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Postpartum Care Plan

Pt 24yo female 1 day postpartum. Baby is in NICU due to other complications but only the mother was my pt. I need five diagnoses total and I only have four. If there is any input on the four I have already that would be appreciated also. Due in 24hrs.

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Postpartum Care Plan

Ineffective Breastfeeding

R/T situational crisis AEB pt verbalization of not being able to breastfeed while her baby is in the NICU.

NOC:

Pt will use breast pump effectively by the end of shift.

NIC:

  1. Educate pt on the use of the pump. This will ensure correct use.
  2. Assist pt with use until the pt feels confident to use independently. Assisting the pt will ensure confidence when performing independently.
  3. Observe pt use breast pump independently. Observing will confirm correct use.

Evaluation:

Goal met; Pt demonstrated the correct use of the breast pump independently as 1130. Cont. POC

Acute Pain

R/T episiotomy AEB pt states...

Quote

"It hurts when I sit or walk. I would rate my pain at a 6 or 7. I really need something to make the pain better."

NOC:

Within 4 hours of interventions pt will experience a decrease in pain level by reporting a pain score of 2 or less.

NIC:

  1. Administer analgesic medication as ordered as needed to promote comfort.
  2. Explain discomforts and reassure the pt that they are time-limited to assist in coping with pain,
  3. Administer stool softener to prevent straining with first bowel movement

Evaluation:

Goal met; Pt stated pain level at a 2 one hour after interventions. Cont POC

Impaired Tissue Integrity

R/T episiotomy AEB 3rd degree laceration in the perineal area

NOC:

The pt will remain free of infection throughout shift, without any signs and symptoms of infections, and exhibit evidence of progressive healing as demonstrated by clean, dry, absent edema, and intact episiotomy site.

NIC:

  1. Monitor episiotomy sire for redness, edema, warmth or discharge to identify infection
  2. Instruct pt on use of sitz bath to promote healing, hygiene, and comfort.
  3. Encourage frequent perineal care and peripad changes to prevent infection
  4. Instruct pt on positioning to relieve pressure on perineal area

Evaluation:

Goal met; Pt showed signs of progressive healing as demonstrated by clean, dry, absent edema and intact episiotomy site.

Risk For Ineffective Coping

R/T mood alteration and pain

NOC:

The pt will cope with mood lacerations, by verbalization of positive statements about newborn and participation in newborn care

NIC:

  1. Provide a supportive, nurturing environment and encourage the mother to vent her feelings and frustrations to relieve anxiety
  2. Encourage pt to travel up to the NICU to spend time with the newborn
  3. Offer praise and reinforcement of positive mother-infant interactions to enhance self-confidence in care

Evaluation:

Goal met

Quote

"Even though it hurts to walk I feel that it is worth it to go and see the baby."

Cont POC

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Allie0188

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uRNmyway

uRNmyway, ASN, RN

1 Article; 1,080 Posts

Specializes in Med-Surg.

That all looks good to me. I might add some more interventions, I know my teachers wanted a lot more than what you listed.

Do you have to write one more physical or psychosocial?

Which way are you leaning? What do you see as a problem or potential issue? If you can give something to work with, it's easier to help you phrase it.

Allie0188

Allie0188

1 Article; 4 Posts

She needed to ambulate. But the only thing keeping her from that was pain. I was not sure if impaired physical mobility was appropriate. Also we only have to have three interventions minimum.

sadiemae1123

sadiemae1123

214 Posts

Has 16 years experience.

With a 3rd degree tear she's at risk for constipation, you might add that. There's also risk for impaired parenting if the baby is in the NICU.

uRNmyway

uRNmyway, ASN, RN

1 Article; 1,080 Posts

Specializes in Med-Surg.

I think you came close to this, but along with your skin integrity issues, you have risk for infection. That might be another way to go. I agree with the role problems (parenting). That's where my mind went right away.

Allie0188

Allie0188

1 Article; 4 Posts

What Would your interventions be for impaired parenting with the baby in the NICU

uRNmyway

uRNmyway, ASN, RN

1 Article; 1,080 Posts

Specializes in Med-Surg.

Well, would kind of depend on whether the NICU is in the same hospital. Again, anything to offer? I'm glad to help, but don't want to do your homework for you!

Esme12

Esme12, ASN, BSN, RN

4 Articles; 20,908 Posts

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma. Has 43 years experience.

Think....you just had a baby but it has to be in the ICU for babies....how will that affect how you care and bond with your baby? How does it change what you can do for your baby? What is "wrong" with the newborn that may impact the ongoing care of this infant when they get home?

How can you as the nurse help the Mom?

Allie0188

Allie0188

1 Article; 4 Posts

Risk for impaired parenting r/t baby in the NICU AEB pt states " I just don't feel like a mom yet."

NOC: pt will verbalize one positive statement about parenting by end of shift.

NIC: 1) Explain to pt that babies time in the NICU is limited to encourage pts outlook

2) Encourage pt to go and see baby as much as physically able to establish bonding

3) ...................

RunBabyRN

RunBabyRN

3,677 Posts

Specializes in L&D, infusion, urology. Has 2 years experience.

How is she COPING with the baby in the NICU? It's not just that it interrupts the parenting process. How is she handling it emotionally, especially if she can't breastfeed?

Esme12

Esme12, ASN, BSN, RN

4 Articles; 20,908 Posts

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma. Has 43 years experience.
Allie0188 said:
Risk for impaired parenting r/t baby in the NICU AEB pt states " I just don't feel like a mom yet."

NOC: pt will verbalize one positive statement about parenting by end of shift.

NIC: 1) Explain to pt that babies time in the NICU is limited to encourage pts outlook

2) Encourage pt to go and see baby as much as physically able to establish bonding

3) ...................

IMPAIRED PARENTING

Related to: (Specify: unmet social and emotional maturation needs of parental figures, ineffective role modeling, lack of knowledge, situational crisis or incident.)

Defining Characteristics: (Specify: lack of parental attachment behaviors, verbalization of resentment toward child and of role inadequacy, inattention to needs of child, noncompliance with health practices and medical care, inappropriate discipline practices, frequent accidents and illness of child, growth and development lag in child, history of child abuse or abandonment, multiple caretakers without regard for needs of child, evidence

of physical and psychological trauma, actual abandonment of child.)

Goal: Parents will exhibit improved parenting skills by (date/time to evaluate).

Outcome Criteria

Demonstration of appropriate parenting behaviors.

Maintenance of safe environment for child.

Establishment of positive relationship with child and realistic expectations for self and child.

Acceptance of support for achievement of desirable parenting skills.

How best would you help Mom what does NANDA say?

NicuGal

NicuGal, MSN, RN

2,743 Posts

Specializes in NICU, PICU, PACU. Has 30 years experience.

I would not put that the baby's time in NICU is limited, you don't know that. Impaired coping mechanism is a big one. Depending on the baby's problem, there can be a problem with bonding. Also, is she breastfeeding? That helps some moms cope as supplying MBM may be the only thing they feel they can do for their baby at that time.

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