Nursing Care of Postpartum Mother and Infant

1. Nursing Care of Postpartum Mother and Infant By Sheryl Duncan, Ashley Halliwill, and Dawn Simon September 30th, 2008

2. Patient Background • Age: 30 • Religion: Christian • Education: Attending 2nd year of nursing school. • Works as an STNA and goes to college. • African American • Married

3. Patient Medical History • Admitted to hospital for a Vaginal Delivery. • Allergies: NKA (No known allergies) • Significant family medical Hx: father has diabetes mellitus • Medical or Surgical Hx: appendectomy & tonsillectomy

4. OB History • Gravida 1 Para 1 • LMP: 12/10/07 • EDD: 9/17/08 • # of weeks of gestation: 40 weeks • Type of Delivery: Vaginal • Anesthesia: Epidural • Meds during pregnancy: prenatal vitamins

5. Prenatal Labs

6. Prenatal Labs (Cont.’d)

7. Prenatal Labs (Cont.’d)

8. Prenatal Medications

9. Diagnostic Testing

10. Labor and Delivery Data • Onset of Labor: 9/19/08- 0524 • Delivery of baby: 9/21/08- 0649 • Delivery of Placenta: 0654 • Total length of delivery: 19 hours 54 minutes

11. Labor and Delivery Data (Cont.’d) • 9/21 Upon arrival: • 0217 - FHR 140’s, moderate variability, no decelerations. • Toco q 2-4 min • Cervical effacement: 80% dilated: 3-4 cm • Stationed: -3 • Bulging bag of fluid

12. Labor and Delivery Data (Cont.’d) • 0403 – FHR 130’s, moderate variablility, no decelerations. • Toco q 3-4 min • Cervical effacement: 90%; dilated 7 cm • Stationed at -2

13. Labor and Delivery Data (Cont.’d) • 0602 - FHR 140’s • Toco q 2-3 min • Cervical effacement: 100%; dilated 10 cm • Stationed at 0 • AROM at 0 station • Monitoring closely • AROM : Clear liquid

14. Labor and Delivery Data (Cont.’d) • 0656 at +1 and then +2 station • Patient labored well • Bilateral superficial para urethral lacerations which did not require repair.

15. OB Complications • No complications as evidenced by: - BMI within normal range - normal vitals - no history of disease - normal labs - within normal limits of recommended age for pregnancy

16. Postpartum Labs

17. Postpartum Labs (Cont.’d)

18. Postpartum Labs (Cont.’d)

19. Postpartum Medications

20. Postpartum Medications (Cont.’d)

21. Postpartum Medications (Cont.’d)

22. Postpartum Medications (Cont.’d)

23. Postpartum Medications (Cont.’d)

24. Postpartum Medications (Cont.’d)

25. Postpartum Procedures and Treatments • Newborn to breast immediately p birth • Ice applied to perineum • Ambulate as tolerated • Pain medication prn • Tucks pads offered • Nursing bra for support

26. Postpartum Nutritional Assessment • Physical Appearance: appears well groomed and BMI of 21. • Prepregnant weight: 144lbs/65kg • Weight gain during pregnancy: 30lbs • Weight during pregnancy : 174lbs/79kgs

27. Newborn History • Blood type: A positive • Hep B Screen: Hep B vaccine since mothers screen was not available at time. • VDRL/RPR: negative • Rubella: negative • Glucose Screen: 73

28. Newborn Physical Assessment • Infant Gender: Male • Feeding: Breastfeeding • Apgar Score: 1 min. = 9 5 min. = 9 • Birth weight: 6lbs./3oz • Head to heel: 50.2 cm 19.8 in • Head circumference: 35.6 cm 14 in

29. Newborn Physical Assessment (Cont.’d) • Skin- dry • Mouth- moist • Moro, suck, rooting, and babinski reflex all present • Abdomen- soft • Bowel sounds- present • Fontanels- soft, level • Tone- good • Cry-vigorous • Extremities-symmetrical

30. Newborn Physical Assessment (Cont.’d) • Respiratory- Even and clear p suction • Cardiovascular- Regular • Sensor- intact • Procedures- PKU, circumcision, and heel stick blood glucose • Pain assessment- 0

31. Newborn Record • Aspiration of amniotic fluid, excess suctioning required • Failure to latch first 24 h

32. Newborn Labs

33. Newborn Medications

34. Newborn Medications (Cont.’d)

35. Newborn Medications (Cont.’d)

36. Newborn Medications (Cont.’d)

37. Care Plan • Pain Management R/T Labor (Alleviation of pain or a reduction in pain to a level of comfort that is acceptable to the patient) - Assess pain level q2h, contractions, emotional coping - Administer epidural pain medication per PT request - Assess pain level q1h p medication administration - Teach pain relief methods (breathing patterns, positions, acupressure, massage, cold/heat applications, distractions) - Coach/praise PT and include labor support person

38. Care Plan (Cont.’d) • Emotional Support R/T Labor and Delivery Process (Provision of reassurance, acceptance, and encouragement during times of stress) - Assessment of PT’s emotional status - Therapeutic touch - Listen and address any PT concerns, fears, etc. - Praise - Encouraging words

39. Care Plan (Cont.’d) • Breastfeeding Assistance R/T need for teaching - Assessment of PT’s knowledge level - Preparing a new mother to breastfeed her infant - Teach proper technique - Schedule time with lactation consultant - Assist with latching - Emotional support - Educate different positions and ways to hold newborn ( transverse, football, side lying)

40. Care Plan (Cont.’d) • Nutrition, Imbalanced: less than body requirements R/T ineffective breastfeeding -Assess newborn latch and swallowing sounds -Schedule lactation consultation due to no latch within 24 hours -Check bilirubin level due to increased risk for jaundice -Supplement formula until proper latch is established - Monitor newborns weight to make sure it maintains a healthy weight

41. Thanks For Listening!!!