Student name:
Supervisor Name:
Course Name:
Assignment Due Date:
Postpartum Case Study
Kardy Bee is G3P3 who had a successful vaginal delivery 3 hours ago to a 9-pound baby boy. She is type O+ blood group. Kardy has a third-degree perineal laceration with swelling and pain, and the quantified blood loss is 378ml. She has not voided since delivery and has a boggy uterus on examination.
The first nursing diagnosis is decreased fluid volume. This diagnosis is evidenced by blood loss of 378 ml and a decreased blood pressure. Decreased blood volume is among the leading cause of mortality due in the setting of postpartum haemorrhage secondary to uterine atony (Rani, QE01-QE05). The second nursing diagnosis is acute pain. Acute pain related to third-degree perineal laceration. Her pain is subjectively rated 8 of 10, and this would cause her significant discomfort. Kardy has difficulty in voiding thus exacerbating the existing pain. A need to prioritize and prevent or improve the care for these clients to avoid potential adverse outcomes has been identified (Woolner et al. xx). The third nursing diagnosis is urinary retention. Kardy had not voided 3 hours after birth. Urinary retention is diagnosed by failure to void after two consecutive hours. However, in this case, it is not definitively clear, the cause of urinary retention.
Priority Nursing Interventions
Priority nursing interventions, in this case, including ensuring adequate and timely delivery of Pitocin, arranging for blood samples for grouping and cross-match in readiness for transfusion, encouraging uterine fundus massage, the provision of adequate intravenous fluids at an appropriate rate, providing appropriate pain medication, consulting relevant teams to review the laceration for repair and evaluate the wound site, assessing client satisfaction, and monitoring vitals. (“Postpartum Hemorrhage: Background, Problem, Epidemiology”).
Standard Postpartum Care for Mothers and Rationale
As per WHO guidelines, standard care for postnatal mothers involves mandatory retention within the facility for 24 hours following uncomplicated delivery, serial assessments for perineal tears, vaginal bleeding, tone of the uterus, fundal regression, vitals and documentation of urine void within 6 hours. After 24 hours, subsequent assessments should focus on general status, systemic complaints, breastfeeding difficulties, and other maternal concerns. Further, deliberate attempts to establish emotional wellbeing, close observation for physical abuse, socio-economic framework, and support for the mother are recommended. (“WHO Recommendations on Postnatal Care of the Mother and Newborn”). This routine provides a careful screening service for potential postnatal problems.
Nursing Interventions for Painful Perineum
The nurse can provide analgesic medication, ice packs, stool softeners, ensure perineal hygiene, wound cleanliness, educate and reassure the client (“Chapter 29. Postpartum Perineal Pain Management”, 435-460).
Patient Education
Currently, the client needs to be informed on performing the uterine massage, observing perineal hygiene, vigilance for deterioration and reporting of any concerns and acceptable mother-infant bonding practices. At discharge, training on cord care, breast care, exclusive breastfeeding, and the mother encouraged to report for serial follow-up appointments and reviews (“WHO Recommendation on Postnatal Discharge Following Uncomplicated Vaginal Birth”).
Works Cited
Emerich Lentz Martins, Haimee. “The Practice of Nursing in the Prevention and Control of Postpartum Hemorrhage: An Integrative Review.” American Journal of Nursing Science, vol. 5, no. 1, 2016, p. 8.
“Maternal Mortality.” WHO | World Health Organization, 19 Sept. 2019, www.who.int/en/news-room/fact-sheets/detail/maternal-mortality.
Rani, P. R. “Recent Advances in the Management of Major Postpartum Haemorrhage – A Review.” JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH, 2017.
“WHO Recommendations on Postnatal Care of the Mother and Newborn.” World Health Organization, www.who.int/maternal_child_adolescent/documents/postnatal-care-recommendations/en/.
“Chapter 29. Postpartum Perineal Pain Management.” Vaginal Labor Pain Management, 2016, pp. 435-460.
“WHO Recommendation on Postnatal Discharge Following Uncomplicated Vaginal Birth.” WHO/OMS: Extranet Systems, extranet.who.int/rhl/topics/preconception-pregnancy-childbirth-and-postpartum-care/care-during-childbirth/who-recommendation-postnatal-discharge-following-uncomplicated-vaginal-birth.
“Postpartum Hemorrhage: Background, Problem, Epidemiology.” Diseases & Conditions – Medscape Reference, 27 Aug. 2020, emedicine.medscape.com/article/275038.