1. Nursing Care for the Postpartum Mother and Newborn By: Krystle Duffield, Melinda Mollenkopf, Tiffany Thompson

2. Reason we chose patient Language Barrier ◦ Challenges nurses must face in a culturally diverse society ◦ Important that nurses be able to communicate and meet patient’s needs ◦ If unable to communicate, know what resources are available

3. Introduction of Mother Initials M.B. Hispanic female Age 21 G3P3 Reason for admission: Repeat elective C/S Allergies: NKDA Education: 1 yr Religion: Evangelical Language: Spanish Work: Homemaker Smoker/Drinking/Subst. abuse: No

4. OB/Gynecolgic Hx G3P2 Prior delivery route: Vertical c/s x2 Anesthesia: Epidural LMP: 5/13/08 EDD:2/13/09 GTT: 1hr 150g/dL Medications: Prenatal vitamins during pregnancy STI’s: Negative No reported complications with previous pregnancies History of Post-Partum Depression

5. Maternal Assessment

6. Maternal Assessment Cont.

7. Maternal Labs Prenatal

8. Maternal Labs Postpartum

9. Maternal Medications ante/inta/postpartum

10. Labor/Delivery Type: Scheduled transverse c/s Pain management: Epidural Amniotic fluid clear Surgery started at 0705 Baby girl born at 0836 Surgery Finished at 0912 Internal sutures with external staples and dressing applied. Foley inserted for I&O

11. Assessement of Newborn Newborn weight: 6lbs 2oz Birth date: February 5, 2009 at 0836 Sex: Female Gestational Age: 38.6 weeks Ballards Score: 38 APGAR: 9 at1min, 9 at 5min

12. Newborn Assessment Cont.

13. Newborn Labs Lab TestResultsNormal RangeInterpretation Hgb2016-22 Patients is normal Hct57.348-65Indicates no blding problems. Pt is normal. RBC5.724.2-6.2Indicates no amemia. Results normal. WBC39.59-35Results slightly elevated. Indicates possible infection. PLT205140-300Normal results. Dextrocity63g/dl40-90Used to rule out hypoglycemia. Normal results.

14. Newborn Medications

15. Nutritional Assessment

16. Maternal-Newborn Attachment The mother seemed to be tired and groggy throughout the day. The first time the SN saw the mother holding the infant was in the morning for pictures. The mother then put the baby back into the bassinet. The mother left the baby in her room most of the day. The S/O, father, did feed the baby and change it’s diapers. The mother held the baby for the second time while under the SN’s care just before the SN left for the day at 0700.

17. Nursing Diagnosis Risk for infection R/T a site for organism invasion, Secondary to surgery. Impaired communication R/T foreign language barrier Nausea R/T effects of anesthesia Risk for ineffective Therapeutic Regimen Management R/T previous unsuccessful experiences.

18. Nursing Care Plan Risk for infection Goal-Patient will report risk factors and signs associated with infection and precautions needed. Interventions ◦ Teach and maintain good hand washing technique  R-Hands carry germs and washing them is an important and easy way to prevent infection ◦ Eat a diet with protein, carbohydrates and adequate hydration.  R-To repair tissue, the body needs increased protein and carbohydrate intake, as well as hydration for vascular transport of O2 and wastes. ◦ Teach the signs and symptoms of infection  R-If patient notices any signs and symptoms of infection, she can go to doctor and be treated. The sooner she is treated, the easier it is to treat and less health risks for mom.

19. Nursing Care Plan Impaired communication R/T foreign language barrier. Goal-Mother will communicate needs and concerns (through interpreter if needed). Interventions Do no evaluate understanding on a “yes” or “no” response. ◦ R-An answer of “yes” may be an effort to please, rather than a sign of understanding Use gestures, actions, pictures, or drawings ◦ R-An attempt on the nurse’s part to communicate over a language barrier encourages the client to do the same. Use a fluent translator when discussing important matters. ◦ R-Patient needs to know what is being don to her or what is going on to reliever any anxiety and confusion.

20. Nursing Care Plan Nausea R/T effects of anesthesia Goal-Patient will report decreased nausea Intervention Offer small amounts of clear fluid and beverages with ginger ◦ R-Clear fluids are easier on the stomach that food and ginger has been found effective fore treatment of nausea. Obtain an order from doctor for an anti-emetic prescription of N/V gets too painful or reoccurring. ◦ R-Patient may need prescription to prevent vomiting because vomiting causes incision site pain and can cause dehydration and electrolyte imbalance Place patient in semi-fowlers or high-fowlers position for 2hrs after eating. ◦ R-This prevents aspiration and regurgitation of food/drink due to gravity keeping food/drink in stomach and not pass through the cardiac sphincter to esophagus.

21. Nursing Care Plan Ineffective Therapeutic Regimen Management GOAL-pt will relate the intent to practice health behaviors needed/desired for recovery from c/s and prevention of complications. Interventions ◦ Have bilingual nurse or translator develop trust of patient with frequent, consistent interactions.  R-People are more willing to learn from and listen to people they trust. ◦ Educate the importance of her follow-up care and pediatricians appointments in small increments.  R-information overload loses the importance of the information and is not completely understood because its no being processed through the brain. ◦ Teach when patient is not fatigued/in pain  R-Fatigue and pain can negatively affect learning. Barriers to learning will decrease retention and increase frustration.