Problem etiology symptoms nursing diagnosis help

[brooklyn2448]

Hi, so I am a nursing student and have began my OB rotation. I am trying to understand these new care studies we have to do. Where you start with a problem to get to your nursing diagnosis. I was on a labor and delivery unit. I cared for a 35 year old F, 39 weeks gestation, GBS +. it was decided to induce her labor. She came in the day before I had her. The doctor ruptured her membranes at 2200, she was given a dose of Cytotec to ripen cervix at midnight and had her first dose of penicillin around that time, and began pitocin at 0400. She started on low dose of pit and slow increase until she was at 16units/hr. I came in at 0700 for my clinical and she was dilated 1-2cm, 50% effaced pit was at 12 units. She was pretty restless. We went up to 16 units and the nurse rechecked her dilation and eff 4-5, 80%. She got another dose of penicillin. She was ready for an epidural at this time so the nurse increased rate of LR and called doc for epidural. She rested better afterwards and had a foley inserted. around noon she was 9-10 cm 100% eff. She had the baby (9lbs 2 oz), we monitored her for a few hours before she went to postpartum.

As far as nursing diagnosis goes I feel like risk of infection or bleeding could be useful, but my teacher wants a problem/issue to start with. She would not let me use induction of labor because it is too broad. She said I could use AROM. I am open for suggestions. I am having trouble connecting the dots to get from there to my nursing diagnosis. Questions to help get me there are what are you on alert for, what interventions should be used.

I am so lost. Maybe I should do one for the baby instead? Help and thank you!

[llg, PhD, RN]

Was the woman in any discomfort? Were you and the nurses doing anything to help her comfort level? That's one possible active problem to start with.

[brooklyn2448]

When I first got there the only discomfort she had was when the Penicillin was running. She said it hurt and burn. The nurse diluted it with LR and provided her with ice to place over iv site. When the nurse checked her dilation and EFF a short while later she was beginning to have discomfort from labor contractions. She asked for epidural and afterwards we repositioned her so she could rest.

She also was very restless when I first arrived. She did a lot of standing and sitting up in bed. Thanks for the response.

[DannyBoy8, RN]

Look for research on 'early arom'.

[BSNbound21, BSN, RN]

Would GBS+ not be an issue for a risk for infection diagnosis? Granted the risk for infection is w/the newborn not the mother. You could focus on the pain/discomfort of labor as an issue and what nursing interventions assisted to remediate that. You could focus on the foley catheter (risk for infection/impaired urinary elimination) or go the potential hemorrhage route. I'm a nursing student also; just trying to throw some ideas out. Good luck!

[brooklyn2448]

GBS+ was another issue I was thinking about. If I do that it all has to be related to the baby. The nursing diagnosis and interventions are not the hard part. It is getting to that. I wrote down what I was thinking. Any feedback are welcome ? Questions that I have to answer include:

What are you alert for today?

What assessments are needed?

What are complications/risks?

What interventions were used?

Nursing diagnosis: PES

For GBS we would be alert for: Jaundice, apnea, respiratory depression, diarrhea, hypoglycemia, lethargy, seizures, abnormal labs (wbc,???),

Assess: VS, labs, urine output (foul odor), bowel sounds and stool, body temperature, lung sounds, breathing patterns, blood sugar, skin color, color and consistency of sputum, seizures, vomiting, jitteriness

Complications/Risks: Sepsis, pneumonia, meningitis

Interventions: Penicillin in mom

Nursing diagnosis: Risk for infection r/t GBS+ MOM