Question

Case Studies

Essentials of Maternity, Newborn, and Women's Health Nursing

Chapter 16: Nursing Management During the Postpartum Period

1. You are caring for Bonnie, age 42, who has just undergone a cesarean birth for her first baby. You are responsible for monitoring her condition during recovery and for teaching her how to take care of herself and her baby. (Learning Objectives 2, 3, 4, 5, and 7)

1A. You note that Bonnie has a positive Homans’ sign in the left leg. What are the risk factors for thromboembolic disorders, and how will you determine if she has a DVT? If Bonnie has a DVT, what else is she at risk for?

1B. Bonnie is ready for discharge and asks you about bleeding, perineal care, and what she should eat while breast-feeding. What are you going to teach her?

1C. Bonnie, the baby, and Bonnie’s husband are following up for newborn care. What nursing interventions should be included to promote parental role adaptation and parent–newborn attachment?

2. You have just received report on the following patient. Hannah G1P1 gave birth vaginally two days ago to a baby girl. She had a midline episiotomy and has protruding hemorrhoids. Hannah is rubella negative and has A– blood type and her daughter is O+. Hannah is breast-feeding her daughter. Hannah is expected to be discharged to home later this afternoon. (Learning Objectives 6 and 8)

2A. Describe the nursing management for Hannah and her family during the postpartum time period.

2B. Hannah and Justin are preparing for discharge. What areas of health education are needed for discharge planning, home care, and follow-up visits for Hannah and her baby girl?

Answer 1

1A. You note that Bonnie has a positive Homans’ sign in the left leg. What are the risk factors for thromboembolic disorders, and how will you determine if she has a DVT? If Bonnie has a DVT, what else is she at risk for?

Homan' s sign is a first symptom for deep vein thrombosis. Pain in calf during ankle dorsiflexion termed as Homan 's sign.

Some risk factors for thromboembolic disorders are :

• Major trauma
• Localised vascular damage
• Obese patients over 40 years of age , previous incidence of DVT , complicated surgical procedures
• Gynaecology patients over 40 years of age, postpartum patients,Pregnancy,Mutiparity
• Prolonged Bedrest

All postoperative patients are at some risk for DVT. Initial pain and tenderness may be accompanied by painful swelling of entire leg with fever, chills and diaphoresis. Pain when relieved during rest may be a sign for DVT. If Bonnie has DVT she is at risk for pulmonary embolism which is a life threatening condition.

1B. Bonnie is ready for discharge and asks you about bleeding, perineal care, and what she should eat while breast-feeding. What are you going to teach her?

Bonnie is a postpartum mother ,she should be instructed about cleanliness and safety.Advice her to take rest Inform her that she may experience bleeding for atleast 20 days following delivery . She should be advised to report to the physician if there is large blood clots or more odor from the bleeding. Her bleeding should decrease day by day. Instruct her to change pads frequently and keep perineal area clean to avoid any infection because the perineum is a place having more moisture (as it is wet). Always she should wash perineal area after bowel and bladder habits and keep it dry.

While breast feeding she should consume more fruits and green leafy vegetables along with meat & dairy products. Milk consumption may give good calcium for herself and also baby. Advice her to drink more water and fluids , so that she gets adequate milk to feed the child.

1C. Bonnie, the baby, and Bonnie’s husband are following up for newborn care. What nursing interventions should be included to promote parental role adaptation and parent–newborn attachment?

• Advice the father and mother to interact with the newborn.
• Breast feeding increases the bonding between mother and baby. After feeding , tell the father to handle the newborn so that their relationship strengthens.
• Tell the mother and father to talk to the newborn in a calm voice positively with smile.
• Note the coping behaviors of parents whether it is positive or they have more arguments in taking care of child.
• Evaluate the support of families for the parents and their culture .
• Advice them about immunization .
• Plan a follow up visit.

Answer 2

1. A) Risk factors for thromboembolic disorder are :-

1) Trauma

2) Post-surgery

3) Immobility or inactivity (especially increases in the leg with increased risk of PE)

4) Obesity

5) Pregnancy

6) Estrogens/Birth control

7) Malignancy- often among most hypercoagulable state and most common to cause this

8) Age

Duplex sonography is used to detect the presence and extent of acute /chronic venous thrombosis .

#. If Bonnie has a DVT then she is at risk for pulmonary embolism .

1B ) Nursing education for Bonnie :-

- Eat nutritious health food full of proteins ,vitamins , minerals etc which would help in formation of milk and healing of wound

- Breast feed the baby 8 to 10times a day and at night also

- Breast feed only till 6months ,no other foods to be given to the baby

- Dont carry heavy weight till 6months and after 6 months also take maximuny weight upto 20lbs

- Avoid infection and maintain hygiene

- Keep baby warm , check the temperature of the baby to detect hypothermia

- Don't apply anything on the umbilical cord , wash it with soap and water and keep it dry

- keep the perineal area clean

- check the amount of bleeding by counting the number of pads being used . In case of excessive bleeding report to the physician

1C ) Nursing intervention for newborn attachment include :-

- advice them to be a part of newborn care

- encourage them to disclose their concerns and doubts about newborn care

- provide them demonstration of baby care

- advice them to have regular follow ups

2A)and B) Nursing management for Hannah and her family include :-

- newborn care education

- advice them to check for yellowish discoloration in the baby due to RH incompatibility

- advise them to reach soon to physician in case of yellow discolouration to avoid complications

- advice them to take a nutritious healthy diet for the mothers recovery and baby's growth

- advice them to have regular follow ups