Published Jul 25, 2009
This is my first postpartum careplan and I usually rock at careplans, but for whatever reason this one is tripping me up everywhere.
She had a cesarean section, this is her 4th child. Mom & child are healthy. Problem - she cannot breastfeed. She said she couldn't with her previous children and did not elaborate (or seem comfortable with me prying) on why, other than saying "I just can't breastfeed. It doesn't work."
So...how does this dx sound? Ineffective breastfeeding r/t maternal breast anomaly and previous history of breastfeeding failure AEB client self-report.
For some reason the AEB doesn't sound right to me. But since she wouldn't elaborate on why she can't, or maybe she doesn't know why, but I can't really assume why?? So I thought client self-report.
Oh - can I put a client quotation in a dx? Cause I could do AEB client self-report of "I just can't breastfeed."
What do you think???? Any help would be appreciated!! My clinic instructor is an NP and has her doctorate so I want to get this right! She's a bit of a nit-picker.
Daytonite, BSN, RN
So, let me understand this. . .she is not breastfeeding. . .at all, right? If that is the case, then you can't use Ineffective breastfeeding r/t maternal breast anomaly and previous history of breastfeeding failure AEB client self-report. That is a misdiagnosis. A breast anomaly is something physically wrong with the shape of the breast. Ineffective breastfeeding is only used when the mother is breastfeeding, but is having problems with it. The definition of this diagnosis is dissatisfaction or difficulty a mother, infant, or child experiences with the breastfeeding process. If she's not even breastfeeding and this baby is being fed by means other than the breast then you can't use this diagnosis. Breastfeeding is very fatiguing and painful for some mothers which is sometimes why they don't want to do it after their first experience.
Ok, that makes sense. Thank you very much!! It's under nutritional/metabolic pattern, so I will go with impaired skin integrity r/t cesarean incision.
Speaking of which...would I want to go with impaired SKIN or impaired TISSUE integrity in regard to the incision?? I'm thinking tissue?
Impaired Tissue Integity. Read the definition and you will see the difference between the two.
DAYTONITE...i need your help!!! i read a *ton* of your other posts but a lot of the links you had were either outdated (not there anymore), you had to be a subscriber, or it wasn't what i needed.
I have a headache and I'm ready to cry and pull my hair out...this postpartum care plan is slowly killing me.
We need to have a thorough HEAD-TO-TOE assessment of the mom - everything imaginable that can be assessed in a human being. However, for the life of me, I cannot find anywhere - amongst the many medical books at my house or on the internet or this site - that has a thorough head-to-toe assessment for a postpartum woman (typical changes in a postpartum woman head-to-toe).
I know you must have the answer. Please, please, please...I would appreciate it more than you can imagine if you can point me in the direction of a thorough outline of physical & physiologic changes in the postpartum woman. I can't even find it in my OB text!!
Thank you soooooooooooooooooooooooo much!!
this should help. . .i do not have a head-to-toe assessment, but i do have an assessment data base from maternal/newborn plans of care: guidelines for individual care, 3rd edition, by marilynn e. doenges and mary frances moorhouse based roughly on gordon's functional health needs of the normal and abnormal data that you are likely to find for a c-section patient following a c-section. you can pull the information apart and re-classify by head-to-toe. it is on page 331 of the book:
maternal complications of c-section (this information is needed for care planning)
Has anyone ever told you how fantastic you are?!? Thank you!! This is a lot of help. I think I was just looking too much into it last night; i have a tendency to over-analyze everything. Once I simplified things and just thought of the obvious, it all became much easier.
Once again, thank you for your help. It is MUCH appreciated =) Bless you!
I have had 30+ years as a nurse to figure this stuff out. Believe me, I was not a stellar student.
There is a great deal of logic and reason in all of this. What you need to do is look at this assessment data (it includes history and physical exam information) and see how it is similar as well as different from, lets say, a regular old surgical patient that you might have had a semester or two ago. A C-section is a surgery. Some things are similar to what you assessed and looked for in surgical patients and you can build on that knowledge. Other stuff is specific to an OB patient and you need to note exactly what it is and think about why that is important. Think about what the OB patient experiences and what the presence of a fetus has on the mother's body and that is going to explain why that abnormal assessment data came to be. Make those connections so it all sticks in your mind because it is very logical and reasonable that it has happened and came into existence.
Now, do you think you can assess for a mother who has delivered vaginally? A baby coming through the birth canal puts a lot of pressure and trauma on the surrounding parts of the mother's body. It is not quite correct when people say that the birthing process is "normal". Labor and delivery is like getting beat up internally and no one being able to see it from the outside. I ask because you will probably need to know this kind of information for your test(s) at school and for the NCLEX. I am trying to help you do some critical thinking here.
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