Maternity Care Plans: help?

[itsdebraanne, ASN, RN]

i need help with my care plan. this is the patient story:

pt. 28 years old, g2p1. two hours post delivery, boggy uterus at +2 from umbilicus. one hour later, 1200cc blood clot was expelled. heavy rubra. 1st post-op day, wbc 15.7, 7.2 hgb, 26.9 hct. post-partum assessment: c/o slight burning with urination and cloudy, dark urine. pain 7/10. temp 37.8 c (100.04 f). pulse 112. resp 28. c/o dizziness when out of bed to bathroom. pt reports weight loss of 60 pounds.

list of concerns:

1200cc blood clot

c/o burning with urination

pain 7/10

dizziness when oob to br

weight loss of 60 lbs

priority nsg dx:

1. risk for hemorrhage

goal: pt rubra flow will decrease from heavy to moderate with the admin of methergine po as ordered by md 2 days post-partum.

interventions: place in trendelenburg's position, give 02, increase ns iv fluid, initiate standing order (airway or iv infusion) as per protocol/md

2. risk for infection

goal: patient's pain will be relieved or controlled at the end of 12 hour shift.

interventions: increase (encourage) fluid intake. provide comfort message (back rub - to take her mind off the pain in her lower abdomen, change position in bed, provide sitz bath, warm soaks to the perineum to relax muscle)

okay, so my concerns are in red. my instructor would like the goals to be measurable, have a time frame, and specific to patient and problem. monitoring and assessment are not interventions by themselves. interventions need to improve the condition, not watch it.

are my goals and interventions specific enough? do they seem correct to you?

please don't suggest new nursing diagnoses. they are correct. she mentioned them during lecture.

[Jolie, BSN]

You started out pretty strong with your list of concerns. Now you need to relate your subjective and ojective assessment data to those concens to develop your nursing diagnoses.

1. 1200 cc blood loss...what labs help you to assess this, and are they normal or out of range? What other subjective and objective information from your assessment specifically relates to this concern?

Is this truly a "Risk for" diagnosis, or do you need to word that more strongly? What interventions do you need to take with a patient who has ALREADY lost that much blood? What independent nursing actions can you take to manage this patient's actual blood loss and prevent additional bleeding? (Meaning those that don't require a physician order?) There are a number of measures comon to post partum patients that you would try before needing to implement the measures you list as your interventions.

Your second diagnosis is "Risk for Infection," but your goals and interventions are all related to comfort. This needs revision. What places this patient at risk for infection? Do you have any subjective, objective or lab data to support this potential diagnosis? If so, what? And if so, what goals and interventions are appropriate to prevent infection, or to identify an active infection and treat it?

Pain is a separate issue that requires a separate diagnosis.