For new mothers, the postpartum period comes with significant changes as they adapt to their new role and heal from giving birth. Potential mental health challenges exist as hormonal changes and other factors cause postpartum depression in 6.5% to 20% of women.
Many new mothers also experience anxiety around bonding with their babies or breastfeeding. One study reported that up to 50% of mothers stop breastfeeding their infants due to insufficient milk supply.
Complications can also appear following birth, resulting in severe health concerns and even deaths. The number of maternal deaths sharply increased to 1,178 per 100,000 live births in 2021 due to COVID-19, prompting birth centers to adopt new safety measures.
As a nurse, you can have a significant impact during the postpartum period. Frequent interactions with the new mother put you in a unique position to listen to her concerns and guide her as she enters a new chapter in her life.
Your role also encompasses watching out for symptoms that could indicate physical or psychological complications to address these issues early and improve the outcome with a relevant treatment plan.
As a nurse, you can also make a difference by developing a personalized care plan that reflects each patient's unique health history. When creating a care plan and delivering holistic care, one factor to consider is any existing health disparities in outcomes related to ethnicities and social backgrounds.
1. Impaired Parenting Care Plan
Unfortunately, some parents aren't ready to provide their babies a safe and healthy environment. As a nurse, you're usually one of the first healthcare professionals who are in a position to notice difficulties with bonding.
Nursing Diagnosis
Impaired parenting
Potentially Related To
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A history of childhood abuse
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Unwanted pregnancy
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Socioeconomic challenges
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Lack of maturity
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Knowledge deficit
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Physical illness in the mother or child
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Psychological conditions of the parents
Evidenced By
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Dissociation, rejection, or aggressive behavior toward the baby
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Lack of caretaking skills
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Voicing inability to care for the child
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Inappropriate childcare arrangements or unsafe home environment
Desired Outcomes
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Parent will gain access to resources to develop the right skills and build a support network.
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Parent will learn about parenting styles and healthy bonding.
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Parent will learn about options like guardianship or adoption.
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Parent will initiate measures to create a safe and nurturing environment.
Impaired Parenting Care Plan Assessment
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Communicate with the patient: Use active listening to understand the parents' frustrations and concerns better.
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Identify challenges: Ask about barriers that hinder providing an environment where the child can thrive.
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Consider psychological health: Assess to which extent depression and other health challenges play a part in feelings of inadequacy as a parent.
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Put the child first: Assess the child's safety and consider whether to contact social services.
Impaired Parenting Care Plan Interventions
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Teach and demonstrate: Set an example by showing how to interact and bond with the infant. Educate the parents on normal development and typical behaviors to expect from their child at different milestones to boost their confidence.
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Communication is vital: Encourage open communication and connect parents with relevant resources to address socioeconomic challenges. Address the stigma linked to parenting expectations and asking for help.
2. Readiness for Enhanced Parenting Care Plan
Becoming a good parent takes time. Readiness for enhanced parenting refers to the will to become a better parent.
The average age at which women have their first child is 23 years old, meaning that many new mothers face economic and social challenges on their way to becoming successful parents.
Nursing Diagnosis
Readiness for enhanced parenting
Potentially Related To
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Single parenthood
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Socioeconomic challenges
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Lack of support network
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Physical or psychological health challenges
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Knowledge deficit
Evidenced By
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Anxiety regarding one's ability to care for the child
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Lack of knowledge about parenting
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Lack of concrete plans regarding supporting and caring for the child
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Verbalizing inability to care for the child
Desired Outcomes
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Parents verbalize necessary changes to create a healthy environment.
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Parents learn about resources they can use.
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Parents establish a concrete plan to reach personal or professional goals to better care for the child.
Readiness for Enhanced Parenting Care Plan Assessment
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Assess knowledge: Communicate with the parents to better understand how much they know about parenting skills, normal newborn behaviors, and safety measures they should take, such as how to ensure safe infant sleep.
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Discuss the mother's feelings: Be a compassionate listener. Ask how the mother or father feels about their new role and encourage them to voice anxiety and other concerns.
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Teach about the importance of outside help: Find out how much the parents know about the community resources available to them. Ask about other support systems, such as extended family and friends. Inquire if they feel comfortable asking others for help.
Readiness for Enhanced Parenting Interventions
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Teach caretaking skills: Demonstrate how to care for the baby, including feeding, holding, or changing diapers. Ask the parents to provide a return demonstration to assess their knowledge and build comfort with each task. Teach the new mother to recognize feeding cues and other signs the newborn uses to communicate.
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Help with planning for the future: Encourage open communication and questions to address anxiety. Discuss the future with the parents and encourage them to formulate a concrete plan, including community classes or resources, to keep improving their parenting skills.
3. Ineffective Breastfeeding Care Plan
The CDC reports that breastfeeding exclusively drops significantly over the first six months of life for many infants. While 83.2% of all infants start out receiving some breast milk, by six months, only 24.9% of infants receive breast milk exclusively. One explanation for this decrease in breastfeeding is that families who breastfeed lack the support systems needed to reach long-term breastfeeding goals. This research supports the need for care plan development for families who experience ineffective breastfeeding.
Nursing Diagnosis
Ineffective breastfeeding
Potentially Related To
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Inadequate knowledge about breastfeeding techniques or its importance
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Inadequate support systems
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Ineffective suck-swallow response in the infant
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Maternal breast pain
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Insufficient breast milk production
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Maternal ambivalence to breastfeeding
Evidenced By
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Infant is unable to latch to the breast
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Infant crying or fussing within one hour of breastfeeding
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Inadequate weight gain in the infant
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Sustained weight loss in the infant
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Painful or sore nipples persisting beyond the first week of breastfeeding
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Perceived insufficient milk production
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Insufficient emptying of each breast during a breastfeeding session
Desired Outcomes
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Patient will achieve effective breastfeeding with adequate milk production.
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Patient demonstrates proper breastfeeding techniques, including positioning and latching.
Ineffective Breastfeeding Care Plan Assessment
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Assess risks for ineffective breastfeeding: Assess for modifiable risk factors to provide adequate information and support to the mother to develop effective breastfeeding techniques.
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Assess patient's breastfeeding knowledge: Assess the patient's knowledge, understanding, and beliefs about breastfeeding to correct any inaccuracies or myths.
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Perform a breast assessment: Assess for barriers such as nipple soreness, breast engorgement, history of breast surgery, or poor enlargement of the breasts during pregnancy.
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Assess infant's sucking reflex: It's critical to begin interventions for infant sucking issues early to correct any problems.
Ineffective Breastfeeding Care Plan Interventions
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Educate the mother about breastfeeding: Provide education regarding breastfeeding techniques and encourage questions. Make sure the mother understands producing milk and getting an infant to latch on properly can take time.
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Establish a breastfeeding plan: Refer the mother to a lactation consultant. You can also present bottle feeding as an alternative and assist with proper breastfeeding positioning.
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Encourage skin-to-skin contact immediately after delivery. This technique promotes breastfeeding initiation and improves the mother's milk supply.
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Promote comfort and relaxation during breastfeeding. Being uncomfortable can lead to poor let-down reflexes and the mother stopping breastfeeding too soon.
4. Infection Care Plan
Infections are a reasonably common nursing diagnosis for postpartum women since this complication affects 5% to 7% of women who give birth. It's a severe complication that significantly increases the risk of maternal death and can cause additional anxiety for the new mother.
Nursing Diagnosis
Infection care
Potentially Related To
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Trauma sustained during childbirth
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Retained placental fragments (RTF)
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Cesarean section
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Mastitis
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Evidenced By
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Pain
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Fever
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Rapid heart rate
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Localized swelling and tenderness
Desired Outcomes
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Patient is without signs or symptoms of infection.
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Vital signs return to normal.
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Infection Care Plan Assessment
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Perform a physical exam: Look for common signs of infection, such as swelling, tenderness, and pain at the site of the infection (breast, perineal area, abdomen). Discuss the patient's symptoms to rule out other possible causes of pain.
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Lab work: Use blood tests to confirm the presence of infection. An elevated white blood cell count will indicate an infection.
Infection Care Plan Interventions
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Seek medical care: Refer the patient to a doctor immediately for further assessment and possible antibiotic therapy.
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Assess Surgical Incisions for signs of infection: Keep the incision site clean and assess for signs of infection, such as odor, redness, swelling, and purulent drainage.
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Educate the patient: Teach the patient the signs and symptoms of infection and when to report them to the nursing staff or their healthcare provider.
5. Risk for Pain Care Plan
A study conducted in Finland found that 83% of women giving birth for the first time used an epidural. While pain management is a crucial goal during labor and delivery, many mothers also need a pain management plan in the weeks that follow.
Nursing Diagnosis
Risk for pain
Potentially Related To
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Multiple births
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Cesarean birth
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Trauma sustained during birth
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Prolonged labor
Evidenced By
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Patient voicing pain or discomfort
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lady partsl tears
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Uterine rupture
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Nerve injury
Desired Outcomes
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Patient reports pain is 4/10 or less within 2 hours of nursing interventions.
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Patient verbalizes an improvement in pain and discomfort.
Risk for Pain Care Plan Assessment
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Identify the patient's risk for pain: Assess the patient's birth experience and potential for painful injuries. Communicate with the labor and delivery team regarding birth trauma or any C-section complications.
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Listen to the patient: Assess the patient's pain levels and self-reported symptoms regularly. Using a 0-10 scale will help you track pain levels.
Risk for Pain Care Plan Interventions
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Administer analgesics as prescribed: Providing analgesics per the physician's order helps control exacerbation of pain. Monitor for side effects and effectiveness of the intervention and report any changes or further needs to the physician.
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Monitor the healing process: Beyond managing pain, this nursing diagnosis for postpartum calls for monitoring the healing process closely to observe for any signs of possible complications, such as infection.
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Utilize distraction to reduce pain: Encourage activities that help distract the mother from the pain while she is not caring for the newborn. Examples include meditation, position changes, or breathing exercises. Provide plenty of support and reassurance since recovering from a physical injury can make parenting difficult.
6. Caregiver Role Strain Care Plan
More than 50% of Americans over 40 find themselves caring for aging parents and children. Welcoming a new addition to the family can be a source of stress that results in caregiver role strain for those who already have obligations.
Nursing Diagnosis
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Caregiver role strain
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Potentially Related To
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Acting as a caregiver to an aging or sick relative
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Acting as a caregiver to multiple children
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A history of burnout
Evidenced By
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Lack of energy
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Feelings of hopelessness
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Neglecting one's needs
Desired Outcomes
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Parent verbalizes strategies to use to improve feelings of burnout or overwhelm.
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Parent demonstrates ability to care for infant without physical or emotional side effects.
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Parent verbalizes hope and confidence in their ability to perform in their new role.
Caregiver Role Strain Care Plan Assessment
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Learn more about the caregiver's situation: Ask the parent about their home situation and other caregiving obligations. Letting new parents open up about their anxieties and concerns can reveal they juggle many roles at home.
Caregiver Role Strain Care Plan Interventions
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Help create realistic expectations: Discuss healthy expectations for a new parent and encourage the patient to set boundaries if they struggle with their other roles.
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Provide support: Demonstrate proper infant caregiving skills to help the patient feel more confident about their ability to care for their newborn.
7. Fatigue Care Plan
Research shows that mothers of children under the age of two experience higher levels of fatigue, independently from the amount of sleep they get. Fatigue typically includes a lack of motivation, frequent drowsiness, and low energy levels.
Nursing Diagnosis
Fatigue
Potentially Related To
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An underlying health problem
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Undiagnosed postpartum depression
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A history of fatigue or burnout
Evidenced By
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Feelings of tiredness
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Lack of energy
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Change in mood
Desired Outcomes
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Patient verbalizes adequate energy levels.
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Patient utilizes tools and resources to prevent fatigue as they settle into their role as a parent.
Fatigue Care Plan Assessment
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Ask about sleep and energy: Identify new mothers at risk for fatigue by asking about their sleep schedule and overall energy levels.
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Identify underlying causes: Assess vital signs and lab values to rule out physical causes of reported symptoms. Encourage open communication with the patient to identify potential signs of postpartum depression.
Fatigue Care Plan Interventions
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Provide assistance: Help the patient perform tasks as needed, including caring for the newborn.
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Treat underlying causes: Treat abnormal lab values or let the patient rest to recover after giving birth.
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Educate the patient: Provide information about diet, exercise, or sleep hygiene to help the patient manage fatigue in the future.
8. Self-Esteem, Situational Low Care Plan
Research shows that as many as 23% of teen girls suffer from low self-esteem. For many women, these feelings persist into adulthood and can lead to a severe situational low during the transition to parenthood.
Nursing Diagnosis
Self-esteem, situational low
Potentially Related To
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Difficult childhood
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Disapproval from relatives regarding the pregnancy
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A history of depression and low self-esteem
Evidenced By
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Being overly critical of oneself
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Focusing on negative things
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Withdrawing from activities they once enjoyed
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Decreased desire to care for the newborn
Desired Outcomes
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Patient verbalizes their understanding of the self-esteem issues.
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Patient verbalizes feeling more confident about fulfilling their role as a parent.
Self-Esteem, Situational Low Care Plan Assessment
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Assess the patient's mental state: Ask questions and encourage open communication to identify negative feelings. Listen for statements that reflect low self-esteem and feelings of doubt or hopelessness.
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Identify whether negative feelings affect the patient's ability to care for the child: Ask the patient if they are experiencing difficulty bonding or if they lack confidence in their ability to provide care to the infant. Observe for evidence of these feelings, such as not soothing the infant when it cries.
Self-Esteem, Situational Low Care Plan Interventions
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Focus on the positive: Help the patient reframe the situation by highlighting their achievements. Consider asking the physician for a referral to a counselor or psychologist if ongoing support is needed.
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Educate the patient: Discuss the adverse effects of deprecating statements. Encourage the patient to seek help to deal with their self-esteem issues.
9. Deficient Fluid Volume Care Plan
Postpartum hemorrhage, or an excessive loss of blood when giving birth, is a condition that affects 14 million women globally each year. Excessive blood loss can result in a deficient fluid volume diagnosis, a condition where the patient loses water and electrolytes.
Nursing Diagnosis
Deficient fluid volume
Potentially Related To
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Uterine atony
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Postpartum hemorrhage
Evidenced By
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Blood loss of 500ml or more
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Hypotension
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Weakness
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Dehydration
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Changes in mental status
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Tachycardia
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Decreased urine output
Desired Outcomes
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Patient maintains a blood pressure above 90/60 mm Hg.
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Patient's hemoglobin levels are within normal limits.
Deficient Fluid Volume Care Plan Assessment
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Monitor vital signs: Postnatal hemorrhage is a leading cause of maternal death. Monitor for signs of hypotension, confusion, faintness, weakness, and tachycardia.
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Identify signs of dehydration: Assess the patient's degree of dehydration by looking for signs like urine concentration or loss of skin elasticity.
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Assess the uterus: If there are signs the patient is bleeding, a thorough assessment of the uterus must be completed. Assess for a "boggy" or soft uterus, which can indicate it isn't contracting after the birth of the infant.
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Monitor lochia: Bleeding after delivery is expected. However, the amount of bleeding should decrease after a few hours and should not contain large clots. Watch closely for serious bleeding beyond and extended bleeding and report to the physician immediately should there be concerns.
Deficient Fluid Volume Care Plan Interventions
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Manage postpartum bleeding: Use blood-absorbing products, uterine massage, and uterotonic agents to stop the bleeding.
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Increase fluid intake: Drinking more fluid may be sufficient in mild cases, but administering intravenous hydration is a common treatment for this nursing diagnosis for postpartum women.
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Replace electrolytes: Follow electrolyte replacement protocols and administer potassium and phosphorus replacement products if ordered.
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Continue monitoring vitals: Monitor the patient's vitals until they return to normal. Report any significant changes or concerning values to the physician.
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Maintain bedrest. Encourage bed rest to prevent falls, dizziness, and orthostatic hypotension. If not contraindicated, consider elevating the patient's legs to promote venous return.
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Administer blood products. If the blood loss requires blood products, administer them per the facility's protocol.
10. Ineffective Tissue Perfusion Care Plan
Ineffective tissue perfusion is a potential complication that stems from postpartum hemorrhage. In some cases, severe blood loss results in a lack of oxygenated blood flow. Tissues and organs can die.
Nursing Diagnosis
Ineffective tissue perfusion
Potentially Related To
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Postpartum hemorrhage
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Low hemoglobin
Evidenced By
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Irregular heart rhythm
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Altered respiratory rate
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Abnormal arterial blood gasses
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Nausea
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Vomiting
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High or low blood pressure
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Elevated BUN/creatinine
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Decreased urine output
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Altered mental state
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Restlessness
Desired Outcomes
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Patient will maintain cardiopulmonary perfusion as evidenced by normal heart rate and rhythm, and the absence of shortness of breath.
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Patient will maintain adequate peripheral perfusion as evidenced by warm skin. temperature, intact skin, strong pedal pulses, and no signs of edema.
Ineffective Tissue Perfusion Care Plan Assessment
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Monitor vitals closely: Look for changes in heart rate and rhythm, and respirations.
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Assess the severity of the situation: Lab work can provide insights into perfusion issues. Compare results over time to assess for changes.
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Obtain a complete health history: Ask the patient or their family member if they have a history of conditions that affect perfusion. This might include having a history of myocardial infarction, congestive heart failure, blood clots, vascular diseases, diabetes, or organ failure.
Ineffective Tissue Perfusion Care Plan Interventions
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Manage symptoms: Symptom management becomes a primary nursing action. Conduct frequent and thorough assessments to identify and report any significant changes in the patient's condition.
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Improve blood flow: Administer vasodilators, if ordered, to open blood vessels and improve blood flow.
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Keep monitoring vitals: Watch vitals closely for any changes. Ineffective tissue perfusion can result in a heart attack or organ failure.
11. Imbalance in Mood and Behavior Care Plan
An imbalance in mood and behavior can occur during the postpartum period. The pressure of assuming a new role can cause mood changes, but shifting hormonal levels and other physical symptoms can exacerbate these changes.
Nursing Diagnosis
Imbalance in mood and behavior
Potentially Related To
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Pain
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Undiagnosed postpartum depression
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Feelings of anxiety
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Underlying mood disorder
Evidenced By
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Change in mood
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Withdrawal
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Extreme fatigue
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Inability to stop crying
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Increased anxiety
Desired Outcomes
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Patient returns to a stable mental state.
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Patient has a clear path forward for managing future mood changes.
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Patient recognizes the need for counseling and attends per the counselor's recommendations.
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Patient engages in social activities.
Imbalance in Mood and Behavior Care Plan Assessment
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Rule out physical issues: Pain and fatigue can cause highs and lows. Rule out a postpartum hemorrhage by monitoring blood pressure and other vitals. An increase in body temperature beyond the third day after giving birth can indicate an infection.
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Gather more information: Ask the patient if they have a history of anxiety, depression, or mood disorders before having the infant.
Imbalance in Mood and Behavior Care Plan Interventions
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Educate the patient: Educate the patient about hormonal changes and other postpartum changes to make these symptoms easier to navigate.
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Manage physical symptoms: Keep the patient comfortable by alleviating pain and addressing other physical symptoms.
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Provide support: Offer plenty of reassurance by modeling good caretaking behavior and encouraging the patient to bond with the infant.
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Connect the patient to appropriate resources: Discuss mental health and encourage the patient to seek help from their support network or community resources to treat underlying mood disorders.
FAQ
Read on to learn more about common postpartum diagnoses.
What are normal postpartum symptoms?
It's normal for women to experience lady partsl discharge, incontinence, and changes in bowel movements after giving birth. Hormonal changes can lead to mood changes, breast tenderness, and other symptoms.
What are three nursing diagnoses related to postpartum hemorrhage?
Three other nursing diagnoses you might use for a patient with postpartum hemorrhage include deficient fluid volume, risk for imbalanced fluid volume, and ineffective tissue perfusion.
Which factors put a woman at risk of experiencing postpartum complications?
A pre-existing health condition increases a new mother's risk of experiencing complications. Factors like age, weight, ethnicity and socioeconomic status can also play a role.
Additional Readings and Resources
Learn more about postpartum diagnoses and nursing plans with these resources:
References
