OB diagnosis

kgh31386, BSN, MSN, RN · Jul 13, 2009

There's always a risk for infection and fluid volume deficit. And if you do choose to do a "risk for", there won't be any AEB, just a R/T

Daytonite, BSN, RN · Jul 14, 2009

pt: 36 y/o f gravida 2 t0p0a1l0 estimated @ 40 weeks gestation in labor; cervical ripening done w/ cervadil then labor induced w/ pitocin @ 8mu/min; catheter placed; epidural placed at 4 cm dilation; last i had seen - she was 5 cm, 90% effaced, & -1 station; pt's vitals were stable as well fetal heart rate was baseline

acute pain r/t altered characteristics of chemically stimulated contractions, pressure of presenting part, tissue dilation and stretching, nerve compression, muscle hypoxia and intensified contraction pattern aeb [restlessness, moaning, crying, facial mask of pain]
risk for maternal injury r/t adverse response to therapeutic intervention [of cervidil]

significant history (i have 3 nursing diagnoses to write & was looking to use each of these issues as a diagnosis):

advanced maternal age (36) - this is might have been what lead to her having diabetes; obviously w/ the age we are worried about genetic abnormalities w/ the fetus (idk if that is a nursing diagnosis though?)

anxiety r/t threat to maternal and fetal health aeb fear of consequences to self because of patient's age of 36

previous induced abortion (don't have any info on this) - this puts her at risk of many things (scarring from the abortion can make one more susecptible to placenta accreta, c/s)

anxiety r/t threat to maternal and fetal health aeb fear of consequences to self because of previous obstetrical history

gestational diabetes (diagnosed @ 28 weeks, blood sugar taken day before was 129 she is only controlling is with diet) - macrosomic neonate, risk for infection r/t increased glucose levels in urine aeb ?(there is no urinalysis)

anxiety r/t threat to maternal and fetal health aeb fear of consequences to self because of elevated blood sugars.

also, lives in africa and had prenatal care completed there, she is only is the u.s. to have the baby (husband works here) - emotional state > anxiety, impaired communication (english is not her first language)

fear r/t situational state aeb voiced concerns, increased tension, apprehension, voiced feelings of inadequacy, sympathetic body responses (need to list them)
fear r/t perceived threat to mother or fetus aeb voiced concerns, increased tension, apprehension, voiced feelings of inadequacy, sympathetic body responses (need to list them)
anxiety r/t situational state aeb voiced concerns, increased tension, apprehension, voiced feelings of inadequacy, sympathetic body responses (need to list them)
anxiety r/t perceived threat to mother or fetus aeb voiced concerns, increased tension, apprehension, voiced feelings of inadequacy, sympathetic body responses (need to list them)
impaired verbal communication r/t cultural difference aeb inability to speak or understand english

i think your list of diagnoses should include:

acute pain r/t altered characteristics of chemically stimulated contractions, pressure of presenting part, tissue dilation and stretching, nerve compression, muscle hypoxia and intensified contraction pattern aeb [restlessness, moaning, crying, facial mask of pain]
fatigue r/t emotional demands and energy requirements aeb [see defining characteristics at [color=#3366ff]fatigue]
anxiety r/t perceived threat to maternal and fetal health and situational state aeb fear of consequences to self because of patient's age of 36, previous obstetrical history, elevated blood sugars, voiced concerns, increased tension, apprehension, voiced feelings of inadequacy, and sympathetic body responses (need to list them)
impaired verbal communication r/t cultural difference aeb inability to speak or understand english
risk for infection r/t repeated invasive procedures, traumatized tissues and prolonged labor
risk for maternal injury r/t adverse response to therapeutic intervention [of cervidil]

keep in mind that the care plan is about the mother, not the baby, so the focus is on the mother.

Laurinq · Jul 20, 2009

Thank you, very helpful!

CrunchyMama, ASN, RN · Jul 20, 2009

I'm going to HATE OB!

Daytonite, BSN, RN · Jul 20, 2009

i'm going to hate ob!

why? think of it as just another system of the human body that you are studying. do not lose the momentum of how you have been studying medical diseases because it won't change.

like studying any medical disease, first do a refresher about the female gyn anatomy. then, learn what a normal, uncomplicated pregnancy is. that is the benchmark that pregnancies are measured against for normal assessment purposes. everything else is abnormal and becomes a medical and nursing problem and there are plenty of them.

there is a list of ob websites that are helpful on this sticky thread, especially the brookside press site (http://www.brooksidepress.org/products/military_obgyn/home.htm). please bookmark and use them:

https://allnurses.com/nursing-student-assistance/medical-disease-information-258109.html - medical disease information/treatment/procedures/test reference websites

kgh31386, BSN, MSN, RN · Jul 20, 2009

I'm a guy and OB was just another class. No easier, no harder...just different material

Daytonite, BSN, RN · Jul 20, 2009

I'm a guy and OB was just another class. No easier, no harder...just different material

And I was a gal, never had a baby and never had thoughts about having one. After seeing a few born I definitely didn't want to have a baby! My class was 33% guys. Most OB docs are male. Don't paint yourself into a corner before you even begin.

CrunchyMama, ASN, RN · Jul 21, 2009

Thank you for your advice. Dealing with pregnancy and how everything works won't be a problem. I'm just against certain things (such as inducing for no reason), so it's going to be hard for me to control my beliefs. It's probably going to be the worst 8 weeks of my life, lol.

Daytonite, BSN, RN · Jul 21, 2009

Thank you for your advice. Dealing with pregnancy and how everything works won't be a problem. I'm just against certain things (such as inducing for no reason), so it's going to be hard for me to control my beliefs. It's probably going to be the worst 8 weeks of my life, lol.

Look at inducing this way. . .if they don't induce, the baby doesn't come out. Women died years ago because of labor not starting or progressing. It does happen. OB problems were the #1 reason women died before modern medicine and why getting pregnant was cause for concern. It's really only a few OB docs that abuse the methods available today.

When I was a supervisor I saw a very tragic case when a baby died as a result of a home delivery. The midwife knew something was wrong and the mom needed assistance with delivery, first induction and eventually a C-section, but the mom wasn't going to go for it. The baby ended up literally stuck in the proximal end of the lady partsl canal. By the time they were able to finally convince the mom to get to the hospital for help the baby was dead.

CrunchyMama, ASN, RN · Jul 21, 2009

I'm fine with inducing for medical reasons. But if a mom is at 40 weeks and all tests show that everything is fine with baby and mom...there's no reason to rush things along. I'm a firm believer in babies will come when they're ready. A due date is only an estimation and often ultrasounds are wrong regarding fetal weights. Labor has to happen in steps and inducing skips some of these steps...which can lead to a c-section. We have a high induction/c-section rate that it's pathetic and sad. Had I of known all this, I would've told my Dr. NO I didn't want to be induced during my 1st pregnancy....but like many people I faithfully listened to my Dr. because she was a Dr. So I became a statistic...I was induced and finally after nearly 2 days was rushed in for an emergency c-section. Anyway....I just wish more people were informed when it comes to childbirth but that's not how it is. I think there's a place for everything....when medically needed.