Postpartum careplan help!!!

[savage2121]

I just started my OB rotation and absolutely love it to death... I am having a heck of a time figuring out NANDAs to use on my patient. I need to come up with 3 Nandas for the mother and 3 for the infant.

My patient is a 23 year old mother to a 14 month old little girl (lady partsl delivery). She just gave birth to another little girl (lady partsl delivery - has some excess bleeding afterwards that required 1000mcg of Cytotec). Mom also had a small laceration in the birth canal that required 2 stitches.

So far im going to use: (For Mom)

1. Acute pain related to tissue edema secondary to recent lady partsl delivery as evidence by reports of cramping, perineal discomfort, and hip pain.

2. Axiety (Im trying to find a way to state that she has anxiety about her role as a mother of two young children).

And I cant think of a 3rd.

FOR THE BABY.....

1. Risk for imbalanced body temperature secondary to incapability of compensating for environmental exposures.

I cannot think of other that would be good. The baby has good overall health with apgars of 9,9. She had a small amount of facial bruising from a fast delivery.

Any help would be greatly appreciated.. Thank you thank you..

Melanie Johnson

[Daytonite, BSN, RN]

nursing diagnoses are always based upon abnormal assessment data.

for the mother. . .

some of the mother's assessment was:

• had excess bleeding after delivery
  
• a small laceration that required 2 stitches
  

you decided she had problems of acute pain and anxiety based upon assessment data of

• cramping
  
• perineal discomfort
  
• hip pain
  
• anxiety about her role as a mother of two young children
  

question. . .where in your care plan are you addressing the laceration repair and the fluid deficit from the hemorrhage and probably the dehydration due to the length of time in labor? those are two nursing problems (nursing diagnoses) that i think are much more important than acute pain or anxiety that need to be addressed. i guarantee that the nursing staff is addressing their care toward that laceration and her fluid status and perhaps her pain, but her anxiety is not on the top of their problem list. and, a risk for infection (risk for infection) of the laceration is a concern and will also need to be addressed with discharge teaching. if this mother is breastfeeding, there are 3 nursing diagnoses for breastfeeding including one for effective breastfeeding. also, women after labor, although they are very elated, are also very fatigued. fatigue (fatigue) is a nursing diagnosis that is appropriate to use in many cases.

for the baby. . .

think about what you know about the assessment findings of a normal newborn compared to an adult. what's different? for one thing newborns can't regulate their body temperature which is why we don't leave them exposed to the room atmosphere for very long with just a diaper covering them. it's not a risk, it's a real problem. that's ineffective thermoregulation r/t immature compensation for changes in environmental temperature. some newborns just have a few difficulties with excessive secretions in the respiratory track (the big hint here is that the nurses will keep a bulb syringe nearby the baby) so ineffective airway clearance (ineffective airway clearance) or risk for ineffective airway clearance can be used. they also have a stump from the umbilical cord hanging off their future belly button. do you? are they treating this cord stump? the point of the stump attachment is always at a risk for infection, so you can use risk for infection r/t break in skin integrity at umbilical cord site (risk for infection). is this baby breastfeeding? if so, use effective breastfeeding. and, some babies just don't start feeding well at first by breast or bottle--it happens. these kids are imbalanced nutrition: less than body requirements r/t poor infant feeding behaviors (imbalanced nutrition: less than body requirements).

if the baby is under the bililight for hyperbilirubinemia the nursing diagnosis to use is risk for injury r/t phototherapy (risk for injury).

the underlined blue type are a weblinks to nursing diagnosis pages with nanda information and some goals and nursing interventions.

[savage2121]

Thank you for the extremely helpful information. It's always good to hear someone else's side of things. It helps to open up my eyes to things that i might not have seen before, like the risk for infection due to the umbilical cord. Goofy.. It was right in front of me.. That makes complete sense. Thank you so much..

Melanie Johnson :bowingpur

[Daytonite, BSN, RN]

You are welcome.