By Sheryl Duncan, Ashley Halliwill, and
Dawn Simon
September 30th, 2008
Patient Background
 Age: 30
 Religion: Christian
 Education: Attending 2nd year of nursing school.
 Works as an STNA and goes to college.
 African American
 Married
Patient Medical History
 Admitted to hospital for a Vaginal Delivery.
 Allergies: NKA (No known allergies)
 Significant family medical Hx: father has diabetes
mellitus
 Medical or Surgical Hx: appendectomy & tonsillectomy
OB History
 Gravida 1 Para 1
 LMP: 12/10/07
 EDD: 9/17/08
 # of weeks of gestation: 40 weeks
 Type of Delivery: Vaginal
 Anesthesia: Epidural
 Meds during pregnancy: prenatal vitamins
Prenatal Labs
Prenatal Tests
Normals
Type & Rh
If mother is Rh
A+
negative then treat
with Rhogam to
prevent
sensitization to the
Rh factor, and to
prevent hemolytic
disease in the
newborn in
subsequent
pregnancies
37-47%/12-16
42%/14
No need for
Rhogam, mother is
Rh positive
Negative
Normal
Hematocrit &
Hemoglobin
VDRL/RPR(tests
for syphilis)
Patient Results
Negative
Analysis
Normal findings
Prenatal Labs (Cont.’d)
Prenatal Tests
Normals
Patient Results
Analysis
Rubella
Immune
Immune
Normal
Urine C & S
Negative for
asymptomatic
bacteria
Absence of sickle
cell hemoglobin
Negative for
Chlamydia
trachomatis/Neiss
eria gonorrhoeae
No abnormal cells
found
Normal levels of
HCG
Negative
Normal
Absent
Normal
Negative
Normal
Sickle Cell
Chlamydia/
Gonorrhea
PAP Test
Quad Screen
No abnormal cells Normal
found
452,000 IU/24 hr Normal
Prenatal Labs (Cont.’d)
Prenatal Tests
Normals
Patient Results Analysis
GBS
Negative
Negative
Normal
Glucose Fasting
At/below 95
mg/dL
92 mg/dL
Normal
1 hr Glucose
Tolerance
2 hr Glucose
Tolerance
3 hr Glucose
Tolerance
At/below 180
mg/dL
N/A
171 mg/dl
Normal
N/A
N/A
N/A
N/A
N/A
Prenatal Medications
Medications
Dose, Route
Indication for
use
Side Effects
Nursing
Responsibilities
Prenatal
Vitamins
-1 tablet po once
daily
-tablets (200 mg,
250 mg, or 300
mg calcium; 60
mg, 65 mg, or 90
mg iron;
1.0 mg folic acid;
4,000 IU or 5,000
IU vitamin A; 400
IU vitamin D;
11 IU vitamin E;
1.5 mg thiamine;
3 mg riboflavin;
and other
ingredients)
It will help
prepare the mom
to be’s body for
pregnancy and
promote the
health of the
growing baby
while inside the
mother
Acute Abdominal
Pain, Black
Stools,
Constipation,
Diarrhea,
Nausea
Advise PT to take
with food or a
full glass of water
or milk to
prevent stomach
irritation,
encourage PT to
eat lots of fiber
to prevent
constipation,
inform PT to
contact a HCP
immediately if
PT experiences
any bloody or
tarry stools or
severe
abdominal pain.
Diagnostic Testing
Test
Date
Norms
Patient Findings
Ultrasound- 7
weeks gestation
Jan. 28, 2008
Baby is within
Normal
normal gestational
requirements
Ultrasound- 24
weeks gestation
May 28, 2008
Baby is within
Normal
normal gestational
requirements
Labor and Delivery Data
 Onset of Labor: 9/19/08- 0524
 Delivery of baby: 9/21/08- 0649
 Delivery of Placenta: 0654
 Total length of delivery: 19 hours 54 minutes
Labor and Delivery Data
(Cont.’d)
 9/21 Upon arrival:
 0217 - FHR 140’s, moderate variability, no
decelerations.
 Toco q 2-4 min
 Cervical effacement: 80% dilated: 3-4 cm
 Stationed: -3
 Bulging bag of fluid
Labor and Delivery Data
(Cont.’d)
 0403 – FHR 130’s, moderate variablility, no
decelerations.
 Toco q 3-4 min
 Cervical effacement: 90%; dilated 7 cm
 Stationed at -2
Labor and Delivery Data
(Cont.’d)
 0602 - FHR 140’s
 Toco q 2-3 min
 Cervical effacement: 100%; dilated 10 cm
 Stationed at 0
 AROM at 0 station
 Monitoring closely
 AROM : Clear liquid
Labor and Delivery Data
(Cont.’d)
 0656 at +1 and then +2 station
 Patient labored well
 Bilateral superficial para urethral lacerations which
did not require repair.
OB Complications
 No complications as evidenced by:
- BMI within normal range
- normal vitals
- no history of disease
- normal labs
- within normal limits of recommended age for
pregnancy
Postpartum Labs
Postpartum Labs Normal values
Patient Results
Analysis
WBC
4500-10,000
13.69 10^3/m
Normal
RBC
3.6-5.4 x10 ml
4.74 10^6/mcl
Normal
HGB
12-16g/dl
Low- 11.6 g/dl
HCT
37-47%
Low- 34.1%
Platelets
150,000-350,000
186 10^3/mcl
Due to blood loss
from labor and
delivery
Due to blood loss
from labor and
delivery
Normal
MCV
81-99 fl
87 fl
Normal
MCH
27-31 pg
29.9pg
Normal
Postpartum Labs (Cont.’d)
Postpartum Labs
Normal values
Patient Results
Analysis
MCHC
32-36%
34.3%
Normal
RDW
11-15%
High- 15.9%
MPV
7.5-11.5 fl
9.8 fl
Due to the blood
loss after delivery
and the loss of iron
stores the mom gave
to the newborn
Normal
LYMPHOCYTE
18-48%
Low- 5.5%
Due to the blood
loss after delivery
and the loss of iron
stores the mom gave
to the newborn
Postpartum Labs (Cont.’d)
Postpartum
Labs
Normal vaules
Patient Results
Analysis
MONOCYTE
0-9%
2.4%
Normal
NEUTROPHIL
48-73%
High- 91.9%
EOSINOPHIL
0-5%
0.1%
Due to the blood
loss after delivery
and the loss of
iron stores the
mom gave to the
newborn
Normal
BASOPHIL
0-2%
0.1%
Normal
Postpartum Medications
MEDICATIONS
DOSE/ROUTE
Simethicone
80 mg/ po three
times prn
INDICATIONS
FOR USE
SIDE EFFECTS
NURSING
RESPONSIBILIT
IES
To treat diarrhea Nausea,
Assess PT for
and gas
stomach upset, any kind of
allergic
dry mouth,
reaction,
constipation,
monitor for
drowsiness,
dizziness, rash; effectiveness by
assessing if the
hives; itching;
PT has a
difficulty
decrease in
breathing,
flatulence and
tightness in the diarrhea
chest; swelling
of the mouth,
face, lips, or
tongue
Postpartum Medications
(Cont.’d)
MEDICATIONS
DOSE/ROUTE
INDICATIONS
FOR USE
Acetaminophen
650 mg 2 tabs po For severe pain
q4hr prn
Acetaminophen
650 mg 1 tab q4hr
prn
For moderate
pain
SIDE EFFECTS
NURSING
RESPONSIBILIT
IES
GI: HEPATIC
Pain: Assess
FAILURE,
type, location,
HEPATOTOXICI and intensity
TY(OVERDOSE), prior to and 30GU: renal failure 60 min
(high
following
doses/chronic
administration
Evaluate
use),
hepatic,
Hemat:
hematologic,
neutropenia,
and renal
pancytopenia
function
Derm: rash
periodically
Same as above
Same as above
Postpartum Medications
(Cont.’d)
MEDICATIONS
DOSE/ROUTE
INDICATIONS
FOR USE
SIDE EFFECTS
Acetaminophen
325 mg 2 tabs po
q4hrs prn
600 mg po q6hrs
prn
pain
Same as above
Can be given
along with
acetaminophen
for pain
Headache,
dizziness,
drowsiness,
psychic
disturbances,
EENT: amblyopia,
blurred vision,
arrhythmias, GI
BLEEDING,
HEPATITIS,
dyspepsia,
nausea, vomiting
Ibuprofen
(Motrin)
NURSING
RESPONSIBILITI
ES
Same as above
BUN, serum
creatinine, CBC,
and liver function
tests should be
evaluated
periodically;
Assess pain 1-2
hrs prior and
following
administration.
May cause
prolonged
bleeding time.
Postpartum Medications
(Cont.’d)
MEDICATIONS
DOSE/ROUTE
INDICATIONS
FOR USE
SIDE EFFECTS
NURSING
RESPONSIBILITIES
Zolpidem
(Ambien)
5 mg po prn at
bedtime
For sleep
CNS: amnesia,
daytime
drowsiness,
dizziness,
"drugged" feeling,
GI: diarrhea,
nausea, vomiting,
Misc:
hypersensitivity,
physical
&psychological
dependence
Assess PT for side
effects, monitor
PT’s ability to
sleep and how
long the PT is
able to stay sleep
Postpartum Medications
(Cont.’d)
MEDICATIONS DOSE/ROUTE
Docusate
sodium/casant
hranol (PeriColace)
100 mg/30 mg 1
capsule po prn
at bedtime
INDICATIONS
FOR USE
SIDE EFFECTS
NURSING
RESPONSIBILITIES
Assess for
To produce soft Throat
stool with iron irritation, mild abdominal
supplement
cramps, rashes distention,
presence of
which may
bowel sounds,
cause
and usual
constipation.
pattern of
bowel function
Assess color,
consistency,
and amount of
stool produced
Postpartum Medications
(Cont.’d)
MEDICATIONS
DOSE/ROUTE
INDICATIONS
FOR USE
SIDE EFFECTS
Ferrous sulfate
1 325 mg tab
once
Hgb <10 or >9
Staining of
teeth,
constipation,
dark stools,
diarrhea,
epigastric pain,
GI bleeding
Ferrous sulfate
1 325 mg tab
twice daily
Hgb <9 or >8
Same as above
NURSING
RESPONSIBILITIES
Monoitor liver
enzymes and
serum levels,
stools, observe
for constipation
or
diarrhea.Stomac
h pain, fever,
nausea, and
vomiting may all
be signs of
toxicity.
Same as above
Postpartum Procedures and
Treatments
 Newborn to breast immediately p birth
 Ice applied to perineum
 Ambulate as tolerated
 Pain medication prn
 Tucks pads offered
 Nursing bra for support
Postpartum Nutritional
Assessment
 Physical Appearance: appears well groomed and BMI
of 21.
 Prepregnant weight: 144lbs/65kg
 Weight gain during pregnancy: 30lbs
 Weight during pregnancy : 174lbs/79kgs
Newborn History
 Blood type: A positive
 Hep B Screen: Hep B vaccine since mothers screen was
not available at time.
 VDRL/RPR: negative
 Rubella: negative
 Glucose Screen: 73
Newborn Physical Assessment
 Infant Gender: Male
 Feeding: Breastfeeding
 Apgar Score: 1 min. = 9 5 min. = 9
 Birth weight: 6lbs./3oz
 Head to heel: 50.2 cm 19.8 in
 Head circumference: 35.6 cm 14 in
Newborn Physical Assessment
(Cont.’d)
 Skin- dry
 Mouth- moist
 Moro, suck, rooting, and babinski reflex all present
 Abdomen- soft
 Bowel sounds- present
 Fontanels- soft, level
 Tone- good
 Cry-vigorous
 Extremities-symmetrical
Newborn Physical Assessment
(Cont.’d)
 Respiratory- Even and clear p suction
 Cardiovascular- Regular
 Sensor- intact
 Procedures- PKU, circumcision, and heel stick blood
glucose
 Pain assessment- 0
Newborn Record
 Aspiration of amniotic fluid, excess suctioning
required
 Failure to latch first 24 h
Newborn Labs
Tests
Norms
Patient Results
Analysis
Glucose
45-120 mg/dl
73
Normal
Newborn Medications
MEDICATION MECHANISM
DOSE/ROUTE INICATIONS
FOR USE
SIDE EFFECTS NURSING
RESPONSIBILITIES
Hepatitis B
vaccine
First dose is
0.5ml (10mcg)
given
intramuscular
ly into the
anterolateral
thigh within
12 hours of
birth for
infants born
to HBsAgpositive
mothers.
Soreness at
injection site.
Occasionally
edema,
swelling,
warmth, and
induration at
the injection
site;
irritability; or
a low grade
fever (37.7C)
Provides
passive
immunization
for newborns
of HBsAgnegative and
HBsAgpositive
mothers.
Prophylactic
treatment
against all
subtypes of
hepatitis B
virus. If
mother is
positive for
hepatitis B.
Vaccine
should be
used as
supplied. Do
not dilute.
Shake well.
Monitor for
adverse
reactions.
Monitor
temperature
closely.
Newborn Medications
(Cont.’d)
MEDICATIONS
MECHANISM
DOSE/ROUTE INICATIONS
FOR USE
SIDE EFFECTS NURSING
RESPONSIBIL
ITIES
Erythromycin
Prophylactic
tx of
ophthalmia
neonatorum,
which is
caused by
Neisseria
gonorrhoeae.
Ophthalmic
ointment
(0.5%)instille
d as a narrow
strand ribbon
0.5-1 cm long
along lower
conjunctival
surface of
each eye.
Sensitivity
reaction; may
interfere with
ability to
focus and
may cause
edema and
inflammation
. Side effects
usually
disappear in
24-48 hrs.
Preventitive
treatment of
gonorrhea in
the newborn
and protects
against
Chlamydia.
Required by
law.
Wash hands,
do not
irrigate the
eyes after
instillation,
may wipe
away excess
after 1
minute, and
observe for
hypersensitivi
- ty
Newborn Medications (Cont.’d)
MEDICATIONS MECHANISM
DOSE/ROUTE
INICATIONS
FOR USE
SIDE EFFECTS
Vitamin K
Intramuscular
injection given
in the vastus
lateralis thigh
muscle. 0.51mg within 1
hour of birth.
Prophylactic tx
of vitamin K
bleeding
deficiency or
hemorrhagic
disease.
Pain and
edema may
occur at
injection site.
Allergic
reactions,
such as rash
and urticaria,
may also
occur.
Promotes liver
formation of
the clotting
factors due to
newborns lack
of Vitamin K.
NURSING
RESPONSIBILI
TIES
Protect drug
from light.
Observe for
signs of local
inflammation.
Observe for
jaundice and
kernicterus.
Give vitamin K
before
circumcision
procedure.
Newborn Medications (Cont.’d)
MEDICATION
MECHANISM
DOSE/ROUTE
INICATIONS
FOR USE
SIDE EFFECTS
NURSING
RESPONSIBILITIES
A&D
Ointment
Protective
barrier
ointment
for
prevention
of diaper
rash.
Topical p
every
diaper
change
To serve as
a barrier
between
urine and
skin for
circumcision site
none
Teach
mother
when and
how to
administer
ointment.
Care Plan
 Pain Management R/T Labor
(Alleviation of pain or a reduction in pain to a level of
comfort that is acceptable to the patient)
- Assess pain level q2h, contractions, emotional coping
- Administer epidural pain medication per PT request
- Assess pain level q1h p medication administration
- Teach pain relief methods (breathing patterns,
positions, acupressure, massage, cold/heat
applications, distractions)
- Coach/praise PT and include labor support person
Care Plan (Cont.’d)
 Emotional Support R/T Labor and Delivery
Process
(Provision of reassurance, acceptance, and
encouragement during times of stress)
- Assessment of PT’s emotional status
- Therapeutic touch
- Listen and address any PT concerns, fears, etc.
- Praise
- Encouraging words
Care Plan (Cont.’d)
 Breastfeeding Assistance R/T need for teaching
- Assessment of PT’s knowledge level
- Preparing a new mother to breastfeed her infant
- Teach proper technique
- Schedule time with lactation consultant
- Assist with latching
- Emotional support
- Educate different positions and ways to hold
newborn ( transverse, football, side lying)
Care Plan (Cont.’d)
 Nutrition, Imbalanced: less than body
requirements R/T ineffective breastfeeding
-Assess newborn latch and swallowing sounds
-Schedule lactation consultation due to no latch
within 24 hours
-Check bilirubin level due to increased risk for
jaundice
-Supplement formula until proper latch is established
- Monitor newborns weight to make sure it maintains a
healthy weight
Thanks For Listening!!!