Please read the following case study details. Then answer the questions below.
Setting
You are a nurse caring for women on the post-partum floor. Kristen was admitted to the floor an hour ago right before change of shift.
Introduction
Kristen gave birth to a 6lb4oz little boy named Sawyer. She had a vaginal delivery complicated by the umbilical chord being wrapped around the infant’s neck. Midline episiotomy was done with extension to deliver the infant quickly due to fetal heart tones and narrow pelvic inlet. 3rd degree laceration. Father of baby not involved at this time and awaiting pending paternity results. Patient’s mother at beside for support. Kristen states she wants to try an breastfeed, but is scared of it hurting.
Chief Complaint
Patient hit call light for nurse, stating “I feel some pressure like I need to push again. Can someone help me up to the bathroom?”
Medical History
Chicken pox as a child. UTD on all immunizations. Tonsils removed 2013.
DOB: 12/31/2005NKDABlood type: O negativeRubella: Non-ImmuneHIV: NegativeHSV: DeniesHepatitis: NegativeHeight: 5’7Weight: 170 lbs. First day of LMP: 6/13/2002
G-1 T-0 P-1 A-0 L-1 G-1 P-1Vaginal Delivery: 35 weeks 2 days APGARS: 1 MIN: 7, 5MIN: 9(1 off for breathing, 2 off for color)
Fundus firm, 1 aboveMild to moderate bleedingNo bowel movements 500 cc’s output post delivery in L&D via straight cath. Patient has yet to ambulate to bathroom to void. Nipples sore per patient, no cracks or fissures noted
Questions
- Based on the chief complaint what do you think is the cause of this vaginal pressure? (Explain the associated risks and nursing interventions)
- Utilizing the BUBBLEEE acronym and the patient information provided, identify additional assessment information and interventions needed for each section.
- Breasts:
- Uterus:
- Bladder:
- Bowels:
- Lochia:
- Episiotomy and perineum:
- Extremities:
- Emotions:
- What patient education is needed for this patient prior to sending her home at discharge? List at least 5 different topics that need to be addressed.
- Add a question: After you have analyzed the content from the discussion board, please add a question to the end of your initial post regarding the reading material for the week.
Please be sure to validate your opinions and ideas with citations and references in APA format.
How to Solve Please read the following case study details. Then answer the questions below. Setting You are a nurse caring for women on the post-partum floor. Kristen was admitted to the floor an hour ago right b Nursing Assignment Help
Introduction:
This case study involves a post-partum patient who had a vaginal delivery complicated by an umbilical cord wrapped around the infant’s neck. The patient also had midline episiotomy with extension and a 3rd degree laceration. She has a chief complaint of feeling pressure and needing to push again.
1. Based on the chief complaint, what do you think is the cause of this vaginal pressure?
The cause of the vaginal pressure could be due to uterine atony or a retained placental fragment. Uterine atony is when the uterus fails to contract after delivery and is a common complication after childbirth. This can lead to excessive bleeding, which is a significant risk for the patient. Nursing interventions for uterine atony include massaging the fundus, administering uterine stimulants such as oxytocin, and assessing the patient’s vital signs and level of consciousness. If the cause of pressure is a retained placental fragment, the patient may require a manual removal of the placenta, which is a painful and invasive procedure. Therefore, it is essential to assess the cause of pressure accurately and quickly to minimize potential risks.
2. Utilizing the BUBBLEEE acronym and the patient information provided, identify additional assessment information and interventions needed for each section.
BUBBLEEE stands for breasts, uterus, bladder, bowel, lochia, episiotomy and perineum, extremities, and emotions.
Breasts: Assess the patient’s comfort level with breastfeeding, teach appropriate latching techniques, check for engorgement and signs of mastitis.
Uterus: Assess the fundus for firmness, location, and postpartum bleeding. Administer uterine stimulants as ordered, assess the patient’s vital signs.
Bladder: Assess for urinary retention or incontinence, monitor the patient’s urine output, and encourage frequent ambulation to stimulate urinary flow.
Bowels: Assess bowel sounds, encourage ambulation, and administer stool softeners to prevent constipation, which can cause discomfort and pain, make lacerations and episiotomies more painful, and interfere with wound healing.
Lochia: Assess the amount, color, and odor of postpartum discharge, and monitor for any signs of infection or excessive bleeding.
Episiotomy and perineum: Assess the laceration site for signs of infection or hematoma, assess pain level, and teach proper perineal care.
Extremities: Assess for edema and monitor the patient’s mobility.
Emotions: Assess the patient’s emotional state and provide emotional support as needed.
3. What patient education is needed for this patient prior to sending her home at discharge? List at least 5 different topics that need to be addressed.
Patient education for discharge should include breastfeeding techniques, perineal care, safety measures for the newborn, warning signs of postpartum complications such as bleeding, infection, and thromboembolism, and any postpartum medications prescribed. The patient may also need counseling on contraception options, newborn care including feeding, bathing, and sleeping, and postpartum emotional and physical support.
4. Add a question: After you have analyzed the content from the discussion board, please add a question to the end of your initial post regarding the reading material for the week.
What are the most common causes of uterine atony, and what interventions are used to treat it?
