Need 3 more interventions for my L&D care plan!

[NTPinky]

Hi all,

I have to turn a care plan for L&D, containing 4 nursing diagnoses, and 5-10 interventions with rationales for each. I've finished 3 so far, but I'm stuck on the last one. Here are the ones I have so far:

1. Risk for ineffective individual coping r/t fatigue of labor
   
2. Acute pain r/t to uterine contractions
   
3. Anxiety r/t fear of the unknown
   
4. Risk for altered pattern of urinary elimination r/t sensory impairment secondary to labor
   

I need help with #4, as I only have the following 2 interventions:

1. Palpate the bladder superior to the symphysis q1-2h (Rationale: Distention may occur from increased fluid intake and the inability to feel the urge to void due to epidural)
   
2. Straight catheterize q2h to avoid bladder distention (Rationale: Bladder distention impedes progress of fetus down the birth canal, inhibits uterine contractions, and leads to decreased bladder tone or atony after birth)
   

I appreciate any suggestions!

Thanks in advance,

Pinky

[mommatrauma, RN]

Wasn;t sure if you were looking for during labor interventions or if it mattered...so I offer my post delivery interventions and rationales hope they are helpful...

Perform post void risidual check. Rationale: To show effective bladder emptying at time of urination.

Give pain medicine as ordered. Rationale: Patient may be more reluctant to try and urinate if they are having perineal pain post delivery

[bikesnboards]

hope this works right - i'm new at this whole post/reply stuff... anyway -

- encourage frequent voiding (at least q2h) and catherize if necessary to avoid bladder distention (rationale: to avoid bladder distention because it impedes progress of fetus down birth canal and may result in trauma to the bladder)

- assist to bathroom or commode to void if appropriate and provide privacy (rationale: to facilitate bladder emptying with an upright position and relaxation)

- discuss possibility of difficulties with urinary elimination with the client (rationale: to allay anxiety associated with altered urinary elimination)

[NTPinky]

Thanks for the replies so far. In answer to mommatrauma (cool nickname), the interventions have to be specific to labor, and not postpartum.

I'd appreciate any additional feedback anyone has to offer! Thanks so much!

Pinky

[cardiacRN2006, ADN, RN]

I am not allowed to use collaborative interventions for my care plans. (Things like give meds or straight cath every 2hrs). The interventions must be independant. Is that the same for everybody else?

[BETSRN]

Hi all,

I have to turn a care plan for L&D, containing 4 nursing diagnoses, and 5-10 interventions with rationales for each. I've finished 3 so far, but I'm stuck on the last one. Here are the ones I have so far:

1. Risk for ineffective individual coping r/t fatigue of labor
   
2. Acute pain r/t to uterine contractions
   
3. Anxiety r/t fear of the unknown
   
4. Risk for altered pattern of urinary elimination r/t sensory impairment secondary to labor
   

I need help with #4, as I only have the following 2 interventions:

1. Palpate the bladder superior to the symphysis q1-2h (Rationale: Distention may occur from increased fluid intake and the inability to feel the urge to void due to epidural)
   
2. Straight catheterize q2h to avoid bladder distention (Rationale: Bladder distention impedes progress of fetus down the birth canal, inhibits uterine contractions, and leads to decreased bladder tone or atony after birth)
   

I appreciate any suggestions!

Thanks in advance,

Pinky

Knowledge Deficit.

By the way, if you need to straight cath more than once, you should be putting in a foley for 24 hours!

[SmilingBluEyes]

straight cath q2 hr? um not on my watch. If it's that big an issue, you need an indwelling cath.

i would go w/the knowledge defecit Bets suggested.

[SmilingBluEyes]

how about relieving discomfort with nursing interventions like repositioning, and use of massage and/or heat? I do that all the time.

also anything to do w/allaying fears and anxiety......

and educate, educate, educate. back to the knowledge defecit thing.....