Essentials Of Maternity, Newborn, And Women’s Health Nursing
Essentials Of Maternity
Chapter 14: Nursing Management During Labor and Birth
1. Desiree, a 28-year-old G2P1, is admitted to the labor and birth unit. Her birth plan indicates that she is planning natural childbirth without pharmacological interventions. She has attended childbirth education classes. Desiree is considered low risk based on her personal and family health history and physical exam. Her pregnancy has progressed without complications. She is approximately 38 weeks pregnant. Vaginal assessment reveals cervical dilation at 10 cm, 100% effaced, and +1 station. Position of the fetus is LOA. The external fetal monitor indicates a reassuring fetal heart rate at 130 beats per minute. Maternal status is stable. (Learning Objectives 1, 2, 6, and 9)
- Based on the vaginal assessment, identify the stage of labor and appropriate nursing interventions for this stage of labor.
- Explain how the nurse determined that the external fetal monitor would be appropriate for Desiree. What factors would necessitate a change to internal fetal monitoring during labor?
- Desiree says, “I’m not sure I can cope with the pain much longer.” How would you respond, considering her birth plan, stage of labor, and assessment data?
2. Emily, a 26-year-old G3P2, has been in labor for 5 hours and is 7 cm, 90% effaced and +2 station. She has external fetal monitoring in place, which reveals a baseline fetal heart rate of 120 bpm, minimal variability, and occasional variable decelerations. Suddenly, as a contraction is beginning to subside, the fetal heart rate drops to a low of 80 bpm and has a slow return to the baseline 1 minute after the contraction has ended. (Learning Objectives 4 and 5)
A. What is happening to Emily’s baby at this point in time? What does this mean?
B. What role do you, as the nurse, play regarding fetal assessment and what interventions do you need to implement/recommend at this point in time?
Chapter 15: Postpartum Adaptations
1. You are caring for Linda, who has just delivered her first baby. You are responsible for assessing Linda’s condition during recovery and for doing patient teaching when the opportunity arises. (Learning Objectives 2 and 3)
- While she is recovering, you keep checking her fundal height. Linda asks you how her uterus will go back to the way it was before she had the baby. How would you explain this physiologic process? What could impede the process?
- Linda wants to know how long she should expect to bleed. What would you tell her?
- The next day Linda appears very passive and you have overheard her telling everyone who will listen about her labor experience. What phase of adjustment is Linda going through? What other stages should she go through while adjusting to her new role?
2. Gretta and Sam just had their first child. Gretta is excited and talkative about her birth experience and wants to keep her baby with her constantly. She tells you his name is Joseph and they will call him “Joey” for short. Gretta is breast-feeding and is attentive to Joey’s needs. You observe that Sam does not initiate contact with the baby but when Gretta insists that he hold Joey, he picks him up slowly and awkwardly and stares at his face for a long period of time. When Joey cries, he immediately returns him to Gretta’s arms. (Learning Objective 4)
A. Based on your observations of Sam’s interactions with Joey, relate where Sam is developmentally in the process of paternal attachment and bonding.
B. What nursing interventions could you implement that would assist Sam in the transition to fatherhood?
Essentials of Maternity, Newborn, and Women’s Health Nursing
Chapter 11: Maternal Adaptation During Pregnancy
1. Jessica and Mike are new clients at your obstetrics office. You are asking them about the reason for their visit. Jessica says she thinks she is pregnant because she missed a period. Mike tells you Jessica is always nauseated in the morning and eats all the time the rest of the day. They have not been using birth control and have wanted to have children since they got married last summer. Jessica says her clothes are feeling tighter and her breasts seem tender. Mike says he has noticed that Jessica has been frequently getting up to go to the bathroom at night. (Learning Objectives 2 and 4)
a. What subjective symptoms have led Jessica and Mike to presume she is pregnant? What other conditions could be the cause of Jessica’s symptoms? How can a pregnancy be confirmed as probable? Diagnosed as positive?
The subjective symptoms include nausea, breast tenderness and amenorrhea. Jessica missed her period and eats all the time. Eating all the time could be caused by food cravings. No birth control, frequently getting up to go to the bathroom at night
A pregnancy can be confirmed as probable if there is an increased frequency of urination, increased skin pigmentation in the stomach and the face, abdominal bloating and mild uterine cramping. The proof positive signs are visualization of the fetus, positive hCG urine or blood and fetal heartbeat.
Other conditions that could be the cause of Jessica’s symptoms include diabetes, anemia, gastrointestinal disorders, malnutrition, endocrine dysfunction and menopause.
This is because the hormone hCG is present in both urine and blood.
Other conditions that could be the cause of Jessica’s symptoms are pancreatitis and anxiety disorders. The fact that she feels nauseated shows that she may be having pancreatitis. “Pancreatitis is an inflammation in your pancreas- an organ that secretes enzymes to help you digest your food” (Fairbrother et al, 2017). This may also have made her to have more foods cravings. She could be having anxiety disorders because these causes nausea. Her food cravings may have been caused by pica.
b. Discuss the nutritional needs of Jessica and her baby.
Jessica will need to consume more legumes, nuts and meat. These will provide her body with iron and proteins. The key nutrients needed by the baby include iron, vitamin A, calcium, vitamin C, D, B6 and B12. The baby will need more calcium to strengthen bones and teeth. Some of the foods that can be taken include milk and cheese. Foods such as leafy greens and carrots will provide the vitamin A while vitamin C will be provided by tomatoes, broccoli, oranges and citrus fruit. Foods such as liver and whole grain cereals will help provide vitamin B6 and B12.
Vitamin C would help promote healthy gums and bones. It would also help the body of the pregnant mother to absorb iron. Iron helps increase the blood flow to ensure that adequate oxygen is supplied to the baby. “A pregnant woman should be getting 27 milligrams of iron and 1200 milligrams of calcium” (Pick et al, 2015). These nutritional needs are met by ensuring that one eats a variety of recommended foods.
The foods she should avoid include undercooked or raw fish, high-mercury fish, raw eggs, organ meat, unpasteurized milk, cheese, caffeine and alcohol. Raw fish can cause several infections such as norovirus. Undercooked and processed meat increases the risk of infection from various parasites and bacteria such as Salmonella.
0. Beth (aged 18) is experiencing her first pregnancy and is now 24 weeks gestation. She tells you that she is “amazed by the changes that have happened to my body already.” Beth wants to understand what additional changes are going to occur to her “besides just getting a really huge belly.” Additionally, Beth relates to you that she is in her senior year of high school, is no longer involved with the baby’s father, and lives at home with her mother and 12-year-old brother. (Learning Objectives 3 and 5)
1. Explain to Beth (in terms she can understand) what general body adaptations she will experience throughout the remainder of her pregnancy.
Beth may experience swollen ankles and feet, pain in the abdomen area, leg cramps, dizziness and skin changes. “You might be experiencing pain on either one or both sides of your abdomen or hip area” (Pick et al, 2015). This is caused by the straining and stretching of the ligaments that hold the uterus. She may also experience trouble sleeping because of the huge size of the belly and have frequent heartburn.
0. What psychosocial adaptations may Beth experience as a result of being a teenage, single mother living at home?
The psychological adaptions include high stress levels, lack of financial support and emotional disorders. She may also experience pain during the delivery, fears of giving birth, social life changes and dramatic body alterations. She may also experience fears of raising the baby without the help of the father. The father would be able to provide financial and emotional support if he was available.
REFERENCES
Pick, M. E., Edwards, M., Moreau, D., & Ryan, E. A. (2015). Assessment of diet quality in pregnant women using the Healthy Eating Index. Journal of the American Dietetic Association, 105(2), 240-246.
CHAPTER 15: Postpartum Adaptations
Case 1
You are caring for Linda, who has just delivered her first baby. You are responsible for assessing Linda’s condition during recovery and for doing patient teaching when the opportunity arises.
I. While she is recovering, you keep checking her fundal height. Linda asks you how her uterus will go back to the way it was before she had the baby. How would you explain this physiologic process? What could impede the process?
Did not answer the question as askes.. this is good info but not physiology.
After child birth, there are postpartum changes that occur in the body to return it to how it was before the pregnancy. One of those processes in contraction of the uterus so that it can return to normal. The uterus will change in size from 1kg to sixty – eighty grams for a period of six weeks. The fundus will contract down towards the pelvis for 1cm everyday. After two weeks of such contractions, the uterus will have contracted and returned into its normal place before pregnancy (Susan et al., 2016). However, sometimes the uterus may not contract as required and this can be caused by; prolonged labor, prolonged use of oxytocin, precipitous labor, chorioamnionitis, and uterine distension.
II. Linda wants to know how long she should expect to bleed. What would you tell her?
III. Stages of Lochia/
Postpartum bleeding varies from one person to another. However, generally Linda should expect heavy bleeding to last up to ten days then after that she might experience spotting or light bleeding up to four to six weeks after the day of delivery. During this time, the body is getting rid of all the tissues and blood that it used for nourishment of the baby because it does not need them anymore.
IV. The next day Linda appears very passive and you have overheard her telling everyone who will listen about her labor experience. What phase of adjustment is Linda going through? What other stages should she go through while adjusting to her new role?
Linda is going through the Taking-In Phase. This is the phase where the woman reflects about her delivery experience and is also passive. The woman most of the times prefers to talk about her pregnancy, labor and childbirth experiences. Linda will still go through Taking Hold Phase where she will begin making decisions on her own, and the Letting Go Phase where she will finally accept her new role of being a mother.
Case 2
Gretta and Sam just had their first child. Gretta is excited and talkative about her birth experience and wants to keep her baby with her constantly. She tells you his name is Joseph and they will call him “Joey” for short. Gretta is breast-feeding and is attentive to Joey’s needs. You observe that Sam does not initiate contact with the baby but when Gretta insists that he hold Joey, he picks him up slowly and awkwardly and stares at his face for a long period of time. When Joey cries, he immediately returns him to Gretta’s arms.
i. Based on your observations of Sam’s interactions with Joey, relate where Sam is developmentally in the process of paternal attachment and bonding.
Sam might be going through paternal perinatal mood and anxiety disorders. Fathers may develop this disorder after their baby is born especially if they are new dads. Sam does not have any interest in parenting not even helping his wife with the baby. He does so when forced to and whenever the baby cries, he gets worse and cannot handle a crying baby. Just like PPD in women who have just given birth, the condition can disappear with time. Sam needs therapy to help him create a bond with his child and embrace fatherhood (Segre et al., 2016).
ii. What nursing interventions could you implement that would assist Sam in the transition to fatherhood?
As a nurse, I would enroll Sam for improved, father focused postnatal program. This will help him to deal with her current problem and learn how to bond and develop natural attachment to his baby (Susan et al., 2016). Also, I would encourage him to read materials that have father-focused postnatal content and interact with other fathers and share ideas on fatherhood. This will help him transition well to fatherhood.
References
Segre, L. S., O’Hara, M. W., & Perkhounkova, Y. (2016). Adaptations of psychotherapy for psychopathology during pregnancy and the postpartum period.
Susan S. R., Terri, K., & Susan, C. (2016). Maternity and Pediatric Nursing, Second Edition ISBN: 978-1-60913-747-2
