CAREPLANFORAMOTHER

CareplanforaMotherofaFullTermNewborn
AlishaBhimani
NellHodgsonWoodruffSchoolofNursing,EmoryUniversity

ThispaperrepresentsmyownworkinaccordancewiththeSchoolandUniversityregulations.

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AlishaBhimaniFebruary10,2015
PhysicalAssessment
B.R.isa22yearoldAfricanAmericanfemalewhounderwentaplannedcesarean
section(C/S)on01/26/15at2103.ThestudentnurseassessedB.R.on01/28/15at0930.The
clientisawakeandsittinguprightinbedatapproximately30degrees,innoapparentdistress.
ShehasanIDbraceletonherrightwrist,correctlyidentifyinghernameanddateofbirth.Sheis
alertandorientedx4,withclearspeechandappropriatebehavior.Sheappearswelldeveloped,
withprepregnancyweight234lbs.Theclienthasapulseof76beatsperminute,respirationsof
16breathsperminute,unlabored.Thebloodpressureis112/60mmHgtakenontheleftarm.The
temperatureis36.8Ctakenorally.Shereportsherpainasa4outof10intheabdominalarea.
HEENTareunremarkable.Breathssoundsareclearandequalwithoutdistress.No
coughpresent.HeartsoundsareRRRwithoutmurmur.Radialanddorsalispedispulsesare2+
bilaterally.Noedemapresentinlowerextremities.Capillaryrefill<3s.Abdomenissoftand
tenderupondeepfundalpalpation.Breastsaresoftwithoutnippleirritation.Bowelsoundsare
activeinallfourquadrantswithclientreportingofpassinggas.Thebladderisnotdistendedand
clientreportsvoidingadequateamountsofclear,yellowurinewithnodifficulty.Lastvoidat
1400.Fundusispalpatedfirmatthemidline,exactlylocatedattheumbilicus.Incisionappears
clean,dryandintactwithnosignsofinfection.Clientambulatesindependentlywithout
weaknessorpaininextremities.Notinglingorpainfeltinlowerextremities.Skiniswarmand
drywithoutlesions.Goodattachmentwithinfantobserved.

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3
SBAR

Situation
B.R.isa22yearoldG2P1female(DOB08/01/1992),twodayspostpartum,admitted
totheMother&Babyuniton01/26/2015followinguncomplicatedC/Sdeliveryofafullterm,
healthyfemaleinfant.Theclientandhernewbornremainontheunittoday,01/28/15,forfurther
recoveryandmonitoringastheyawaitscheduleddischargetomorrow.

Background
B.R.smedicalhistoryincludesHepatitisBafterC/Sin2012,aswellasbrokenleftarm
surgeryandgeneralizedheadachesthroughoutpregnancy.PreviousC/SBreechin2012and
brokenleftarmsurgeriesreported.ClientalsohadahistoryofHepatitisBafterC/Sin2012.No
allergiesreported.MotherhasadiagnosisofHTNandmaternalgrandmotherhashxofcancer.
NoprenatallabsavailableatdeliveryexcepthistoryofHSV,butnopresentoutbreak.SheisHIV
negative,GBSnegative,immunetorubella,anduptodateTdapvaccinations.Shehasnot
receivedherinfluenzavaccine.ClienthasaB+bloodtype.Theclienthasahistoryofoccasional
marijuanauseandstoppedin2013.Nouseofalcohol,tobaccoorotherdrugs.Sheliveswiththe
fatherofhernewbornandhashissupport.Onthedeliverydate,theclientwasprescribedFlagyl
at1800duetoacurrentTrichomoniasisinfectionwiththispregnancy.
B.R.presentedtothehospitalat38weeksand3daysgestationwitharepeatedbreech
andruptureofmembranes.Epiduralpainmanagementwasstarted,andlaborwasaugmented
withIVPitocinandmonitoredusingIUPCandafetalheartratemonitor.Theinfantpresented
breechwithnuchalcordx1sotheclientunderwentaloweruterinetransverseC/S,whichwas

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unremarkablewithclearamnioticfluid.Totalbloodlosswasestimatedat800mL.
Theneonatemeasured19inches(48.3cm)inlengthandweighed7lbs.,2oz.(3240g).
HerAPGARscoreswere5at1min,7at5minand9at10minutesafterbirth.Shehasa
decreasedtonewithHR<100,spontaneousrespirationsandacryaround1minute.Afterdeep
OGsuctioningduetocentralcyanosis,therewasanincreaseinO2saturationto85%.Infantalso
presentedwithMongolianspotsandShewasadmittedtothenewbornnurseryforexaminationof
leftupperandlowerextremitiesanomaly.Theneonatesconditionwasdeterminedtobestable
andthenshewastransferredtoB.R.sroom.
B.R.reportsfeelingwellwithnocomplaints.Thelabvaluesthatweresignificantwerea
lowRBCcount(3.3110e6/mcL),lowhemoglobin(9.9gm/dL)andalowhematocrit(29.7%).
Theseweremostprobablyduetothesignificantlossofblood.Itissaidthatironpillsshouldbe
administeredafterpregnancytohelpwiththelossofblood.(VanLeeuwenetal,2006).The
clientispermittedaregulardietandlightactivity.Activemedicationsfordischargeinclude
ibuprofen600mgPOq6hrforpain.Shehasbeenformulafeedingandplanstocontinueusing
thebottle.Hersignificantotherispresentandsupportive,appropriatelyassistingherwith
parentingresponsibilities.Shenowremainsontheunitawaitingdischargetomorrow,bonding
withhernewborn,andrequiringminimalinterventionsandassistance.

Assessment
PhysicalDiagnosis(Venes,2005)

Acutepainr/tpostpartumphysiologicchanges(breastengorgement).
PsychosocialDiagnosis(Venes,2005)
Ineffectivefamilycopingrelatedtosituationalcrisisofbirthofachildwithadefect.

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Recommendations
Physical:BreastEngorgement
Outcome.Clientwillverbalizeanacceptablelevelofpainandexhibitssignsof
decreasedcomfort.
Interventions.Assesslocation,typeandqualityofpain.Administerprescribedpain
medicationsforpainrelief.Applyicepacks15minutesonand45minutesofftohelpwith
engorgement.Encourageuseofsnugandwellfittedbrawithoutanunderwire.Becauseclient
wantstobottlefeed,encouragetheuseofcabbageleavestosuppressmilkproductionand
decreasediscomfort.Thisisanonpharmacologicalmethodthatreallyhelpsinthesuppression
oftheproductionofmilkbecausethecabbagecontainsglucosinolatecompoundsthathave
historicallybeeneffective(NewScientist,2007).Encouragetheclienttonotstimulatethe
breastsbecausestimulationwillleadtopositivefeedbackandanincreasedproductionofmilk
(Hoddinott,2008).
Psychosocial:RiskforCaregiverRoleStrain
Outcome.Clientwillshowpositivecopingmechanismsalongwiththeabilityto
performthechildsphysicalandemotionalcare.
Interventions.Educatemotherabouthernewbornsneedssincethenewbornhasbeen
bornwithaleftupperandlowerextremityanomalysymbrachydactyly.Thisisacondition
wheretheendsofthehandandfeethavesmallremnantswherethefingersshouldhave
developed.Theymayevenhavetinynailsthatareremaining(Kozin,2003).Helptheclienthold

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theinfantandcreateabondingandattachmentwiththeinfant.Pointoutpositiveattributesofthe
infantsuchasthehairoreyes.Explainthesurgicalprocedureandexpectedoutcome.Refer
clienttosupportgroups.
Evaluation
Strengths
1. Usesappropriatetextsandjournalarticlestofindcurrentresearchrelevanttoclinical
practicesettingandpopulation.Forthiscareplan,Ifoundarticlesthattalkaboutcabbage
leavesbeingeffectiveindecreasedmilkproduction.Ialsodidalotofresearchonthedefect
presentintheinfant.
2. Incorporatesdischargeneedsintotheweeklynursingcareplan.Inthisunit,Iwas
effectivelyabletolearnaboutthedischargeprocessanddoadischargeonmyown.Iwas
abletoeducatethepatientwithdischargeteachingsthatareimportantforthemotherand
baby.Itwasdefinitelyalearningexperience.
OpportunitiesforImprovement
3. Performsnursingcarethatisrespectfulofinfantsprivacyandadherenttolegal
requirementsforconfidentiality.Ontheunit,Ididnotpracticetakinganyadditionalstepsor
methodstoensureapatientsconfidentiality.Ishouldhaveactivelycheckedthebabys
identification,alongwithanyvisitorstoconfirmanylegalrequirements.
4. PerformsshiftshiftreportutilizingSBARformat.Ididnothavetheopportunitytoobserve
manyshifttoshiftreportsbetweenthenursesonthemotherbabyandIwanttobeprepared
toperformmyownSBARforthemotherbabyunit.

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EvidencedBasedPractice
Mother/infantattachmentisahottopicontheMother&BabyunitatEmoryMidtown.
Rightafteradelivery,theinfantisgiventohermothertoholdimmediatelyandallowskinskin
contact.Ipersonallyobservedavaginalbirthinwhichassoonasthewomangavebirth,the
newbornwasgiventothemothertoholdonherchest.However,Ialsoobservedadifferent
scenariowhereawomangottoseeherbabyonlyforafewminutesafterbirth.Thebabywas
thentakentoSpecialCareNurseryUnitforthenightwhilethemotherwastakentotheMother
Babyunit.Themotherwasnotabletoseehernewbornandspentalotoftimeapartfromthe
infant.Researchshowsthatbabiescaredforinthehospitalnurserytendtohaveahardertime
breastfeedingandalsocrymore(Crenshaw,2007).
Skintoskincontactalsoshowsthatbabiescryless,breastfeedsooner,haveeasier
breathingandalsostaywarmwiththemothersskin(Hockenberry,2007).Babieswhoalsostay
inthesameroomastheirmothersseemtohavebenefitsversesstayinginthenursery.The
mothercanhaveabetterbondingandattachmentbybeingabletoeasilyholdtheirbabies.Italso
givesasenseofcomforttothemother.IfIwereamotherwithababyinthenursery,Iwould
constantlyworryaboutmychild.Thiswoulddisruptmysleeppatterns.Ithinkmotherswho
havetheirbabyinthesameroomwillsleepbetterknowingthattheirbabyiswiththem.
Overall,Ithinkthatpracticessuchasskintoskincontactandtryingtokeepthebabyin
thesameroom,asthemotherwouldreallyhelpinthemother/infantattachmentprocess.

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Separationofmothersandbabiesshouldbeavoidedasmuchaspossibleaftergivingbirth
(Klauss,1972).Ialsoagreewiththisandbelievethemother/infantattachmentandbonding
shouldalsobeaveryhighpriorityamongallnursescaringforallnewmothers.

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9
References

Crenshaw,J.(2007).CarePractice#6:NoSeparationofMotherandBaby,WithUnlimited
OpportunitiesforBreastfeeding.TheJournalofPerinatalEducation,16(3),3943.
Hockenberry,M.J.,&Wilson,D.(2011).Wongsnursingcareofinfantsandchildren(9thed).
St.Louis,MO:ElsevierMosby.
Hoddinott.(2008).Breastfeeding.BMJ.Britishmedicaljournal,336(7649),881887.
Klaus,MH,Jerauld,R,Kreger,NC,etal.(1972).Maternalattachment.importanceofthefirst
postpartumdays.TheNewEnglandjournalofmedicine,286(9),4603.
Kozin,HS.(2003).Upperextremitycongenitalabnormalities.JournalofBoneandJoint
Surgery.85:15641576.
VanLeeuwen,A.M.,Kranpitz,T.R.,&Smith,L.S.(2006).Davisslaboratoryanddiagnostic
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(2007).Organiclingerie.NewScientist,194(2604),9393.