Mary_Schwindt_Narrative One_MatChClb.docx - Practical Nurse Program – Old Town Campus Maternal Child Clinical OB Case Study 1 Patient Report Location

Mary_Schwindt_Narrative One_MatChClb.docx - Practical Nurse...

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Practical Nurse Program – Old Town Campus Maternal Child Clinical OB Case Study 1 Patient Report: Location: Labor and Delivery Unit Patient name: Deborah Nelson Medical record #: 3178564 Date of birth: September 15 Age: 31 Sex: Female Attending provider: Carol Stevens, MD Day: Day 1, Monday Time: 2030 Chief complaint upon admission: Labor Primary diagnosis: Spontaneous labor Secondary diagnosis: Pregnancy Overview Deborah Nelson is a 31-year-old gravida 2 para 1 African American female at 37 weeks' gestation. She was admitted to the labor and delivery unit on Sunday at 2230 and is experiencing a long but uneventful labor. She has an uncomplicated birth of the newborn girl, with the assistance of epidural analgesia, at 2030 on Monday. 1. As the labor and delivery nurse, in the first 30 minutes following the delivery of the newborn, what care is provided for the new mother? Assess the uterus (Leifer, 2019, page 209) The fundus should be assessed at routine intervals for firmness, location, position in relation to the midline. If the mother is at higher risk for hemorrhage she should be assessed more frequently. The nurse should explain the reason behind the assessment and provide education on how to do a fundus exam on her own. A boggy fundus should be massaged until firm to prevent hemorrhage. Assess for a full bladder. The mother should be assisted to the bathroom or a urinary catheter should be placed if unable to void. The mother should be educated on the sequence of lochia and what changes in characteristics in color to report. Lochia Rubra is dark red and lasts 4-5 days after delivery
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Lochia Serosa is pinkish and lasts 6-8 after delivery Lochia abla is clear and should appear on the 10th to 21st day Ask the patient if she is breastfeeding or bottle feeding. If she chooses to bottle feed, educate her on how to perform a self breast exam. If she chooses to breastfeed observe the breast by doing a full breast exam and provide education on how she should do a self exam. (Leifer, 2019, pg. 215) Educate breastfeeding mothers to wash with warm water without soap to avoid mastitis, if the breasts are engorged apply an ice pack wrapped in a towel before breastfeeding and apply a heat pack to the breasts before feeding. The last breast she nursed with should be the first breast she begins with for the next feeding. Educate the non breastfeeding mother to avoid stimulating the breasts. She should always wear a tight fitting bra when she is not in the shower. She should avoid running hot water over her breasts when in the shower (turn her back to the water). If she becomes engorged, educate the patient to apply cabbage leaves inside her bra. Assess the patient’s legs for warmth or coolness, pain, or inflammation. Check the capillary refill and pedal pulses bilaterally. If any coolness is present or absent pulse suspect DVT.
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