Patient history
JM is a 28-year old Hispanic 38 weeks pregnant, admitted into the maternity unit. This is her first pregnancy and seems calm and relaxed, except for the normal anxiety of this stage of pregnancy. Her obstetric history; G1, T1, P1, A0, L0
1st stage
Subjective: The patient verbalizes that she is afraid of the delivery process because it is her first time into the maternity ward. Patient verbalizes extreme abdominal pains.
Objective: Patient exhibits, facial tension, poor eye contact and grimacing observed. Patient appears anxious, pre-occupied as well as decreased perceptual field. Vital signs (T-370 C, BP- 138/74 mmHg, RR-14 cpm, PR-72 bpm).
Interventions
Pursuant to the above assessment findings, the following interventions are necessary;
Monitoring of vital signs
Providing comfort to the patient through providing encouragement, educating the patient on proper breathing techniques as well as encourage lying of different positions
Encourage the patient to void and palpate for bladder distention, update the patient on the labor and delivery process and need be, administer analgesia
Rationale
Monitoring of vital signs is pretty essential for the purposes of identifying abnormalities that may interfere with the normal labor and delivery process. Providing comfort is important for the purposes of forming a therapeutic relationship between the patient and the care team as well as overcoming of the anxiety and fear associated with the process (Hodnett et al., 2013). Voiding and pain relief helps in helping to relieve the severity of pain and discomforts during the labor process.
Outcomes
Maintenance or a normal range of vital signs
Eased and reduced patient anxiety and tension
2nd stage
Subjective: Patient was moaning, shouting and verbalized extreme abdominal pain
Objective: Patient was sweating profusely, facial tension/grimacing was observed as well as restlessness
Interventions
Encourage the patient to employ effective breathing technique (panting), stay with the patient to offer comfort and place a cool cloth on her forehead.
Rationale
Effective breathing technique helps in easing tension and discomfort, while encouraging the patient helps in overcoming fear. Placing a cool clot on the patient’s fore-head helps in easing the tension and building a therapeutic relationship (Hodnett et al., 2013).
Outcomes
Patient demonstrates reduced tension
Patient demonstrates trust and friendship with the care team
3rd stage-delivery of the placenta
The placenta was successfully delivered 30 minutes after birth. Interventions pursued to aid in preventing excessive loss of blood and to speed up the placenta delivery process included the administration of an IM oxytoxic drug to help in uterine contraction and hence aid in delivering the placenta. Controlled Cord Traction (CCT) was used to prevent the placenta and the membranes from being pushed downwards while pulling the cord (Hockenberry & Wilson, 2014). In general the patient was encouraged to be relaxed and various relaxation techniques were used including a fundal massage on the abdomen, not only to relax the mother but also to prevent bleeding and the formation of clots (Hockenberry & Wilson, 2014).
New born
Newborn assessments: Various assessments for the newborn immediately after birth include the Apgar test (pulse rate, activity, grimace, appearance and respiration) as well as physical examination, notably on vital signs, weight, height and head circumference as well as cord care (Hockenberry & Wilson, 2014). These examinations are purposely intended to identify abnormalities and hence allow a proactive intervention to arrest the severity or magnitude of an abnormality (Hockenberry & Wilson, 2014).
Newborn care: Apart from cord care and the newborn assessment, immediate care for the new born just after delivery is necessary as a way of fostering comfort and a quick adjustment to the new environment. These care modalities include; drying the babe from the amniotic fluid and helping to keep warm (Hockenberry & Wilson, 2014). The newborn is usually wet with amniotic fluid and this may subject the newborn to cold. As such, drying, offering warm clothing and placing the baby on the mother’s arms helps in fostering warmth and fosters mother-infant interaction (Moore et al., 2012).
Lying-in and postpartum complications
There were no serious complications that occurred during the postpartum period/ lying-in period except for anxiety, signs of depression and pains (perineal) (Hockenberry & Wilson, 2014). However, during the course of bed rest, these symptoms cleared, except for perineal pain which required a more long-term approach in terms of using pain relievers and cushions when sitting down for at least one week.
Patient discharge instructions
The patient discharge instructions essentially focus on helping the patient regain a formal life routine after the birth period as well as managing and preventing conditions that may compromise the quality of post-partum life. As such, the discharge instructions focus on the following areas:
First day at home
The first day at home would be more stressful than usual since one is expected to take self-care-both to the new born and self and this would be an anxious day, hence underscoring the importance of seeking assistance from a family member, house help or friend (Alden et al., 2013).
Pain
It is recommended that for pains, especially abdominal, the use of mild pain relievers such as ibuprofen.
Physical activity
Gradually resume physical activity within two weeks of the postpartum period. During the first two weeks, avoid strenuous physical activity and with time, start allocating more time to physical activities and at the same time, considering adequate resting during the day (Alden et al., 2013).
Breast feeding
Wash and dry the breast properly before and after breast-feeding
If nipples get dry, you may apply milk after breast-feeding the babe and allow air drying
In the event of engorgement apply express milk and warm packs (Haran et al., 2014).
Care of the episiotomy
While the stitches will dissolve in about 2-3 weeks, it is important to consider agents such as Lanacaine and Tucks to help relieve discomfort and foster the dissolving (Haran et al., 2014). Sitz bath can also go a long way in relieving pain.
Diet and nutrition
It is important to eat a healthy balanced diet as well as plenty of fluids as well as continuing the prenatal iron and vitamin supplementation.
Postpartum appointments
Call the obstetrician to plan for routine postpartum assessments after every 6 weeks until the postpartum period is over. This is essential for the purposes of identifying problems early enough and pursues corrective or proactive measures.
Baby
Ensure effective and consistent postnatal care including immunizations and routine check-ups.
Emotional
Emotional problems are pretty common in mothers after birth due to added responsibilities and emotional stress that come with the labor and delivery process (Haran et al., 2014). As such, as part of postpartum instruction, it is important to stay alert to any signs of stress-something that may be manifested through anger, headaches and withdrawal. In case of these symptoms, it is important to seek social and emotional support from family members, friends or even a professional counselor.
Sexual activity
The patient can resume normal sex life after 4-6 weeks after delivery, although there is an insistence on the use of condom, for the purposes of health and safety for the mother and the infant (Haran et al., 2014).
References
Alden, K. R., Lowdermilk, D. L., Cashion, M. C., & Perry, S. E. (2013).Maternity and women's health care. Elsevier Health Sciences.
Haran, C., Van Driel, M., Mitchell, B. L., & Brodribb, W. E. (2014). Clinical guidelines for postpartum women and infants in primary care–a systematic review. BMC pregnancy and childbirth, 14(1), 1.
Hockenberry, M. J., & Wilson, D. (2014). Wong's nursing care of infants and children. Elsevier Health Sciences.
Hodnett, E. D., Gates, S., Hofmeyr, G. J., & Sakala, C. (2013). Continuous support for women during childbirth. The Cochrane Library.
Moore, E. R., Anderson, G. C., Bergman, N., & Dowswell, T. (2012). Early skin-to-skin contact for mothers and their healthy newborn infants. Cochrane Database Syst Rev, 5(3).
