Nursing Care Plans Maternity Healthcare Chapters Reading Case Study


Question Description

Chapter 15, Postpartum Adaptations

  • You are caring for Linda, who has just delivered her first baby. You are responsible for assessing Linda’s condition during recovery and for doing patient teaching when the opportunity arises. (Learning Objectives 1 and 2)
  • Gretta and Sam just had their first child. Gretta is excited and talkative about her birth experience and wants to keep her baby with her constantly. She tells you his name is Joseph and they will call him “Joey” for short. Gretta is breast-feeding and is attentive to Joey’s needs. You observe that Sam does not initiate contact with the baby but when Gretta insists that he hold Joey, he picks him up slowly and awkwardly and stares at his face for a long period of time. When Joey cries, he immediately returns him to Gretta’s arms. (Learning Objective 7)
  1. While she is recovering, you keep checking her fundal height. Linda asks you how her uterus will go back to the way it was before she had the baby. How would you explain this physiologic process? What could impede the process?
  2. Linda wants to know how long she should expect to bleed. What would you tell her?
  3. The next day Linda appears very passive and you have overheard her telling everyone who will listen about her labor experience. What phase of adjustment is Linda going through? What other stages should she go through while adjusting to her new role?
  • Based on your observations of Sam’s interactions with Joey, where is Sam developmentally in the process of paternal attachment and bonding?
  • What nursing interventions could you implement that would assist Sam in the transition to fatherhood?

Chapter 16, Nursing Management During the Postpartum Period

1. You are caring for Bonnie, age 42, who has just undergone a cesarean birth for her first baby. You are responsible for monitoring her condition during recovery and for teaching her how to take care of herself and her baby. (Learning Objectives 1, 2, 3, 4, and 7)

A. You note that Bonnie has a positive Homans’ sign in the left leg. What are the risk factors for thromboembolic disorders, and how will you determine if she has a DVT? If Bonnie has a DVT, what else is she at risk for?

B. Bonnie is ready for discharge and asks you about bleeding, perineal care, and what she should eat while breast-feeding. What are you going to teach her?

C. Bonnie, the baby, and Bonnie’s husband are following up for newborn care. What nursing interventions should be included to promote parental role adaptation and parent–newborn attachment?

2. You have just received report on the following patient. Hannah G1P1 gave birth vaginally 2 days ago to a baby girl. She had a midline episiotomy and has protruding hemorrhoids. Hannah is rubella negative and has A– blood type and her daughter is O+. Hannah is breast-feeding her daughter. Hannah is expected to be discharged to home later this afternoon. (Learning Objectives 5 and 7)

A. Describe the nursing management for Hannah and her family during the postpartum time period.

B. Hannah and Justin are preparing for discharge. What areas of health education are needed for discharge planning, home care, and follow-up visits for Hannah and her baby girl?

Chapter 22, Nursing Management of the Postpartum Woman at Risk

1. Amy calls the office 3 days after delivering a healthy baby girl and tells you she is passing small clots and feels like her bleeding is heavier than it should be. You advise Amy to come into the clinic to be checked. (Learning Objectives 1, 2, 3, and 6)

  1. What are the “four T's” that need to be assessed in a possible case of postpartum hemorrhage?
  2. Amy also tearfully tells you that she is experiencing anxiety and feelings of being overwhelmed. What is she experiencing, and what education are you going to provide?

2. Alyssa, age 26, had a cesarean delivery 7 days ago and is breast-feeding her baby. She calls the office today and reports that she has a temperature of 102. (Learning Objective 5)

  1. Given the limited information you have, describe the four most likely types of infection Alyssa may have contracted.
  2. What additional questions do you want to ask her to try to ascertain the cause of her fever?
  3. Describe the care required to treat each of these infections.

Tutor Answer

School: University of Maryland

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Question 15:
1) This physiologic process can be explained as Linda’s uterus can eventually return to the
regular size during the involution, which consists of the contraction, catabolism, and
regeneration. During contraction, it can decrease these previously stretched fibres of the muscle
throughout Linda’s pregnancy. During catabolism, the enlarged myometrial cells would be
reduced. And finally, during the lochial discharge, there would be the regeneration of the
epithelium of the uterine from decidua’s upper layer after it has already been sloughed off and
then shed.
The things that could impede the progress are that Linda’s retrogressive system does not
happen because of her infection or placental fragments. After the contraction within Linda's
uterus happens normally and furthermore because of hormones accounted for breastfeeding
are activated causing that contraction. Consequently, it can reduce in size by 2cm per day and
can return to the pelvis by half of a month.
2) She can be told that her heavy bleeding normally exists for no longer than 10 days, and after
that, her spotting or slight bleeding can be noticed until a month and a half or 6 weeks.
3) Linda is indeed undergoing her 2nd phase in which her feelings can be expressed and
understood by shad, and that phase normally lasts no more than 3 days. Moreover, she needs
someone to support and listen to her because she will talk more than usual; however, she will
be so perceptive and have passive actions. Other than that, she has to undergo two more
phases which are a letting-go phase and taking-hold phase.

Sam will be developmentally within the process of paternal attachment as well as
bonding in an arbitrary state of the nervous system, which makes him become anxious
and thus he can think more about his responsibilities.
The nursing interventions which can be implemented by me include my encouragement
that makes him hold the child, my support to the female so that she can do the
breastfeeding. Besides, other nursing interventions are that I can make sure that the
man will spend more time with the child, and I will inform him about Gretta's bad
experience before she gives birth to the baby.

Question 16:
A) DVT is one of the risk factors for aspiratory embolism, and other risk factors can be the
immobilization including the bed rest and the obesity. Medical illness including cancer can be
another risk factor as well, which brings about Bonnie's risk of experiencing orthopaedic surgery.
The symptoms for that are her complaint in pain or the tenderness and swelling of her toes.
B) I am going to teach Bonnie that her bleeding will stop as like her normal period and that her
consistently perineal care is imperative until her blood flow stops. Moreove...

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