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.

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)

CARE PROVISION (implementing plan of care and interventions)

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

Question:

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

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

Answer 1

The method used to assess perineal area after vaginal birth is described as follows:

• First degree perineal tear: injury to the perineal skin
• second degree: injury to the perineum involving muscles not the anal sphincter
• Third degree: Injury to the perineum involving anal sphincter complex
• fouth degree: injury to perineum involving anal sphincter and anal epithelium

Nursing Diagnosis Based on priority:

1.Ineffective breast feeding related to poor knowledge on the importance and benefits of breast feeding as evidenced by improper feeding techniques

Nursing Interventions	Rationale
1. Explain the correct positioning and techniques of breast feeding through demonstration	It will help the mother and baby to have a successful breast feeding without any interruption
2.Promote relaxation and comfort during breast feeding process	this will prevent disruption of breast feeding
3.Check the flow of milk from mother's breast. Advice her to switch between breast to another to have proper emptying of both breasts	It will determine the amount of milk produced by each breast to prevent ingestion of air by infant during feeding

4.Encourage the mother in doing correct positioning during breast feeding . Help the mother in doing so	Repetition of process will motivate the mother to have a successful breast feeding
5.Teach the mother about proper burping technique to remove excess of gas ingested	This will educate the mother to have a good burping position for the infant to prevent reflux of ingested milk
6. Check infant's ability to suck and grasp breast.	Proper positioning of the infant during breast feeding aids in the sucess of the process

7. Make referrals to neonatal nutritionists and lactation specialists if necessary

It will prevent problems of malnutrition if there is suspected ineffective breast feeding