Question

M.M. is a 28-year-old Haitian-American female who recently took a leave of absence under the FMLA from her nurse manager position in anticipation of the birth of her fifth child. She plans to return to work following her 3-month postpartum check-up. Her maternity history includes her status as a G5 P5 F5 P0 A0 L5. M.M. had an instrumental (vacuum extractor), vaginal delivery 12 hours ago. She had a midline episiotomy which is swollen and which she describes as “painful.” M.M. has successfully breast fed her newborn several times since the birth. She has been out of bed and has voided since her birthing experience but has not voided in the past 4 hours. Her BP is 120/60, P is 100, Respirations are 18 and her temperature is 100.1 degrees Fahrenheit. Her temperature an hour ago was 99.0 degrees Fahrenheit. Her uterus is firm and is displaced to the left at u+1. Her lochia amount is heavy. She complains of severe abdominal “contractions” which worsen each time she nurses her infant, and she is concerned that this in not normal. Family members bring her four older children to visit and meet their newest sister. M.M. is concerned that her youngest child, who is 18 months old, may be jealous of his infant sister. M.M. is also concerned about assistance at home once she is discharged, as her husband has been deployed to Iraq and will not return for another 6 months. M.M. has family members available to assist her for only the first week following her discharge home. When you (her nurse) enter her room, you find her lifting her 4-year-old child onto her hip, her maternity pad is saturated and lochia is leaking from her undergarment. She is sweating, out of breath, and near tears.

Answer the following questions:

What is the first action you would take upon witnessing the scene described above, and why?

Describe the complete head-to-toe physical and psychosocial assessment you would perform on M.M.

Identify patient areas of concern by completing a postpartum care plan using ADPIE (Assessment, Diagnosis, Planning, Implementation, and Evaluation).

Answer 1

Immediate intervention:

To put the patient free on her bed and immediate treatment to be started.

Since the patient is struggling for breath this indicates she may develop Pulmonary embolism. start Heparin immediately

Since the patient records increasing Temperature she might be in post partum sepsis. IV antibiotics to be started immediately. Hear rate is increased and this indicates sepsis. cultures of microbes can be done. if not treated this may lead to septic shock.

Since the patient is presenting severe bleeding this indicate post partum menorhagia. Clotting factor, Hematocrit, blood loss to be measured, pelvic exam, physical exam ultrasound need to be done. Fluid need to be started or blood transfusion depending on the amount of loss. Uteru massage or placenta remnant removal.

Head to Toe assessment to be done vitals like Temperature, BP; PR; RR, observatn, palpation, auscultation etc

educate the new mother about her diet plan, exercise, daily activities, sleep etc

ADPIE:

Assess the patient for pain, emotions itching etc.

Educatw the patient about all the alert sign when call Dr.

Support group need to be approached for the new mother.

Counsellung to be given mandatorily since the patient is having severe depression