OB PIH Careplan Help!!!

Cosper123 · Dec 1, 2007

Well I've just started my OB rotation a few weeks ago so this may be of litle to no help, but right off the top of my head I'd say some important nursing priorities would be :

1. Identify and minimize risk factors (for both mother and fetus)

2. Education...young mother with no prenatal care probably doesn't have much set up for support...and probably isn't very prepared for this baby at all.

3. Counsel patient regarding present and/or future pregnancies.

As for a Nursing Diagnosis, I'd imagine anxiety would be a good one. Especially since she expressed fear verbally. For the goal I'd probably go with - Verbalize fears and concerns related to complication and/or pregnancy (with some sort of timeline so it is a SMART goal). As for interventions, 1. assume unhurried attitude whenever dealing with the patient/family. 2. provide 24h access to healcare team. 3. provide warm and supportive atmosphere, accept patient/family as they present themselves. 4. access to support services.

Another good one would be knowledge deficit related to lack of exposure to information, as evidenced by statement of concerns or misconceptions, and statement of no prenatal care. Goals may be having the patient list possible preventative measures, verbalize awareness of conditions placing her and fetus at risk, etc. interventions could be 1. provide education related to the patient's condition, including clear, simple explainations and maternal and fetal implications. 2. Identifiy danger signals required immeadiate notification of healthcare provider. 3. Describe potential implications of premature birth. 4. stress importance of reporting change in uterine tone/contrctions.

May also want to focus on ineffective/compromised family coping, risk for fetal injury, risk for maternal injury.

Once you figure out what your priorities are, you should be able to figure out a nursing diagnosis and from there can look up goals and interventions if nothing comes to mind.

Again just started OB myself and I'm in a hurry so I didn't spend too much time on this, so I'm sorry if this isn't very helpful.

Maybe someone else can give ya some better ideas.

OBPhobia · Dec 1, 2007

Hi!!! Thanks for your reply. Good points throughout. I probable should have clarified more, but my care plan must be on the pregnancy induced hypertension. So i need a nursing diagnosis and goals/interventions. I have been gathering some, but any help would be GREATLY appreciated. I am a male (i know, that doesn't matter) and just have a very tough time with OB. I LOVE Med-Surg, work at a pediatrics clinic, and actually like OB just wished I could grasp the concept. Thanks again!

Cosper123 · Dec 1, 2007

In that case nursing priorities:

1. monitor maternal, fetal, and placental status.

2. prevent or reduce progressive fluid accumulation

3. promote positive maternal/fetal outcome (haha no brainer here, but must be mentioned)

4. provide education to enhance self-care and therapeutic management.

Goals -

1. stable, free of seizures

2. fetus active w/no distress

3. patient understanding and participating in care with plan in place.

For nursing diagnosis consider fluid volume deficient (isotonic), possibly decrased cardiac output (if hypovolemic or decreased venus return), possible ineffective uteroplacental tissue perfusion, risk for maternal injury, possibly at risk for imbalanced nutrition, and knowledge deficit regarding PIH, self care, and treatment needs.

Daytonite, BSN, RN · Dec 2, 2007

hi, obphobia, and welcome to allnurses! :welcome:

a care plan, and even a case study, are written expressions that document the nursing process. the nursing process is a problem solving process and it has five specific steps that you must follow in sequence. for the development of a care plan (case scenario which is an essay form of a care plan) you will focus mostly on the first three steps. a great deal of information has been given to you for step #1 (assessment). for step #2 [problem identification and determination of the nursing diagnosis(es)] you need to make a listing of the abnormal assessment information because it is these things that you will be addressing with nursing interventions (and outcomes) in step #3 (planning) of the process. also, since this is a case study, you should also go to some sort of reference and look up information on pregnancy induced hypertension, its pathophysiology and likely symptoms because your scenario may not have included them all and those that were not included could become potential risk factors for your case scenario patient. there is a thread on the student forums that has a whole listing of websites where you can search for this type of information on medical diagnoses:

https://allnurses.com/forums/f205/medical-disease-information-treatment-procedures-test-reference-websites-258109.html - medical disease information/treatment/procedures/test reference websites

fyi. . .hellp syndrome is a form of pre-eclampsia, aka as pregnancy induced hypertension--this is doctor speak. all three medical conditions are pretty much your patient's pih.

(from page 4 of

nursing diagnosis handbook: a guide to planning care

, 7th edition, by betty j. ackley and gail b. ladwig)

"when the assessment is complete, identify common patterns/symptoms of response to actual or potential health problems and select an appropriate nursing diagnosis label using critical thinking skills.

highlight or underline the relevant symptoms.
make a short list of the symptoms.
cluster similar symptoms.
analyze/interpret the symptoms.
select a nursing diagnosis label that fits with the appropriate related factors and defining characteristics.

the process of identifying significant symptoms, clustering or grouping them into logical patterns, and then choosing an appropriate nursing diagnosis involves diagnostic reasoning (critical thinking) skills that must be learned in the process of becoming a nurse."

just going through the information you listed, i come up with this list of abnormal assessment items:

15 year old sophomore in high school
gravida 1
african american female
blood pressure 178/120, admission blood pressure 180/116
states, "i weighed 110 lbs before i got pregnant." current weight 134 = total of 24 pound weight gain during pregnancy
complained of a headache (8/10)
8 pound weight gain during the last week
has facial edema
2+ edema of hands
3+ pitting edema of feet and ankles
urine output has been 100 cc for the last 2 hours (via foley catheter)
has had no prenatal care until today
35 weeks gestation by dates and sonogram
cervical exam 1 cm, 50% effaced, -1 station
fetal heart rate baseline is 130-140 with frequent accelerations of 15 beats per minute and lasting 15 seconds
hemoglobin- 8.5 g/dl (normal is 12-16 g/dl for females)
hematocrit - 22% (normal is 37-47 for females)
platelets 80 (normal is 150 to 400) [what might be the significance of this for this patient?]
magnesium level 6.4 (normal is 1.4 to 17 for a child)
serum albumin-2.6 (normal is 4 to 5.9 in children)
total serum protein- 3.6 gm/dl (normal is 6.2 to 8 in children)
serum creatinine- 1.6mg/dl (normal is 0.3 to 0.7 in children)
bun 30mg/dl (normal is 5 to 18 for a child)
urine protein 3+ (normal should be none)
ldh (lactate dehydrogenase) 200 (normal is 60 to 170 for a child)
ast (aspartate aminotransferase or sgot) 90 (normal is 8 to 20 for an adult)

and

states, "i am so afraid. it is too early for my baby and my boyfriend is not here."
states, "my mother and daddy are mad at me because i didn't tell them i was pregnant."
states, "my hobbies are dancing and watching tv."
states, "i like school, i was hoping to try out for cheerleader next year."

and, that is what you have to work with. this list is your symptoms, or defining characteristics with which you will use to determine you patient's nursing diagnoses.

some other symptoms that weren't mentioned but can be present in pih are

jugular vein distension
heart gallops
decreased pulse rates
spontaneous bruising
prolonged bleeding
epistaxis
hematuria
nausea/vomiting
weight gains of 2 pounds or more a week are not uncommon
edema can also involve the organs
elevated blood sugars
dizziness
somnolence
blurred vision
loss of visual fields
seeing spots before the eyes
seizures with loss of consciousness
epigastric pain in ruq
slowed respirations
crackles in lung fields with dyspnea
rh incompatibility
diminished fetal movement
family history of pih

let me just say that you should not get too caught up with the nursing diagnoses. i know it is important to determine what they are. they are essentially your patient's nursing problems. however, the nursing diagnosis itself is nothing more than a label that gets attached to the nursing problem. to find nursing diagnoses, you need a nursing diagnosis reference of some kind. i happen to use nanda-i nursing diagnoses: definitions & classification 2007-2008 which is published by nanda international and is the bare bones taxonomy containing only the definitions, related factors and defining characteristics of the various diagnoses. however, there are many commercially available care plan books and nursing diagnosis books on the market that have this same nanda taxonomy information, but outcomes and interventions listed in them as well to help you narrow down your search for the right diagnoses that match with your patient's symptoms.

one overall problem that i see right off the bat is (believe it or not) fluid volume deficit which is manifested by the edema, weight gain, hemoconcentration, and headache. so, your 3-part nursing diagnosis for this would look something like this:

fluid volume deficit r/t plasma protein loss aeb has facial edema, 2+ edema of hands, 3+ pitting edema of feet and ankles, 8 pound weight gain during the last week, hemoglobin of 8.5 g/dl, hematocrit of 22%, urine protein of 3+, and a headache of 8 on a scale of 10.

your nursing interventions will focus on all the items that follow the aeb part of this statement since they are your patient's symptoms. your outcomes are simply your predicted results of the nursing actions/interventions that you list for these symptoms. you can get more specific information on what goes into the writing of goals/outcomes on post #157 on

https://allnurses.com/forums/f50/careplans-help-please-r-t-aeb-121128.html

now, for some of your patient's other symptoms you need to be checking these nursing diagnoses that specifically relate to her maternity status:

decreased cardiac output (for the hypertension)
risk for maternal injury (signs and symptoms of seizure)
deficient knowledge, regarding induction of labor and delivery
anxiety (statements of fear)
compromised family coping (statements of concern about parents)
delayed growth and development (potential inability to perform hobbies and be involved in normal teenage activities)

i'm sure you might think of a few more. that should get you started. good luck with this project!

OBPhobia · Dec 2, 2007

Daytonite,

Thank you greatly!!! You are just too smart. I hope to one day be able to pull all of this together and make a great nurse. I don't have long to do it. I'm closing in on my last semester. Thank you so much again for your help. I will spend the rest of the evening compiling all of this information and digging a little deeper. Nothing to do in the morning, think I'll just finish this one tonight.

Daytonite, BSN, RN · Dec 2, 2007

You are welcome.

whitebunny · Sep 22, 2009

WOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOW I love this post

baroreceptor · Mar 5, 2012

Thank you for this post! Thank you also, Daytonite for the excellent teaching!

I am writing a plan of care for a PIH patient, and was looking for support on the nursing diagnosis fluid volume deficit R/T plasma protein loss AEB labs showing proteinuria 30mg/dL. For some reason, fluid volume deficit was hard to wrap my head around.

Thanks again!

mindlor · Mar 7, 2012

Daytonite passed away some time ago......

She was an angel here on earth.

It is heartwarming to see that her spirit still lives and that she is still able to help us from wherever she is.....

Miss you Daytonite.