Question

Postpartum Scenario

Mrs. A is 20 years of age and gave birth to her first baby at hospital 7 days ago. Her pregnancy, Labor, and birth were uncomplicated. The midwife who attended the birth checked Mrs. A and Her baby the day after the birth. She has not seen a healthcare provider since then. This is her first postpartum clinic visit. Mrs. A has come to the clinic because she has constipation, some edema in perennial area and sore, red nipples. Her baby not able to start breast feeding well.

PRE-ASSESSMENT

1. What physical examination will you include in your assessment of Mrs. A and why?(.05mark)

2. What type of lochia you will find in your assessment of Mrs. A and why? (.05mark)

DIAGNOSIS (interpreting information to identify problems/needs)

You have completed your assessment of Mrs. A and your main findings include the following mention women health problem and needs. (.05mark)

History:

• Mrs. A is feeling well but has sore, red nipples. Constipation since 2 days and perennial edema since 4 days. .

• She reports that the baby breastfeeds approximately every 2 hours.

Physical Examination:

• Mrs. A generally appears well.

• Vital signs are as follows: BP is 110/72, Pulse is 80 beats per minute; Temperature is 37.6°C.

• There is no redness, tenderness, streaking, or masses palpable in the breast tissue; however,

During observation of breastfeeding, it was found that the baby was not attaching well to the

Breast. And Perennial area edematous.(which method you used to assess perennial area) (.05mark)

3. Based on these findings, what is Mrs. A's diagnosis (problem/need) and why? (1 mark)

CARE PROVISION (implementing plan of care and interventions)

4. Based on your nursing diagnosis(problem/need identification), what is your plan of care for Mrs.A and why? (2mark)

EVALUATION

• Mrs. A returns to the clinic in 2 days.

• You find that her nipples are less sore and red, and attachment has improved, although the

Problem has not fully resolved. But her bowel return to normal and perennial edema decrease

• Mrs. A is very eager to continue breastfeeding

7. Based on these findings, what is your continuing plan of care for Mrs. A and why?( 1mark)

NOTE: please write the answer by keyboard, not on papers... so that the answer will be clear. Thanks❤️

Answer 1

1. A thorough breast and perennial examination should be included since she has sore and red nipples as well as she is having constipation for 2 days and perennial edema since 4 days.

2. Lochia is the vaginal discharge after giving birth. Since the women is on the seventh day she is having lochia rubra or cruenta which is the first discharge, composed of blood, shreds of fetal membranes. it is red in color because of the large amount of blood it contains. it typically lasts no longer than 3 to 10 days after birth before easing to light "spotting".

Mrs. A has been came to the clinic with the chief complaints of constipation since 2 days and sore and red nipples. Also has edematous perinneal area. on breast examination, no tenderness, no palpable masses and streaking on the breast present. but due to sore and red nipple she has difficulty in feeding the baby and also the babies attachment to the nipples is not proper.

on perinneal examination, REEDA shows, Redness- is slightly present, Edema- +, Echymosis- '-', Discharge- lochia rubra, Approximation- ++.

Non sustained sucking at the breast and sore nipples that impedes latching are her major problems. nursing diagnosis- ineffective breast feeding related to sore and red nipples as evidenced by poor breast feeding techniques and poor sucking of baby.

management- apply cold compress on sore nipples, do not use tight fitting bras, clean the breast with plain water before and after each feed, apply emolient on the nipples, teach the mother breast feeding technique that mainly include the areola and the nipple to be completely in the babies mouth and the lower lips should be turned outwards( best sign of proper latching) and monitor for proper sucking as she is a primi mother. As she has edema on the perinneal area, advice her to take sitz bath twice a day.

On evaluation after 2 days, her problems resolved to some extent but still continuity in the care. she must be advised to continue the breast feeding. Give her proper health education about the diet with protein and calcium to increase breast milk. Advice should be given that the color of the lochia changes to serous during this time and later changes to white after 15 days.