OB CARE PLAN
Background
A mother, xxx of 28 years old, presented to the hospital with a history of three total number of confirmed pregnancies throughout her life with the current one in term 3. She has zero accounts of abortions or miscarriages, two children aged 8 and 3 years, and gets her support from her spouse and mum. The religion and the occupation of the woman not known. Mother Xxx has had nine prenatal visits, and upon weighing her height was 5.2 feet, and her BMI before pregnancy was 325 lbs. She belongs to blood group o-, her Rhesus factor to be received after birth, and recorded the highest blood pressure of 150/81 during her pregnancy. She has an allergy reaction towards penicillin, Tape, and during her pregnancy, the patient has been experiencing the following problems Intrauterine preg, Diet couticlled GPM (3rd term), Rh- (3rd term), Gest. HT, Prenat. Core (3rd +2), Short cervical length, and Post-partum depression. The patient’s past health history comprises primary insomnia, mild TNT asthma, morbid obesity (BMI 55.56), bipolar disorder, and anxiety. Her previous medication was aspirin, Zyltec, omeprazole,pre-nates/PD, albuterol, and progesterenol. Mother xxx was admitted on 7/10/20 at 2006 hours.
Postpartum mother assessment
The mother’s vitals are as follows; Temperature: 36.6, pulse was 98, respiratory was 18, blood pressure 151/96. The vital signs were graded to be within the normal limits, which were suitable for the patient. More so, the patient was not on the Foley catheter since her voiding indicated no need. The pain rating on the pain scale was 1/10, indicating the level of pain was not alarming. Although all signs observed on the patient reported a good prognosis, there was minimal edema, which needed to be corrected. Her mood, anxiety, and depression also are assessed to establish if she is experiencing postpartum depression. Her prescriptions were ; docusate sodium, nifedipine, PNU calcium, sodium chloride .with strengths of 100mg,30mg,27mg, and 3ml, respectively. With postpartum assessment, the following conditions need to be well addressed to prevent further complications, and this is anxiety and depression. The bonding of the mother with the newborn also are important concepts discussed to create a love bond between the mother and her child. The mother is also advised to stay in bed to recover her strength back. The medications served the following purposes; Ducosate sodium relieves constipation; nifedipine acts as an antihypertensive agent, while sodium chloride is used to correct edema.
Postpartum Newborn Assessment
The newborn vitals were as follows; Temperature:36.6, pulse was 130, respiratory was 60. The heart tone was sharp and regular and produced sound S1, S2, Lungs had no retractions, and this was shown by a clear breathing sound, no nasal failing. More so, there was typical skin ethnicity on the baby, which was warm, dry, and intact, specifically in birthmarks. It was a Mongolian spot. The further assessment went on the baby by checking on the anterior and posterior fontanels, which were found to be soft, and the suture lines were slightly separated. The physical examination of the umbilical cord was established. It was centrally placed, and the bowel sounds were also present, indicating signs of a healthy newborn. Without forgetting the newborn’s lower abdomen were assessed and established, the palate was intact. The extremities were present, undamaged, symmetrically aligned, and the muscle tone was appropriate. The new stool color was yellow, and its brilliance was rated 1.the neonate was to be feed using a bottle since it was not being breastfed because the mother had to undergo first some tests. All those assessments were done to ensure the neonate was healthy. The newborn was given Vitamin K as the medication, which was aimed at stopping any unnecessary bleeding (Jing, Bethancourt, and McDonagh 120).
Necessary screening tests were done on a mother.
They mostly include Postpartum Hemoglobin, Blood type, Rhesus factor The Venereal Disease Research Laboratory test, Group B strep, Hepatitis. The importance of the tests is a discussed below Rhesus factor determines blood incompatibility of mother and baby. If the mother is negative, and the child is positive, the mother must be given RhoGAM to prevent the mother from making antibodies to fight the baby. At the same time, Postpartum Hemoglobin checks foe anemia cases. Blood type determines if RhoGAM must be given to the mother. At the same time, The Venereal Disease Research Laboratory test ensures no transmission of venereal diseases such as syphilis to th newborn during birth. To add on Group B strep, Hepatitis ensures there are no transmissions of conditions to the fetus. Group B strep causes sepsis in newborns.
Necessary screening tests were done on a newborn
A blood test is commonly done. On top of that, another critical analysis is done, such as a screen for hearing loss and dangerous congenital heart disease, phenylketonuria, Congenital hypothyroidism, Cystic fibrosis, Galactosaemia, glucose level, and Other rare disorders of metabolism. They are briefly described below; the Phenylketonuria test determines if there is an appropriate use of one of the building blocks of protein called phenylalanine. The Congenital hypothyroidism test is for checking if a thyroid hormone usually is functioning. Furthermore, Cystic fibrosis test is for determining carriers and non-carriers while Galactosaemia test checks the metabolism of galactose if its normal or defective(Singh, Meharban 48)
Nursing Diagnosis for the mother
Any mother who has given birth key conditions is always looked at, anxiety and depression, and hypertension. For depression and anxiety, they can be devastating to a point where a mother can reject her child—commonly referred to as postpartum depression, which puts a mother at a higher risk of developing major depression later on. The depression comes with the following symptoms insomnia, loss of appetite, intense irritability, and difficulty bonding with the baby. From the above patient’s history, she has cases of insomnia, which s an alarming sign. Hypertension is always referred to as a silent killer; hence early diagnosis aims at arresting its fatal effects like organ damage. Other diagnoses include pain. More so, I noticed perineum swelling in the first 24 hours after giving birth is frequently experienced.
Interventions to mother
Depression and anxiety treatment includes counseling, antidepressants, or hormone therapy and should be initiated immediately. Acetaminophen is used for pain management, works peripherally to block pain impulse generation, and inhibits prostaglandin synthesis. Nurses intervene perineum swelling through advising mothers to lie down to reduce pain and swelling, ice pack application for 20 minutes every 2 to 4 hours to ease increasing (Asrani et al. 45). More so, wearing of firm fitting underwear and 2 to 3 maternity pads for extra support. Lastly, they are advised to start pelvic floor exercises when they are comfortable within the first few days. Without forgetting the mothers need to be taught the use of non-pharmacological treatment to eliminate pain. The methods include listening to music, deep breathing, and meditation. Skin to skin contact of the mother and the baby after birth helps in bonding
Medications for the mother
Ducosate sodium is used for relieving constipation; nifedipine is used as an antihypertensive agent, while sodium chloride is used to correct edema, Acetaminophen for pain relief, and antidepressants to manage anxiety and depression.
Evaluation of the mother
As a nurse, I advocate the need to monitor the mother to ensure that there is an achievement of the problems and that there is a good prognosis. The bonding element between the mother and child is always evaluated to check for depression among mothers. For pain, with proper management, she will report cases of little strain on a scale of 1/10. By the evaluation, a nurse can communicate to the patient to initiate her primary duties smaller by smaller to go back to her healthy routine life.
Diagnosis of a newborn
Mostly shown condition among newborn babies is jaundice; cases of over bleeding can is seen among neonates. With a new, born case of hypoglycemia, it can be observed hence need to address such instances very quickly. For example, the mothers are taught the color of their baby’s stool after birth will be black and sticky, but with time, it changes the same as the color of urine also changes with time.
Interventions for newborn
Jaundice is self-corrective over time; hence it shouldn’t raise a lot of worries. In newborns, the cases of excessive bleeding are resolved by injecting vitamin k to aid in blood clotting. For hypoglycemia cases, the mother needs to know how to test blood sugar levels and design appropriate feeding time since the newborns tend to sleep a lot. Bathing the newborn before sleep provides calm sleep for growth and be healthy. Newborns can not be educated; hence the nurses take the opportunity to teach the mothers what they are expected to intervene on behalf of the babies. Without forgetting Upon birth, babies need to feel the skin to skin to feel the mother’s warmth; this is the technique used to ease newborn crying, help start, sustain lactation, and help maintain the baby’s body temperature (Berhea et al. 80).
Medications for the newborn
Vitamin k to help blood clot.
Evaluation of the newborn
The nurse next visit will know if the mother is taking good care of the child since proper caring is always evidently shown on the baby’s body. A mother needs to feed the newborn so that there are no malnourishment cases, with Proper feeding resulting in faster growth of the baby and immune-boosting (Jing, Bethancourt, and McDonagh 120). Immune newborns’ immune systems can be boosted through vaccinations; hence, mothers need to take their babies for prevention to ensure they acquire vaccines to boost their immunity.
Reflection
From the above clinical assessment, I have been able to learn on the ways I learned how to assess a newborn and a new mother. The essential screening tests to be done on a mother and a young, I understood why are crucial, and the requirements looked at when assessing a newborn and a mother. Most of it, I was able to learn the interventions done upon diagnosis of any presenting condition.
References
Asrani, Anita, et al. “Assessment and comparison between the effectiveness of techniques of improving lactation among postnatal mothers of newborn babies.” Asian Journal of Medical Sciences 9.1 (2018): 41-49.
Berea, Tirhas Asmelash, Abate Bekele Belachew, and Girmatsion Fisseha Abreha. “Knowledge and practice of Essential Newborn Care among postnatal mothers in Mekelle City, North Ethiopia: A population-based survey.” PloS one 13.8 (2018): e0202542.
Jing, Ling, Casidhe-Nicole Bethancourt, and Thomas McDonagh. “Assessing infant and maternal readiness for newborn discharge.” Current Opinion in Pediatrics 29.5 (2017): 598-605.
Singh, Meharban. CARE OF THE NEWBORN REVISED 8ED (2017). CBS Publishers & Distributors Private Limited, 2017.