous thread where you asked for care plan assistance and i listed the steps of the nursing process (https://allnurses.com/forums/f205/cva-basal-ganglion-infarction-262421.html). you must follow those steps in the sequence that they occur. collecting and gathering together the patient's symptoms is the most important part of getting a care plan started.

rushie · May 27, 2012

Wow so great!