Introduction
The purpose of this paper is to develop a comprehensive nursing care plan in relation to a case study. The nursing care plan is a structural framework that is developed by a health care provider for the purpose of ensuring harmonized communication that will eventually result to secure and valuable care for the patient (Doenges, M. E., Moorhouse, M. F., & Murr, A. C., 2005). Maternal health care is a sensitive area of health care provision as it involves handling two lives at once; that of the mother and the unborn child. In this case, developing a maternal care plan requires adequate familiarization with the psychological, social, educational, organizational and biomedical physiological aspects that are relevant to the mother and the unborn child as the direct and indirect recipients of health care respectively (Bindler, R. M., 2007). The Allen/McGill Nursing Model will provide the basis upon which this maternal care plan will be developed. This model takes into account the aspects mentioned above (psychological, social, educational, organizational and biomedical physiological) and uses them as a standard for developing effective nursing care plans (Gottlieb, L. N., Ezer, H., & McGill University, 2001).
Brief Summary of the Case Study
The maternal plan is related to a case study involving Kari M. a seventeen year old currently in her eleventh week of gestation. Kari M. is a grade twelve student and lives with her 25 year-old brother. Her pregnancy has not been well received by her parents at home who were of the opinion that she should not carry a pregnancy to completion. Her brother is a smoker and works on a night shift. To make matters worse, Kari M. does not have a partner creating the possibility of becoming a single mother in the future. Communication between Kari and her parents has broken in recent days after her decision to keep the pregnancy. Under these conditions, Kari has been experiencing a lot of psychological, social and physiological changes. Health complications have not been an issue of concern to her in recent days too. She has experienced nausea and vomiting on a daily basis since she became pregnant. Kari has gradually lost weight due to a combination of fast coming changes within a matter of eleven weeks.
The patient is undergoing teen pregnancy. Aged seventeen, and under the rejection by her parents, her psychological state has been severely affected. She has experienced nausea and vomiting since the first day of her pregnancy. Weight loss has been recorded for the first eleven weeks of gestation. She is in her first pregnancy and has little interpersonal skills to cope with the frequent changes in her body. This has limited the collaborative care expected between the health care provider and the patient during pregnancy. The nausea and vomiting have been persistent, and this condition may affect the mother and the unborn baby. Her mental health has been affected by the family issues. She is experiencing a feeling of guilt, worthlessness, shame, low moods and lack of interest in life. These feelings are tended towards a certain level of depression that could severely affect the pregnancy. Depression levels have been recorded as increasing since the first week of her gestation. She is currently under no medication or plan to manage this issue.
Signs and Symptoms
The patient has reported nausea and vomiting on a daily basis. Though considered a normal occurrence during pregnancy, the day to day vomiting has been recorded as alarming issues. Weight loss has been recorded since her third week of gestation. She looks overworked, and fatigue has been recorded since her first week of gestation. Loss of energy in the body due to the vomiting has been recorded as the cause of weight loss. She has become too choosy in feeding and lost appetite. Her skin color has become pale over the last few weeks. She has experienced excessive levels of dizziness and spends most of her time in bed or indoors. Her mood swings have been extreme considering the hormonal changes and the psychological aspect of her current situation within her family.
She has also reported frequent constipation since the seventh week of her gestation. Her basal body temperature has been recorded above normal since the first week of her pregnancy. Medication techniques have not been effective in controlling this complication. The patient has also reported a severe backache since the fourth week of gestation. Her breasts have become sore and swollen since the third week of pregnancy. She has also reported a higher urinary rate since the seventh week of her pregnancy.
Past Medical and Social History
The patient has had no major health complications in the past. The patient is not a smoker, but lives with her brother who is a smoker. She has never had a blood transfusion nor has she had any serious injuries during her childhood or adolescence. Her medical records indicate that she has received immunization in pneumonia, measles, polio, mumps, tetanus, hepatitis (A & B), Influenza and Rubella within the last ten years. Her last immunization was against tetanus at the age of 14 years.
She has never been diagnosed for diabetes, high blood pressure, mental illness, tuberculosis, pneumonia or any STDs. Her family history does not indicate any severe cases of medical complication. She has frequently used alcohol within the last two years. Her alcohol usage cannot be described as an addiction. She has not used any other drugs apart from alcohol. However, her addiction to coffee is high. She is regarded as a good sportswoman within her learning institution and has participated in several major tournaments representing her school.
Growth and Development
The patient has been brought up in a working class family. She is the last born in her family. Her oldest brother is 25 years of age, currently living with her and working on the night shift in a restaurant. She has been brought up in a middle class suburb of the town. Her educational background suggests she has attended two public schools. Her family income has been enough just to sustain a decent livelihood and cater for her education and that of her brother. She has grown under the tutorage of strict parents. Lack of a partner, especially at an early stage of a relationship when intimacy is a priority has affected her psychological well being. Stress levels are evident both verbally and emotionally. These stress levels are associated with feelings of neglect. Family relations form an important aspect of maternal care. This lack of association between a close associate/partner and the health care provider limits the level of care to be provided.
Family Situation
After her pregnancy, she moved to live with her brother in rental houses within the town suburbs. Her parents have broken contact with her since discovering about her pregnancy and the fact that she went against their preference not to carry a pregnancy to the very end. She does not have a partner. Neglect by family means there is a breaking link as required by the McGill’s model of nursing. The relationship between nurses and the family are important as they offer a learning chance that is crucial in care provision away from the health institution. The expectation is that the mother spends time at home and thus making it important to have well versed family association around them. Above all, it gives the expectant mother a psychological boost.
The patients’ major issue of concern is her deteriorating health. The patient is concerned the current turn of events especially in relation to her family’s approach towards her decision to maintain the pregnancy. Her financial situation is unstable since she is not employed and is completely dependent on her brother. She is also concerned about her education and how she will cope with the situation after pregnancy since she will be responsible for taking care of the child.
Goals
The patient’s short term goal is to recover her health and maintain her pregnancy to the very end. She is not thinking about voluntary termination of the pregnancy as an option. She also hopes to mend a broken relationship with her parents as she thinks that their moral support at this time is crucial to her health and that of her unborn baby. In the long term, she is hoping to complete her education and secure a job that would help her take care of her child.
Nursing Diagnosis
Nursing diagnosis 1: Loss of weight, excessive nausea with vomiting, loss of appetite, imbalanced nutrition and fatigue:
The expected outcome
- Deteriorating health
- Loss of energy in the body
- Pregnancy complications for both mother and the unborn baby
Intervention
- She has been advised to include juicy fruits in her meals and focus her energy and thoughts on her health and that of the unborn child.
- She will also be required to speak to her brother about his smoking habit while in the house.
- She has been placed under orexigenic medication for the next two weeks upon which a review will be done (Gottlieb, L. N., Ezer, H., & McGill University, 2001).
- The patient has been placed on a definite diet plan for the next 6 weeks
Rationale
- Deteriorating health has been occasioned by nausea with vomiting The purpose of assuring the client that this is normal and controllable is to reduce further physical and psychological distress (Ackley, B. J., & Ladwig, G. B., 2010)
- Loss of energy has been occasioned by biophysical and hormonal changes of which the client is not familiar this being her first pregnancy. A diet plan will reverse her current energy loss to normal if strictly followed (Doenges, M. E., Moorhouse, M. F., & Murr, A. C., 2005).
- Orexigenic medication to increase appetite and avert pregnancy complications for both mother and unborn baby provide an assurance for safe pregnancy.
Nursing diagnosis 2: Coping, neglect, fear and anxiety, powerlessness:
The expected outcome
– Ability to make viable decisions concerning options of treatment available
- Increase control of emotions and psychological changes
Intervention
- Increase time spent with the patient
- Offer the patient a chance to learn all possible alternatives of treatment and coping
- Help the patient identify situations under which control is possible such as relaxation procedures and pain control strategies
- Antidepressants and muscle relaxation medication until a review is done (Doenges, M. E., Moorhouse, M. F., & Murr, A. C., 2005).
Rationale:
- More time spent with the patient provides a psychological boost while enabling the patient to learn more about self-care provision
- Learning alternative techniques of treatment places the patient in a position that they can make personal decisions in regard to treatment. This personal decision is the most effective treatment option as long as it is in line with the treatment procedure (Ackley, B. J., & Ladwig, G. B., 2010).
- Application of medical and nonmedical techniques in alleviating the depression and anxiety is crucial in providing psychological and physical relaxation for the benefit of the unborn child and hormonal balances.
Nursing diagnosis 3 - Moral distress and decision conflict:
The expected outcome:
- The patient feels unwanted and worthless as a result of her own decision. She is facing a psychological battle between her conscience and her parents’ decision of which she did not heed. Her financial situation is demanding, and she has no personal means to maintain her own livelihood
- Experiencing ego integrity
- Increased stress levels which could adversely affect hormonal balances
- Depression in the long-term
Intervention:
- The patient has been advised to shed off the guilt tag she has placed on herself and focus on supporting her decision of maintaining a pregnancy
- She has been advised to use her brother as the closet companion for now until her health condition improves
- She will be placed on a weekly counseling program until the end of her pregnancy (London, M. L., Ladewig, P.W., Ball, J.W., Bindler, R.C., Cowen, K.J., 2011).
Rationale:
- Advising the patient that pregnancy is a normal situation will help them cope with the new physical changes in the body as well, as improve her social life once she accepts her new status (Bindler, R. M., 2007)
- Encouraging the patient to accept her brother as her closest relation enables the patient realize the needed to share her feelings, (both physical and psychological) offering her the much needed relieve (Ackley, B. J., & Ladwig, G. B., 2010).
Nursing diagnosis 4: Reduced social interaction: The patient has remained indoors for a large amount of her time since pregnancy
The expected outcome
- Negatively affected her psychological, physical and social well-being
- Psychological discomfort and reduced self worthiness
Intervention
- She will be placed on a four week weekly counseling and training program within the health care institution.
Rationale
- Social interaction is a sure way of avoiding excessive depression especially for expectant mothers. The training program will enable her interact with health care providers more closely as well as other expectant mothers. This will be a a significant step towards self acceptance. Subsequently it will boost her self-worthiness perceptions (Bindler, R. M., 2007).
Conclusion
Maternal care provision involves assessment of all changes in the patient’s body and life. These include her social well being, physical changes, psychological changes and biophysical changes. Each of these is dependent on the others and has an influence on the health of the mother and that of the unborn child (Bindler, R. M., 2007). For this patient, there are several changes taking place in her life not the least, her current rejection by her parents. These changes must be known to the nurse or the patient’s health care provider so that there is a consistent plan to tackle any complications that may arise from such changes.
The nurse or healthcare provider should form a close relationship with the patient. This will enable them form a holistic assessment plan that will ensure a comfortable gestation period for the mother (Gottlieb, L. N., Ezer, H., & McGill University, 2001).
References
Ackley, B. J., & Ladwig, G. B. (2010). Nursing diagnosis handbook: An evidence-based guide to planning care. Maryland Heights, Mo: Mosby.
Bindler, R. M. (2007). Clinical skills manual for maternal & child nursing care. Upper Saddle River, N.J: Pearson/Prentice Hall.
Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2005). Nursing diagnosis manual: Planning, individualizing, and documenting client care. Philadelphia: F.A. Davis.
Gottlieb, L. N., Ezer, H., & McGill University (2001). A perspective on health, family, learning, & collaborative nursing: A collection of writings on the McGill model of nursing. Montreal: McGill University, School of Nursing.
London, M. L., Ladewig, P.W., Ball, J.W., Bindler, R.C., Cowen, K.J., (2011). Maternal & Child Nursing Care. (3rded.) New Jersey, Pearson Education Inc. ISBN: 0135078466
