MCP C-Section patient patho...etc.

[daveintexas8]

How does this sound for major care plan...

40 y/o c-section. Was scheduled for vag delivery, but went to stat c-section due to decels. PPH of 1250 ml.

Patho is going to be the hemorrhage (do you make the patho the pregnancy, the c-section, or hemorrhage ?).

Nursing DXs are

1. Pain

2. Risk for fluid volume deficit R/T hemorrhage

3. Constipation

4. Interrupted family system R/T absence of husband (he ran off to Mexico before the birth).

I can also do

Risk of Infection R/T surgical incision

Thoughts?

[Daytonite, BSN, RN]

1. The patho is the hemorrhage. If she is a PPH of 1250 mL, why are you using Risk for fluid volume deficit R/T hemorrhage when she has definitely had a hemorrhage and suffered a fluid volume loss?
   
2. Assuming she's had epidural anesthesia, how are you care planning for the potential complications of epidural anesthesia:
   • hypotension
     
   • rash around the epidural injection site
     
   • nausea and vomiting from the opiates administered
     
   • pruritis of the face and neck caused by some epidural narcotics
     
   • respiratory depression up to 24 hours after the epidural
     
   • cerebrospinal fluid leakage and spinal headache from accidental dural puncture
     
   • sensory problems in the lower extremities

[*]You accounted for constipation. How about urinary retention due to trauma to the tissues since she did go through labor?

[*]This lady has an incision in her lower belly. How do you expect that to affect her ability to ambulate? There's a diagnosis for that.

[*]Is she breastfeeding? There's a diagnosis for that, too.

[*]The sequencing of your diagnoses is wrong.

[daveintexas8]

1. The patho is the hemorrhage. If she is a PPH of 1250 mL, why are you using Risk for fluid volume deficit R/T hemorrhage when she has definitely had a hemorrhage and suffered a fluid volume loss?
   
2. Assuming she's had epidural anesthesia, how are you care planning for the potential complications of epidural anesthesia:
   • hypotension
     
   • rash around the epidural injection site
     
   • nausea and vomiting from the opiates administered
     
   • pruritis of the face and neck caused by some epidural narcotics
     
   • respiratory depression up to 24 hours after the epidura
     
   • cerebrospinal fluid leakage and spinal headache from accidental dural puncture
     
   • sensory problems in the lower extremities

[*]You accounted for constipation. How about urinary retention due to trauma to the tissues since she did go through labor?

[*]This lady has an incision in her lower belly. How do you expect that to affect her ability to ambulate? There's a diagnosis for that.

[*]Is she breastfeeding? There's a diagnosis for that, too.

[*]The sequencing of your diagnoses is wrong.

Well, first of all Daytonite, I've seen your work all over this topic and you are an all star for helping to get us on the right track. Thanks so much.

1. I see your point on the "why risk of hemorrhage."

Also, in one of my many care plan books (a newer one) it says Nanda has restricted Fluid Volume, Deficient, to address only isotonic dehydration. (I'm gonna do it anyway, I think).

2. This patient is 2 days post op, and she is ambulating sans difficulty to shower, etc., and isn't showing any adverse affects of the epidural, so I'm not really feeling like that is a priority in her case, but of course I didn't consider it until you pointed it out, either.

3. Constipation yes. Urinating without difficulty.

4. Looking into the mobility issue for the incision.

5. Yes, breastfeeding. I was gonna do effective breastfeeding.

6. I'll sequence the dx as follows:

Hemorrhage, pain, breastfeeding, interrupted family, and constipation?

I would think Hemorrhage and pain go 1-2, but the rest not so sure. (I only need 4 total, so the exact ones I'm not 100% on).

[Daytonite, BSN, RN]

Sequence needs to be:

1. hemorrhage
   
2. breastfeeding
   
3. constipation
   
4. pain (acute)
   
5. interrupted family