post natal miother with hbsag positive case study
TRANSCRIPT
POSTNATAL ASSESSMENT
PATIENT IDENTIFICATION
Name : Mrs. Manjulla
Age : 25 years
Ward : Post operative ward
Religion : Hindu
Date of admission : 22/9/12
Date of delivery : 24/9/12
Type of delivery : Caesarean section
Indication : Previous caesarean section
Diagnosis : Hbs AG positive
Obstetrical score : G2P2L2A0
Date of care started : 23/9/12
Date of care ended : 3/10/12
INTRODUCTION
During my posting in St Mary’s Hospital I was posted in postoperative ward
and I took Mrs. Manjulla post natal mother for care study .She delivered a male baby
with birth weight 2900 gms on 24/9/12 at 1.30 pm by caesarean section. I introduced
myself to her and explained how I will be helping her cope with postnatal problem
FAMILY HISTORY
Mrs. Manjulla has no family history of Diabetes mellitus, Hypertenssion,
multiple pregnancy, cardiac problem, and psychiatry problems. But the patient is
suffering with chronic hepatitis B.
SOCIO-ECONOMIC STATUS
She belongs to lower class family. They live in house of their own with all
minimum basic requirements such as electricity, water supply. Her husband is the bread
winner of her family.
PERSONAL HISTORY
Diet: She is taking mixed diet
Hygiene : She is not maintaining good personal hygiene
Sleep : She used to sleep 8 hours at night and 2 hours in day time. She has no sleeping
disturbance
Bowel and bladder : No history of bowel and bladder pattern disturbance.
Habits: She has no bad habits like chewing tobacco or drinking alcohol
MENSTRUAL HISTORY
She attained menarche at the age of 14 years . She is having regular cycle of 28 days
with moderate flow. Her menstrual flow lasts for 4-5 days.
MARITAL HISTORY
She got married at the age of20 years. Her marital life is 5 years and her marriage is
non –consanguinous marriage.
PAST MEDICAL HISTORY
Mrs. Manjulla is known Hbs Ag positive patient.
PAST SURGICAL HISTORY
She underwent LSCS 2 years back.
OBSTETRICAL HISTORY
Past obstetrical history
No.
Of
preg
nanc
is
Typ
e of
de
live
ry
Dat
e
Ges
tati
ona
l wee
ks
Bab
y
Cou
rse
of
preg
nanc
y
Rem
arks
1 LSCS 201038
Girl baby with 2500gms
Uneventful Mother and the baby were healthy
Present obstetrical history
Obstetrical score : G2P2L2A0
LMP : 23/12/11
EDD : 30/9/12
Gestational age : 39 weeks
Ist trimester
12/2/12
IInd trimester
20/5/12
IIIrd trimester
12/8/12
She had ante Had ante natal Had ante natal visits.
natal visit regularly.
Taken folic acid
tablets.
No exposure to
radiations.
She had vomiting
from 3rd week up to
8thth week
Body
weight:45kg
Haemoglobin:
10 gms%
First trimester
was uneventful
visit.
Taken Iron, Folic
acid and Calcium
tablets regularly.
Fetal movements
were felt.
Inj.T.T taken.
Body
weight:50kg
Haemoglobin:
9.9gms%
Second trimester
was uneventful
Taken iron folic acid and
calcium tablets.
Inj. T.T taken
Fetal movements was
good
Body weight:54kg
Haemoglobin : 9.9 gms%
Third trimester was
uneventful
REASON FOR CAESAREAN SECTION
Previous LSCS and Hbs Ag positive
PHYSICAL EXAMINATION
Vital signs
Temp : 99.90 F
Pulse : 86 b/m
Respiration : 24 br/m
BP : 120/70mmHg
Weight : 50kg
Height : 162cm
General appearance : Moderately built
Mood : Cheerful
HEAD TO FOT EXAMINATION
Head : Healthy hair. Clean scalp. No dandruff or lesions
Face : No edema, rashes on the face
Skin : Acne vulgarise is present all over the body
Eyes : Conjunctiva pale in colour, normal vision
Ear : Hearing normal, no abnormal discharge
Nose : No septal deviation , no abnormal discharge
Mouth : Lips and tongue are dry
Teeth : No dental carries
Neck : No thyroid and lymph node enlargement
Chest : Expansion of the chest is normal
CVS : S1and S2 heard
Breast : Soft, nipple erect, no cracks , no tenderness on palpation
Abdomen : On inspection linear nigra and stria gravid present
LSCS incision present .
On palpation uterus well contracted.
bowel and bladder : she passed urine and bowel sounds are normal
Genitalia : Lochia rubra present
Extremities : Normal range of motion, no oedema , human sign is negative
INVESTIGATIONS
Date Name of
investigation
Patient
value
Normal value Remark
20/5/12 Blood grouping AB + ve
20/5/12 Hb% 9.9gm/dl 13-14mg/dl She is an
anaemic mother
20/5/12 RBS 120mg/dl 80-120mg/dl She is not a
diabetic mother
20/5/12 Hbs Ag Positive Negative
20/5/12 HIV Negative Negative
MEDICATION
Sl n
o
Dru
g n
ame
Rou
te
Doz
e
Fre
qu
en
cy
Act
ion
Ind
icat
ion
s
Sid
e ef
fect
s
Con
tra
ind
icat
ion
s
1 Inj .Taxim
IV 1.5gm BD
Bind to bacterial cell wall membrane causing cell death
Skin and skin infections, prophylactic for surgery
GI effects; anaphylactic shock (rare).
Allergy or hypersensitivity to cephalosporins.
2 Inj. Metrogyl
IV 500 gm
BD
Disrupts DNA and protein synthesis in susceptible organisms
Perioperative prophylactic, intra abdominal infection
Head ache, anorexia, nausea, rashes, phlebitis at IV site, unpleasant taste
Hypersensitivity, first trimester of pregnancy
3 Inj. pantop
IV 40 mg BD
Binds to an enzyme in the presence of acidic gastric Ph, preventing the final transport of hydrogen ions in to the gastric lumen
GERD, gastritis Head ache, abdominal pain, diarrhoea, flatulence, hyper glycemia
Hypersensitivity, pregnancy
4 Inj .Tromdal
IV 50 mg HS
Inhibits reuptake of serotonin and nor epinephrine in CNS
Moderate to moderately severe pain
Dizziness, head ache, somnolence, vaso dilation, constipation, nausea
Alcohol intoxication, opioid dependence
DELIVERY NOTES
Mrs.Manjulla was admitted on 22/9/12 due to previous LSCS. She
was taken for LSCS on 24/9/12. Inj. Taxim 1 gm IV, Inj emest 2mg and Inj Pantop 40
mg IV given. Foly’s catheter inserted. Pre preparations given and she was taken to
OT at 1.15 PM. Spinal anaesthesia is given by using 5ml of Buppivaccaine 25%. A Boy
baby with birth weight 2900 gms was extracted by LSCS AT 1.30 pm . Baby cried
immediately after the birth. Post partum sterilisation was done. Wound sutured with 2.0
catgut and 1.0 polypropylene suture and sterile dressing given. She was shifted to post
operative unit at 2.00 pm. IV fluids were continued. She was kept nil per oral for next
24 hrs. Fluids were given after that and oral food intake started after checking bowel
sounds.
POST NATAL MIOTHER WITH HBSAG POSITIVE
INTRODUCTION
Hepatitis B virus (HBV) is a blood borne and sexually transmitted virus. Rates of new
infection and acute disease are highest among adults, but chronic infection is more likely to
occur in persons infected as infants or young children. Before hepatitis B vaccination
programs became routine in the United States, an estimated 30%–40% of chronic infections
are believed to have resulted from perinatal or early childhood transmission, even though
<10% of reported cases of hepatitis B occurred in children aged <10 years Chronically
infected persons are at increased lifetime risk for cirrhosis and hepato cellular carcinoma
(HCC) and also serve as the main reservoir for continued HBV transmission.
HEPATITIS
The term 'hepatitis' simply means inflammation of the liver. Hepatitis may be caused
by a virus or a toxin such as alcohol. Other viruses that can cause injury to liver cells include
the hepatitis A and hepatitis C viruses. These viruses are not related to each other or to
hepatitis B virus and differ in their structure, the ways they are spread among individuals, the
severity of symptoms they can cause, the way they are treated, and the outcome of the
infection.
HEPATITIS B
Hepatitis B is an infection of the liver caused by the hepatitis B virus (HBV). It is
estimated that 350 million individuals worldwide are infected with the virus, which causes
620,000 deaths worldwide each year.
The hepatitis B virus is a DNA virus, meaning that its genetic material is made up of
deoxyribonucleic acids. It belongs to a family of viruses known as Hepadnaviridae. The virus
is primarily found in the liver but is also present in the blood and certain body fluids.
INCUBATION PERIOD
The average incubation period is 90 days from time of exposure to onset of
symptoms, but may vary from 6 weeks to 6 months
TRANSMISSION OF HEPATITS B VIRUS
Hepatitis B is spread mainly by exposure to infected blood or body secretions. Hepatitis B is
not spread through food, water, or by casual contact.
BOOK PICTURE PATIENT PICTURE
Semen, vaginal discharge, breast milk,
and saliva
Blood and blood products
Sexual contact
Using contaminated needles Mrs.Manjulla got hepatitis B due to
contaminated needles.
Tattooing
Body piercing
Sharing toothbrushes and razors
contaminated with infected fluids or blood.
Infected mothers to their babies at birth
Donated livers , and other organs
However, blood and organ donors are routinely screened for hepatitis which typically
prevents this type of transmission.
HIGH RISK PERSONS
The high risk persons getting hepatitis B includes
Health care workers
Dentists
Intimate and household contacts of patients with chronic hepatitis B infection
Public safety workers who may be exposed to blood
Men who have sex with men
Individuals with multiple sexual partners
Dialysis patients
Injection drug users
Persons with chronic liver disease
Residents and staff in institutions that care for persons with developmental disabilities
Persons infected with HIV
Persons who require repeated transfusions or blood products.
THE SYMPTOMS OF ACUTE HEPATITIS B
Acute hepatitis B is the period of illness that occurs during the first one to four months after
acquiring the virus. Only 30% to 50% of adults develop significant symptoms during acute
infection. Early symptoms may be non-specific, including fever, a flu-like illness, and joint
pains.
BOOK PICTURE PATIENT PICTURE
Fatigue Fatigue present
Loss of appetite
Nausea
Jaundice
Pain in the right upper abdomen (due to
inflammated liver)
Pain in the abdomen
THE SYMPTOMS OF CHRONIC HEPATITIS B
The liver is a vital organ that has many functions. These include a role in the immune
system, production of clotting factors, producing bile for digestion, and breaking down toxic
substances, etc. Patients with chronic hepatitis B develop symptoms in proportion to the
degree of abnormalities in these functions. The signs and symptoms of chronic hepatitis B
vary widely depending on the severity of the liver damage. They range from few and
relatively mild signs and symptoms to signs and symptoms of severe liver disease such as
cirrhosis or liver failure.
Book picture
Because of chronic hepatitis the patient is feeling fatigue , puss formed at the surgical wound
and got difficulty to heal the wound . Baby is diagnosed with jaundice.
Cirrhosis of the liver due to hepatitis B
Inflammation from chronic hepatitis B can progress to cirrhosis of the liver. Significant
Symptoms may include:
Weakness,
Fatigue,
Loss of appetite,
Weight loss,
Breast enlargement in men,
Rash on the palms,
Difficulty with blood clotting, and
DIAGNOSTIC MEASURES
Book picture Patient picture
History collection Information through history collection
Physical examination
For detection of hepatitis B virus infection
involve serum or blood tests that detect either
viral antigens (proteins produced by the
virus) or antibodies produced by the host
Blood test shows mother is HbsAg positive
Liver biopsy examined under microscopy
MEDICATIONS
prednisone: used to treat many diseases, including asthma, inflammatory bowel disease,
and certain types of skin disease and arthritis
methotrexate (Rheumatrex, Trexall): used to treat certain types of skin disease, arthritis,
and cancer;
cyclophosphamide (Cytoxan): used to treat some cancers.
PREVENTION OF PERINATAL HBV INFECTION AND MANAGEMENT OF
PREGNANT WOMEN
Treatment
Acute hepatitis B usually resolves on its own and does not require medical treatment. If very
severe, symptoms such as vomiting or diarrhoea are present, the affected person may require
treatment to restore fluids and electrolytes. There are no medications that can prevent acute
hepatitis B from becoming chronic.
If a person has chronic hepatitis B, they should see their health care provider regularly
Prevention
Two available hepatitis B vaccines for immunization are Recombivax HB and Engerix-B
Pregnancy is not a contraindication to vaccination.
For vaccination of adults 20 years of age and older:
1-mL dose by intramuscular injection into the deltoid muscle, at initial visit, then one
month and six months after the first dose, for a total of three doses
After Exposure to Persons Who Have Acute Hepatitis B
When exposure has occurred as a result of sexual contact within 14 days after the most
recent sexual contact administer
A course of HBV vaccine into the deltoid as above
A dose of Hepatitis B immune globulin (HBIG) 0.06 mL/kg IM
For prophylaxis after percutaneous or mucous membrane injury, a second dose of
HBIG should be given 1 month later.
Exposure to Persons Who Have Chronic HBV Infection
Active post exposure prophylaxis with hepatitis B vaccine alone is recommended for
sex or needle-sharing partners and non-sexual household contacts of persons with
chronic HBV infection
Ante partum
At time of admission for delivery
o Review hepatitis B surface antigen (HBsAg) status of all pregnant women.
o Record maternal HBsAg test results on both labor and delivery record and
on infant’s delivery summary sheet. Perform HBsAg testing as soon as
possible on women who
do not have a documented HBsAg test result,
were at risk for HBV infection during pregnancy (e.g., more than one sex
partner in the previous 6 months, evaluation or treatment for a sexually
transmitted disease, recent or current injection-drug use, or HBsAg-
positive sex partner), or
had clinical hepatitis since previous testing
Pregnant Hepatitis B carriers should be advised to
Obtain vaccination against hepatitis viruses as indicated.
Abstain form alcohol use
Avoid hepato toxic drugs such as acetaminophen (Tylenol) that may worsen liver
damage.
Not donate blood, body organs, or other tissue.
Not share any personal items that may have blood on them (e.g., toothbrushes and
razors).
Inform the infant’s pediatrician, OB/GYN, and labor staff that they are a hepatitis B
carrier.
Make sure their baby receives hepatitis B vaccine at birth, one month, and six months
of age as well as H-BIG at birth.
Be seen at least annually by their regular medical doctor.
DELIVERY
BOOK PICTURE PATIENT PICTURE
Although cesarean delivery has been
proposed as a means of reducing mother to
child transmission (MCT) of HBV The mode
of delivery does not appear to have a
significant effect on the interruption of HBV
maternal-baby transmission by immune
prophylaxis. Delivery by cesarean section for
the purpose of reducing MCT of HBV is note
presently recommended
LSCS
CARE OF THE NEWBORN BABY
BOOK PICTURE PATIENT PICTURE
Standard precautions should be utilised when
handling the babyFollowed
The skin at the injection site should be
cleaned with soap and water or with an
alcohol swab before administering hepatitis
B vaccine, immunoglobulin and vitamin K
Followed
The baby should remain in the birthing room
until transfer to the ward unless transfer to
the nursery is indicated
Babies direct rooming in with their mother
may be cared for in the ward nursery as
require
Practised
Breastfeeding is encouragedThe baby is sucking
Give hepatitis B immune globulin and
hepatitis B within 12 hours of birthImmunisation given
For preterm infants weighing <2,000 g, the initial vaccine dose (birth dose) should not be
counted as part of the vaccine series because of the potentially reduced immunogenicity of
hepatitis B vaccine in these infants; 3 additional doses of vaccine (for a total of 4 doses)
should be administered beginning when the infant reaches age 1 month
POST PARTUM PERIOD.
BOOK PICTURE PATIENT PICTURE
Provide information regarding hepatitis B to
HBsAg positive mothers, including
advice that they may breast feed their
infants upon delivery;
modes of HBV transmission;
need for vaccination of their susceptible
household, sexual, and needle-sharing
contacts;
need for substance abuse treatment, if
appropriate
Information given
At time infant is discharged
• Provide infant’s immunization record to mother
and remind her to take it to the infant’s first visit
Information given
to paediatric health-care provider
Mothers with unknown HBsAg status and their infants
Administer single-antigen hepatitis B vaccine (without HBIG) to all infants born to
mothers with unknown HBsAg status <12 hours after birth and record date and time
of administration of hepatitis B vaccine on infant’s medical record.
Alert infant’s paediatric health-care provider if an infant is discharged before the
mother’s HBsAg test result is available; if the mother is determined to be HBsAg
positive, HBIG should be administered to the infant as soon as possible, but no later
than age 7 days.
All mothers and their infants
Administer a dose of single-antigen hepatitis B vaccine to all infants weighing >2,000
g.
Ensure that all mothers have been tested for HBsAg prenatally or at the timeof
admission for delivery and document test results.
PROBLEMS IDENTIFIED
Pain
Impaired skin integrity and spread of sepsis
Insomnia
Risk for fluid volume imbalance
Risk for impaired infant –parent attachment
NURSIND DIAGNOSIS
Acute pain related to surgical incision.
Impaired skin integrity and spread of sepsis due to chronic infection
Disturbed sleep pattern related to hospitalisation.
Risk for fluid volume imbalance related to nill per oral status.
Risk for impaired parent attachment due to presence of infection
ASSESSMENT NURSING DIAGNOSIS
EXPECTED OUTCOME
INTERVENTION RATIONALE IMPLEMENTATION EVALUATION
Subjective data:The mother says that she has pain over the incision site.
Objective data:The mother has difficulty to get up from the bed and walk.Her facial expression shows that she is having severe pain. She is having pain score 8 in pain scale.
Acute pain relate to surgical incision.
Mother experiences less pain with in 2 hrs as evidence by relaxed facial expression.
Provide comfortable position.
Instruct the mother to do deep breathing and coughing exercise
Advice to support the incision area with pillow while coughing or sneezing or moving
Ensure adequate rest
Provide divertional activities Initiate active range of motion exercise and walking
Administer medications as per order
To relieve tension over the incision.
For pulmonary ventilation especially to remove stress and promote relaxation
To relieve tension over the incision.
To reduce pain due to movement.
To promote circulation ,to prevent venous thrombosis and reduce pressure on the surgical site
To reduce perception of pain.
Provided comfortable position
Instructed the mother to do deep breathing and coughing exercise
Advised to support the incision site with pillow while sneezing or coughing.
Ensured adequate rest.
Provided divertional activities Initiated active range of motion exercise and walking
Administered inj. tremadol
She got slight relief from the pain after 2 hours. Pain scale score reduced to 4
ASSESSMENT NURSING DIAGNOSIS
EXPECTED OUTCOME
INTERVENTION RATIONALE IMPLEMENTATION EVALUATION
Subjective data Mother says I am having fever and pain on the surgical site
Objective dataThe unhealed wound and puss formation at the surgical site.Increased body temperature
Impaired skin integrity and spread of sepsis due to chronic infection
The mother achieves timely healing and free of additional complication as evidence by heeling wound and normal body temperature.
Demonstrate strict hand washing policy for patient ,visitors and staff.
Provide proper contamination of infected material
Clean the surgical site with Betadine solution and apply sterile dressing
Demonstrate proper fundal massage
Monitor the vital signs
Monitor oral intake and output and encourage the mother to take more fluids
Administer proper antibiotics to mother
Hand washing prevent cross infection
It prevent the spread of infection
It reduce the growth of the bacteria and virus
It helps in involution of the uterus and remove retained content To identify the fluctuations in the temperature levelIncreased intake replaces the losses and enhance circulation
To reduce growth of the micro organism
Demonstrated strict hand washing policy for patient ,visitors and staff.
Provided proper contamination of infected material
Cleaned the surgical site with Betadine solution and applied sterile dressing
Demonstrated proper fundal massage
Monitored the vital signs
Monitored oral intake and output and encouraged the mother to take more fluids
Administered proper antibiotics to mother
The mother
maintained
normal skin
integrity as
evidenced by
healed wound
within 6 days
ASSESSMENT NURSING DIAGNOSIS
EXPECTED OUTCOME
INTERVENTION RATIONALE IMPLEMENTATION EVALUATION
Subjective data:Mother says that she can’t sleep last night because of pain
Subjective data:She looks very tired .Falling asleep in between feeding the baby.
Disturbed sleep pattern related to hospitalisation .
Mother experiences better sleep with in 24 hrs as evidence by verbal expression.
Provide comfortable
position for sleep
Advice to take sleep
when baby sleeps.
Provide calm
environment in the ward.
Provide comfort devices
like pillows while
positioning the mother
Enhance relaxation.
To avoid interruption in
sleep due to baby’s cry
and feeding
To avoid sleep
disturbance
To get more
comfort.
Provided comfortable
position for sleep.
Advised to take sleep
while baby sleeps.
Provided calm
environment in the ward
by limiting the visitors
and by putting curtains
around the bed.
Kept pillows at back to
position the mother.
She had better sleeping pattern on the next day.
ASSESSMENT NURSING DIAGNOSIS
EXPECTED OUTCOME
INTERVENTION RATIONALE IMPLEMENTATION EVALUATION
Objective data :Chronic infection of motherJaundice of the baby
Risk for
impaired
parent
attachment due
to presence of
infection
The mother
experiences
comfort
parenting as
evidence by
good parent
infant
attachment.
Observe the maternal and infant interaction
Provide opportunity for maternal and infant contact whenever possible
Monitor mother’s emotional response to illness and separation from infant
Encourage the mother to feed the baby whenever possible
Discuss the availability of supportive system in the home setting Administer Hepatitis B immune globulin
To identify copying pattern of the mother
It will improve the bonding between mother and the baby
It helps in identify the mother’s problem and protect the mother from getting post partum depression
Feeding will improve the bonding between mother and the babyIt helps to maintain time for spending the time with the baby.To prevent Hbs Ag transmission from mother to child
Observed the maternal and infant interaction
Provided opportunity for maternal and infant contact whenever possible
Monitored mother’s emotional response to illness and separation from infant
Encouraged the mother to feed the baby whenever possible
Discussed the availability of supportive system in the home setting Administered Hepatitis B immune globulin
The mother
maintained
good
attachment
with the baby
as evidenced
frequent
feeding .
NEW BORN ASSESSMENT
Name of the baby : B/O Manjulla
Sex : Boy baby
Date of birth : 24/9/12
Birth weight : 2900gm
Apgar score : 7 at 1 minute and 9 at5 minutes .
Head circumference : 34cm
Chest circumference : 32cm
Length : 50cm
Skin : Pink in colour, vernix caseosa present
Head : Anterior frontenella and posterior frontenalla
palpable.
Nose : No deviated septum, milia present
Mouth : Pink in colour, no cleft lip or cleft palate
Eyes : No discharges, symmetry in size and shape,
yellowish discolouration
Ears : Corrected placement, no discharges
Neck : No swellings, normal range of motion
Chest` : Symmetric chest movement nipple prominent
Heart rate : 130 b/mt
Respiratory rate : 40 b/mt
Abdomen : Round and dome shape
Bowel pattern : Meconium passed
Bladder pattern : Urine voided
Genitalia : Testis descend to scrotum, no abnormalities
Extremities : No congenital malformations, flexed position
REFLEXES
Rooting : Present
Sucking : present
Swallowing : present
Sneezing and coughing : present
Gagging : present
Blinking : present
Doll’s eye movement : present
Palmar grasp : present
Plantar grasp reflex : present
Moro reflex : present
PROBLEMS IDENTIFIED
Risk for ineffective breast feeding
Risk for hypoglycaemia
Risk for impaired skin integrity
NURSIND DIAGNOSIS
Risk for infection related to immature immune system.
Risk for ineffective breast feeding related to maternal infection
Risk for hypoglycaemia related to ineffective feeding.
Risk for impaired skin integrity related to side effects of phototherapy.
ASSESSMENT NURSING DIAGNOSIS
EXPECTED OUTCOME
PLAN OF ACTION RATIONALE IMPLEMENTATION EVALUATION
Subjective data: Mother asks whether her baby will get any infection from hospital.
Objective data:The baby’s immune system is immature.
Risk for infection related to immature immune system.
The baby remains free from infection
Educate mother about keeping the umbilical cord stump clean.
Advice to reduce the number of visitors.
Advice to change the soiled diaper frequently.
Ensure hourly breast feeding.
Ensure the breast hygiene of the mother.
Administer Hepatitis B immune globulin
To prevent cord contamination.
To prevent cross infection.
To prevent urinary infection and skin rashes.
Breast milk adds to infants immunity.
To prevent the transfer of micro organisms.
To prevent the transmission of mother to the baby
Educated the mother about keeping umbilical cord stump clean and avoid touching it with hand.
Advised to reduce the number of visitors.
Advised to change the soiled diaper frequently.
Educated mother about need for hourly feeding
Advised mother to keep her breast clean before and after feeding the baby.Administered Hepatitis B immune globulin
The baby has no signs of infection
ASSESSMENT NURSING DIAGNOSIS
EXPECTED OUTCOME
INTERVENTION RATIONALE IMPLEMENTATION EVALUATION
Subjective data:Mother says that baby is crying when she try to give breast feed.
Objective data :Mother not holding the baby properly during breast feeding.Baby is not attached to the breast properly.Baby looks sleepy.
Risk for
hypoglycaemia
related to
ineffective
feeding
Baby remains
free from the
risk for
hypoglycaem
ia during the
period of
hospitalisatio
n.
Teach proper feeding techniques.
Advice the mother to feed the baby in time.
Advice the mother to wake up the baby if he sleeps in between feeding.
Teach the mother the importance of breast feeding.
Assist the mother in feeding the baby.
Teach the mother the signs of hypoglycaemia of baby.
To help her to feed baby properly
To avoid risk for hypoglycaemia.
To avoid baby going to hypoglycaemia.
To make her to breast feed the baby properly.
To make sure that the mother is feeding baby properly.
Help to take necessary interventions.
Taught proper positions for feeding
Advised mother to feed the baby atleast 2 hourly.
Adviced mother to keep the baby awake during feeding by ticling on sole or ears.
Educated mother about importance of breast feeding.
Assisted mother in feeding the baby.
Educated mother to notice weather the baby is drowsy or always sleeping.
Baby had no hypoglycaemia and the baby is active.
ASSESSMENT NURSING DIAGNOSIS
EXPECTED OUTCOME
INTERVENTION RATIONALE IMPLEMENTATION EVALUATION
Objective data:
Continuous
phototherapy and
fluorescent lights
Risk for
impaired skin
integrity
related to side
effects of
phototherapy.
The baby
maintains
normal skin
integrity as
evidenced by
proper
phototherapy
Measure the quality of photo
energy of fluorescent bulbs
Apply patches to closed eyes
and inspect eyes every 2 hours
Monitor skin temperature
every 2 hours.
Reposition the infant every 2
hours
Monitor fluid intake and output
and provide breast milk
The intensity of blue
light striking the skin
surface from blue light
To prevent the damage of
the retina from high
density of light
To know the fluctuations
in the body temperature
To allow equal exposure
to fluorescent light
It helps in prevention of
dehydration and maintain
good attachment
Measured the quality of photo
energy of fluorescent bulbs
Applied patches to closed eyes
and inspect eyes every 2 hours
Monitored skin temperature
every 2 hours.
Repositioned the infant every 2
hours
Monitored fluid intake and output and provided breast milk
The baby
maintain
normal skin
integrity as
evidenced by
proper
phototherapy
treatment
SUat 1.3MMARY
I took Mrs. Manjulla a 25 year old post natal mother during my clinical posting in
cooperation hospital, as a part of my clinical requirement. She was on her third post natal
day. She underwent caesarean section on 24/9/11 at 1.30 pm and delivered a male baby with
birth weight 2900 gms. I collected her health history and performed post natal examination.
She was having problems like pain, insomnia, nutritional imbalance and wound infection.
Her baby was having problems like, jaundice ,risk for infection and in adequate breast
feeding. I tried to solve their problems by giving health educations and advising her about
necessary interventions. Some of her problems like pain and insomnia has reduced with the
interventions. Her surgical site stitches were removed on 9 th postoperative day. She acquired
adequate knowledge regarding wound care new born care and she started breast feeding the
baby properly.
CONCLUSION
I took Mrs. Manjulla Hbs Ag positive mother as my postnatal care study. She underwent
caesarean section on 24/9/12 at 1.30pm and delivered a boy baby with birth weight 2900
gms. I was able to study about the care of a postnatal patient who has undergone a caesarean
section and her baby and to provide care for her.
REFERENCES
DuttaD.C . Text Book Of Obstetrics Including Perinatology And Contraception. VIth
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UNIVERSAL COLLEGE OF NURSING
POSTNATAL CASE STUDY
SUBMITTED TO : MRS PRATHIMA.P
ASST.PROFESSOR
HOD DEPARTMENT OF OBG
UNIVERSAL COLLEGE OF NURSING
BANGALORE
SUBMITTED BY: MS AMALA GEORGE
2ND YEAR MSC NURSING
UNIVERSAL COLLEGE OF NURSING
BANGALORE