Antepartum Case Study: Isabel
Although the expected delivery date (EDD) is just but an approximation, it is possible to calculate Isabel’s EDD. This is done by adding 280 days (40 weeks) since the first day of the last menstrual cycle. In this case, it is important to add 280 days to July 20, 2012, in order to arrive at the approximate due date. Therefore, Isabel ought to expect her child on April 26, 2013. According to medical and nursing practitioners, it is important to consider a standard deviation of 8-9 days (Hobel & Chang, 2004). The rationale is that majority of births occur during the 39th week to 41st week of pregnancy.
First, Isabel is experiencing morning sickness that makes her vomit and feels nauseated. This is a sign of discomfort that occurs during the first trimester of pregnancy. Ideally, morning sickness can happen at any time of the day contrary to notions and misconceptions that it only occurs during the early hours of the day (Hobel & Chang, 2004). Morning sickness results from an increase of hormonal secretions (both estrogen and progesterone). Particularly, progesterone increases in order to enhance the relaxation of stomach muscles as a biological process that prevents miscarriages (Hobel & Chang, 2004). Consequently, it may relax both the stomach and intestines leading to the accumulation of acids and gases. Besides, a high level of bilirubin and low blood sugar in the mother’s body may lead to morning sickness. Nonetheless, Isabel ought to understand that incidences of vomiting and nausea decrease as the pregnancy progresses. Second, Isabel reports vaginal discharge that is a major cause of discomfort. It is an early sign of pregnancy and should be associated with the implantation of the fertilized egg into the uterus. It is also related to an increase in estrogen and cervical secretions. The secretions increase as the process of creating a mucus plug takes root. While whitish and odorless discharge is common during the first trimester, smelly and blood-spotted discharge should prompt Isabel to seek medical attention. The rationale is that it may be caused by vaginal infections such as vaginitis and Chlamydia.
Isabel is in the first trimester of her pregnancy. During her visits, major components of prenatal care at this phase include a profile of her medical history. Nursing practitioners ought to ask questions related to Isabel’s menstrual cycle, personal and medical history, initial pregnancies as well as any form of birth control that she might have been using prior to the pregnancy. In addition, the nursing practitioner ought to enquire from Isabel about her lifestyle and habits during the first trimester (Bloom & Cropley, 1994). For instance, it is at this stage that pregnant women who smoke cigarettes ought to receive advice on quitting the habit. Of particular importance, the nursing practitioner during this phase of prenatal care ought to inform Isabel about her expected delivery date and conduct various lab tests that might include ascertaining her blood group, immunity, and predisposition to specific infections.
Throughout pregnancy, should be proactive in noticing danger signs that might emerge. They include heavy bleeding during this phase. Excessive bleeding could be a sign of ectopic pregnancy implying that Isabel would require frequent monitoring and specialized care (Blackburn, 2003). Bleeding is also a major of miscarriages (Bloom & Cropley, 1994). In addition, Isabel ought to be wary of continued vomiting and nausea. Vomiting could lead to dehydration that may not only affect the unborn but also the mother (Bloom & Cropley, 1994).
Labor & Delivery Case Study: Tasha
Upon arrival to the hospital, the nursing practitioner ought to establish a therapeutic relationship with Tasha. Besides, the nurse ought to assess the condition of Tasha as well as that of the baby. As such, the nursing practitioner ought to ask some of the following questions:-
- What names should we call you during this process?
- What date did you expect your child?
- Do you feel comfortable in this delivery room?
- Did you learn anything about childbirth from your nurse-midwife given that this is your first child?
- What do you and your husband expect during childbirth?
- When did you begin to experience regular contractions?
- Has your water broke (membrane ruptured)?
After Tasha’s membranes rapture, the nursing practitioner ought to ascertain whether the water has actually broken. The nursing practitioner ought to carry out various tests by examining the flow of vaginal fluid. Ideally, it is imperative to conduct an atrazine test using a sterilized speculum. The test measures the alkalinity of the fluids. A pH level that is above 6.5 ascertains that Tasha’s membrane has actually ruptured (Hobel & Chang, 2004). However, an atrazine test may not be as effective as a fern test that rarely gets affected by other factors such as infections and coitus.
The nursing practitioner ought to be proactive in conveying confidence to the members of Tasha’s family who are present during birth. The nurse should tell Tasha’s husband (George) that his wife has the ability to give a normal birth. Besides, he should convey the message that her wife is experiencing her first birth and as such, excessive contractions and pain might overwhelm her. However, George should not get worried considering that he is there to support her wife throughout the process. The nurse needs to ensure that Tasha and George are able to manage the contractions while he or she watches for any abnormal signs or problems.
During active labor, the nurse ought to inform the attendant about all information he or she has gathered from the patient. They include patterns of contraction, the outcomes of vaginal assessment, fetal heart rate pattern, vital signs that Tasha exhibits as well as other problems and concerns regarding the condition of the fetus. The nurse should also present other factors such as the level of pain and anxiety that Tasha exhibits. It is important to highlight that the fetal heart rate (FHR) ought to be between 110 and 160 beats per minute (BPM). FHR increases gradually if the fetus makes any movements. Further, the nurse ought to plot the cervical dilation after every exam to ascertain that Tasha’s labor progress is normal. Vital signs are important indicators of the progress of labor and every nurse to keep accurate data and report about the progress of the delivery process.
During the second stage of active labor, the uterus dilates between seven to ten centimeters. The nursing practitioner ought to encourage voiding after every two hours. In addition, he or she ought to clear all fluid around the birth canal since hydration status will remain constant. Third, the practitioner should also encourage Tasha to change positions frequently. Throughout the process, the nurse should provide psychosocial support not only to Tasha but also to George.
The third stage of labor is the time between the expulsion of the fetus and the expulsion of the placenta. On the other hand, the fourth stage of labor refers to a period of six weeks after Tasha gives birth. It is also referred to as postpartum. During these stages, the priority is the well-being of Tasha in order to provide care for her child in an effective way.
Neonatal Case Study: Baby Boy Andrew
According to the vital signs mentioned in the case study, baby Andrew seems to be normal. However, it is important to ensure that the baby learns to swallow breast milk. The rationale is that the relationship between the mother and the baby is growing. As such, the mother should share physical contact with the baby. Besides, the nursing practitioner should embark on the process of head molding. This is in lieu of the fact that baby Adam shows some moldings on his head. The reason is that the head may have experienced molding during labor and delivery processes.
The latch score for Mary and baby Andrew is seven. While the mother is ready to breastfeed the child, the couplet still experiences some challenges. First, the mother is yet to acquire competency in taking care of her child (Bloom & Cropley, 1994). Mary cannot breastfeed without the help of a nursing practitioner. As such, the nurse ought to ensure that the mother gains confidence and understand the process of breastfeeding. It would also entail ensuring that Mary is able to breastfeed in the right position. Second, baby Andrew does not exhibit audible swallowing. The nurse should advise Mary on ways to stimulate the baby in order to increase his swallowing ability. Improvements in Andrew’s ability to swallow will be noticeable since it will become intermittent and spontaneous.
A breastfeeding mother ought to know whether she is producing enough milk for the baby. A satisfied baby will feel sleepy and exhibit other signs. However, the baby may not exhibit some signs of hunger at the postpartum stage. Besides, a mother who is not feeding her child with enough milk should be able to know with ease. The rationale is that she should comprehend and monitor excessive production. Excessive milk is a sign that the child is not getting enough milk.
A newborn needs enough sleep since it is at this developmental phase that the brain is beginning to operate. Nonetheless, the mother should ensure that she has a schedule and knows when to breastfeed the baby. This will not only allow the baby to enjoy prolonged periods of uninterrupted sleep but also allow the mother to concentrate on other aspects of the upbringing of the baby. Many practitioners assert that breastfeeding ought to be consistent and frequent. Hence, mothers should not feel awful to wake the baby.
White spots are common in almost every infant. They are known as milia. They appear when skin pores begin to form on the baby. Hence, Lisa ought not to worry about the white spots since they will disappear as the baby continues to grow. Mary also notices that baby Andrew has bluish spots also known as acrocyanosis (Blackburn, 2003). It is normal for infants to have such spots but they disappear as the baby grows. However, the mother may intervene by applying various gels recommended by pediatricians to enhance the fast disappearance of the spots. Finally, Mary should take care of the cord by ensuring that it dries naturally. She should wash it frequently with liquid that dries up quickly such as alcohol and other fluids recommended by medics.
Postpartum Case Study: Linda Chan and Family
It is important to provide an assessment that reflects the appropriate care of Linda. First, the nurse ought to record the vital signs that Linda exhibits including bladder, perineal, and temperature. In addition, a nurse should record the status of the bladder, blood pressure, respiratory rate, and heart rate. This reduces the risk of hemorrhage that Linda may suffer. In addition, a high pulse rate could result from a specific drug that nursing practitioners may have administered on Linda. It may also be caused by hypovolemia due to excessive bleeding at birth (Blackburn, 2003). In this case study, the nurse administered Fentanyl to Linda during the second stage of delivery. Therefore, the drug may be the cause of a relatively high pulse rate.
Linda’s fundus is displaced to the left side. This implies that her bladder is full. Her full bladder may cause a high uterine fundus that interferes with contraction significantly. This may lead to hemorrhage. As such, it is important for the nursing practitioner to help Linda to urinate by massaging the uterus until it becomes firm. She should also advise Linda to void and catheterize frequently throughout the fourth stage of labor. Further, the report shows that Linda’s perineal is swollen. This might be because of hypovolemia due to excessive loss of blood. Consequently, the nursing practitioner should apply ice cubes or cold packs to remove the swelling. However, it is important to notify the birth attendant to arrange for surgical drainage if the discomfort persists. Besides, the patient’s body temperature ought to guide the practitioner. The rationale is that high body temperature may lead to reduced receptiveness to drugs.
Undoubtedly, Linda is experiencing perineal swelling and pain after five hours of postpartum care. It is imperative to observe these developments owing to the fact that hematomas have begun forming. Small and minute hematomas are controllable by the application of ice packs and are less painful. The ice packs are also applied to increase the comfort of the mother at this stage of labor (Blackburn, 2003). However, Linda’s Hematomas are painful implying that they are large and may cause enlargement of various tissues subsequently. To substantiate their color, a nursing practitioner ought to observe any bluish or purplish color. Consequently, she should be able to make a report to the birth attendant that outlines the discomforts faced by Linda. The birth attendant should immediately arrange for surgery that will remove the excess fluid and hematomas. The nursing practitioner ought to make a follow-up about Linda’s progress.
In order to reduce sibling rivalry, Linda and Robert should enhance their communications skills. This will not only allow them to explain to Angela about her sibling but also ease tension and hatred that may start to emerge. This is in recognition of the fact that Angela is only three years old and may be quick to notice some divided attention during the postpartum stage. Robert and Linda should also ensure that the family spends time together frequently. This will help Angela to internalize that her family has enlarged (Blackburn, 2003). Finally, it is important to establish familial attachment between Angela and the baby. The mother could allow Angela to hold the baby with assistance occasionally. This way, the couple will have reduced sibling rivalry tremendously.
Blackburn, T. (2003). Maternal, Fetal, and Neonatal Physiology: A clinical perspective. Philadelphia: Saunders Publishers.
Bloom R. & Cropley, C. (1994). Textbook of Neonatal Resuscitation. Washington: American Heart Association.
Hobel, J. & Chang, B. (2004). Normal Labor, Delivery, and Postpartum Care. New York: McGraw Hill.