OB CASE STUDY

OB CASE STUDYPiper-Danay SmithMissouri State UniversityNUR 322-The Childbearing Family

Demographics & Basic InformationPatient name: K.C.Age: 19 years oldSex: FemaleRace/Ethnicity: CaucasianUnit: L&DReason for Admission: Scheduled induction of labor

Assumed patient care at 7:00am. My patient was K.C. who was a 19 year old Caucasian female. She was admitted to the L & D unit at approximately 7:40 pm on Monday, October 26th for her scheduled induction of labor. 2Patient StatusDelivery: VaginalGave birth to 7 lb. 2.5 oz. Male at 9:48 AM Gravida 2 Para 1011Complications: -high maternal temperature -abnormal fetal position -abnormal baseline variability -breastfeeding

Patient was in labor for 14 hours and had a vaginal birth delivering a healthy baby boy at 9:48 AM on 10/27. After the successful delivery, she was Gravida 2 Para 1011delivering one live child at 40 w 6 days gestation. She was also pregnant about a year ago but had a SAB. Her fetus was 6 w gestation at the time. There were a few complications during the labor process and PP, but these proved to be minor. During her labor, she had a high temperature reaching as high as 101.2. She reported feeling hot but no other symptoms that indicated a possible infection or other condition. It was discovered that her higher temp could have been attributed to the fact that she had had heat packs on her back which were there to help control her pain, but a sample of her placenta after its delivery (which was at 9:58 am) was taken to be tested as precaution. Early on in the day around 7:30AM, it was discovered that her baby was positioned OP. The nurse helped the patient reposition on her right side with her left leg supported on a stirrup for several minutes to try to encourage fetal rotation. This proved to be successful. The fetus also had minor variable decelerations which did not worry the nurse because of the closeness of labor. After labor and the cleaning and suctioning of the baby, the patient had trouble getting the child to latch on to breastfeed. After coaching from the nurse, patience and encouragement, the baby began to nurse but only for a little bit.K.C. was very fatigued after her labor but was relieved of the successful delivery, considering her miscarriage just that past year. Her temperature returned to normal after the delivery and removal of the heat packs. 3Past Medical HistoryAllergies: PCN Blood type/Rh status: O+Chronic illness: Anxiety and DepressionPrevious Surgeries: tonsil and adenoidectomy (1998)Immunizations--currentNegative for Hepatitis, HIV, and syphilisPrevious birth history: SAB 1 year ago6 weeks gestationCurrent home medications: Flexeril, Ranitidine Hcl, Prenatal vitamins, & Tylenol

Patient is allergic to PCNs. Her blood type is O+. Chronic illnesses included Anxiety and Depression. Her surgical history included a tonsil and adenoidectomy in 1998. All of her immunizations were current. According to her charts, she tested negative for Hep B, HIV, and syphilis. I was unable to find any more information regarding this. As stated before, she did have a SAB one year ago. Her home medications included Flexeril 10mg tablet at night, Ranitidine Hcl150 mg, prenatal vitamin tablet taken 1/d and Tylenol500 MG PO q6h PRN. K.C.s anxiety and depression did not seem to effect her during her stay significantly. She was anxious during labor but this is common. It will be important to watch for signs of anxiety and depression in her PP period since about 50-70% mothers develop PP blues and 10-15% develop PPD. 4Family Medical HistoryParents -Mom: Slightly overweight -Dad: Chronic smoker & HTNGrandparents -Moms side: Both deceased -Dads side: Grandmother (HTN) Grandfather (Type II DM & overweight)Siblings -One younger brother: none

I was unable to gather extensive information on K.C.s family history, but was able to get some information. Her mother is slightly overweight but has no chronic problems. Her father is a chronic smoker and has HTN. In looking at her grandparents, I was unable to gather information about her mothers side since both were deceased. On her dads side, however, her grandmother has HTN and her grandfather has Type II DM and is overweight. K.C.s younger brother (17) has no known conditions. K.C.s blood pressure was a little high throughout her labor ranging from 120s- high 130s/70s-high 80s and dropped slightly PP. This could have been attributable to the stress of labor. It will be important, however, to watch her BP closely and to pursue a healthy lifestyle since HTN and excess weight appears to run in her family. Monitoring her blood sugar periodically can be a proactive step to monitoring any developing signs of Type II DM as well as eating healthy and keeping her weight under control. Tight glucose control can lower her chances of developing GDM in future pregnancies.5Psychosocial History Family Make-Up: -Divorced parents -1 younger brother (17) -Significant otherEmployment: N/AEducation: HS graduateInsurance: MedicaidTobacco usage: Former. Quit- 6/18/15. Father & significant other are current smokersHome environmentPotential Stressors -Possible disagreement between Mom and Dad -First-time mom -Relapse into Depression and Anxiety

K.C.s parents are divorced and are currently on civil terms. She has 1 younger brother who is 17 who was not at the hospital at that time. She also has a boyfriend who she lives with currently. The plan was upon discharge, K.C. would live with her mother for an undisclosed length of time. I was unable to obtain the patients place of employment although she is employed. She is a high school graduate and has not pursued a higher education. She is on Medicaid, currently. Her father and significant other are current smokers although they indicated that they would not smoke around the baby. K.C. herself was a former smoker, but quit 6/18 of this year. There are no indicators of a toxic home environment, but second and third-hand smoke could be a hazard for the growing child. Potential stressors could include disagreements between Mom and Dad since they are divorced and not on the best of terms yet both want to be involved in their grandchilds life. One large stressor will be that K.C. is a first time momeverything about motherhood is new to her. This will cause significant stress. She will be living with her mother and it may increase her dependency which will change their relationship dynamics. Because of the stress of motherhood as well as the phenomenon of PP blues, she may relapse into a period of increased Depression and Anxiety. A strong support system will be important for her emotional and mental well-being6Nursing TheoryHendersons Fourteen Components of Basic Nursing Care *Brief Description *Application to the Patient and Family *Nursing Care

I chose Hendersons Fourteen Components of Basic Nursing Care as the nursing theory to apply to my patient and family. This theory identifies the 14 basic components of nursing care8 of which apply to bodily functions and 6 that address safety and finding meaning in life. The 14 basic needs include: breathing normally, eating and drinking adequately, eliminating bodily wastes, moving and maintaining desirable postures, sleep and rest, selecting suitable clothes as well as dressing and undressing, maintaining body temperature by adjusting the environment, keeping the body cleaned and well-groomed and protecting the skin, avoiding dangers in the environment and avoiding injuring others, communicating with others in expressing emotions, needs, fears and opinions; worshipping according to ones faith, working in such a way that there is a sense of accomplishment, play or participate in recreation, and satisfying the curiosity that leads to normal development and health and use the available heath facilities. This theory ultimately aims to increase the patients independence by caring for the patient until he or she can care for themselves.

Application: K.C. was at a more vulnerable and restricted time of her life during her labor process and shortly thereafter. The stresses of pregnancy and labor required the nurse to provide constant and consistent care for her by manipulating the environment for comfort and temperature, keeping her clean by washing her perineum and changing her gown when it was soiled among other interventions. She was in a more dependent state due to her physical conditionnot just with the pregnancy and labor itself but with the lack of sleep and rest, feeling hot, barriers with clear communication due to the high stress that came with labor, etc. As K.C. gets more rest and obtains more knowledge of the bodily changes that she will experience and how to care for her baby, she will be able to meet these 14 components on her own.

Nursing Care is centered around assessing and meeting the patients needs. Acting as patient advocate is extremely important in the laboring woman who is in a physically dependent state. The nurse will be providing the majority of the patients care including focusing on her comfort, pain control, and patient hygiene. As she is providing this care antepartum, during labor and postpartum, she should involve the patient by allowing her to make choices whenever possible and give her direction. She should educate the patient by informing her about the purpose and plan of each intervention as well as teaching her proper care of the newborn. Ultimately, the nurses goal should be to empower the individual and increase her independence.

7Developmental TheoryDevelopmental and Family Life Cycle Theory *Brief Description *Application to the Patient and Family *Nursing Care

The Developmental and Family Life Cycle Theory assesses normal family changes over the span of a lifetime and evaluates both the individual and family as a whole. The relationships that family members share are affected by changes that occur in the individual and changes that occur in the family affect each member. There are 2 significant concepts in this theory. The first is that families develop and change overtime due to roles, structure and processes. The second is that families experience transitions from one stage to another. Disequilibrium happens during the transitions from one period to the other. There are changes that are expected and predicted within families called normative changes. Changes that are unexpected or off time are nonnormative. Each family will go respond to developmental changes differently and have specific needs.

With the birth of K.C.s first child, her familyas both a unit and as individuals-- are experiencing a drastic change. K.C. and her significant other are transitioning into a new phase of being a childbearing family: from pregnancy to welcoming a new child into the world. They must now adjust to their new roles as mother and father. K.C. , in her young age and as first-time mother, will become more dependent on her mother since she will be moving in with her for a time. This will effect their relationship either positively or negatively. K.C.s mother and father are divorced. Her father will want to be involved in his grandchilds life which will open up the possibility of increased contact with his ex-wife which may create tension. Each family member will experience different stressors from the birth of the new baby boy.

So, even though the nurse is assigned to the mother and baby, he or she must remember that the whole family is his or her client. They are all affected by the new mothers status and condition. The nurse should ask periodically if the family members present with the patient need anything such as blankets, water, etc. and make sure they are comfortable. The nurse should also make him or her self available to answer questions and should explain necessary information to the family members involved in the new mothers care with her permission. One should also be aware that each family goes through this change differentlysome families are thrilled and prepared for this new arrival while others have mixed feelings and feel unprepared for this change. The nurse should be sensitive to each familys needs and, if possible, should introduce resources that may be helpful for a smooth transition if he or she feels the need to do so.

8Growth & AppearanceGrowth & Appearance *Height: 53 *Weight (as of 10/27): 169 lbs +Pre-pregnancy weight: approx. 140 lbs *BMI: 30 *Appearance: Healthy, well-nourished.

K.C. is 53 and, at the morning of labor, was 169 lbs. and her was BMI 30. Her pre-pregnancy weight was about 140 lbs., which means that she gained 29 lbs. total during her pregnancy. The recommended weight gain for a woman carrying 1 child and a normal weight woman is 25-35 lbs, so her weight gain was WNL. She appeared normal for a pregnant woman considering her size, she was healthy and well-nourished. She also appeared fatigued, which can easily be attributed to the stresses of labor. 9Nutritional Status Description of Diet *Tries to follow recommended diet from HCP *Diet deficient in vegetables *Diet high in sugar on occasion

Nursing Counseling

I was able to ask K.C. a few details about her diet, but not much since she was extremely tired from her labor. She stated that she tried to follow the recommended diet from her HCP. Assuming that her HCP recommends the standard diet for pregnant women, this includes: 4 cups of dairy products, 3 servings of meat and meat alternatives, 6-11 servings of grains, 2-4 servings of fruit and fruit juices, 3-5 servings of veggies, and fats, sweet and beverages in moderation. She reported that she drinks about 6-7 glasses of water and a total of about 9 or so glasses a day. She also reported taking prenatal vitamins. She admits that she does not really like vegetables and only has them with either lunch or dinner but usually not both. She also admitted that she craves sweets sometimes so she eats more than what she needs. She estimates that she eats about 2200-2300 cal/day.

Nursing counseling: The nurse would encourage the client to continue the recommended diet with a few modifications. Since she plans on breastfeeding, she should increase her calorie count to about 2500-2700 cal (or about 200 cal more than her usual intake). She should also increase her protein intake with an intake of 65 g/day for the first 6 mo. and 62 g/d for the second 6 mo. She is encouraged to consume 1000 mg of Calcium per day, taking a calcium supplement if needed. Iron should be taken for 2-3 months to replenish storage. She is encouraged to increase her vegetable intake since they provide many essential nutrients. The nurse also reassures her that occasional desserts are okay but to be sure to eat them in moderation. With her age (19), the young mother may be tempted to try and get back to pre-pregnancy weight. She should be encouraged to refrain from fad diets and to simply eat healthy. Once her baby is weaned, she can begin weight loss efforts. A fair amount of weight should naturally fall off in the mean time.10Focused Physical AssessmentVital Signs (10:00am): -BP: 124/72 -Temp: 98.1 -Pulse: 82 -RR: 16 -spO2- 99% -pain scale: 5Cap refill: