care plan on oligohydramnios with iugr

NURSING MANAGEMENT

NURSING PROCESS FOR MOTHER:

1. Nursing diagnosis : Anxiety related to outcome of pregnancy and health of unborn child as witnessed by mother’s frequent doubts about the pregnancy outcome

SUBJECTIVE DATA OBJECTIVE DATA

Mother verbalizes that her baby is very small and there is decreased fetal movements

Mother looks anxious and concerned

DESIRED GOAL/ OUTCOME

To alleviate the anxiousness of the mother

-To clear her doubts about the pregnancy and the well-being of the fetus

PLANNING IMPLEMENTATION RATIONALE

provide and discuss

with her, the ways to improve the

pregnancy outcome with lots of fluids

and nutritious diet

As she is planned of L.S.C.s., importance of the surgery and preparation of the patient.

-patient is kept nill per orally before surgery.

Approach and discuss the

mother’s worry in a calm manner.

-administered in dexamethasone6 mg 6hrly and

told her the importance of this medine

-allow her to ask questions and clear her doubts

provide and discuss with her, the ways to improve the pregnancy outcome with lots of fluids and nutritious diet

-Assure her that the neonate will be kept in the hospital.

As she is planned of L.S.C.s., importance of the surgery and

preparation of the patient.

-patient is kept nill per orally before surgery.

-To alleviate her anxiety

-So that her doubts are cleared

To reduce anxiety related to disease.

-nutritious diet can improve the fetal outcome and increased fluid intake may help raise the amniotic fluid value.

proper care plays a great role in the health of IUGR neonate

Early information about hospitalization helps the

mother to cope after birth of the baby.

to remove any chances of aspiration.

Evaluation: Mother shows less anxiousness about the outcome of labour.

2. Nursing diagnosis : Altered nutrition , less than requirement related to IUGR as witnessed by

low weight of mother


Patient verbalizes weight remaining almost the same Wt= 59 kg

Mother’s weight is almost stationary, with weight being 65 kg approx from 6th month onwards to 8th month

DESIRED GOAL/ OUTCOME to improve the nutrition of the mother, in order to improve the fetal nutritional status


small frequent meals,

plenty of fluids

-Explained her importance of high protein and high calcium diet for fetal growth e.g. all pulses, milk, soybean, calcium tablets.

To increase the daily intake of diet.

monitored weight -take light food before

surgery

Advised mother to take small

frequent meals

-Advised her to take plenty of fluids

-Explained her importance of high protein and high calcium diet for fetal growth e.g. all pulses, milk, soybean, calcium tablets.

To increase the daily intake of diet.

monitored weight and asked to report weight loss

-adived to keep npo after mid night and to take light food before surgery

Small frequent meals are

tolerate better than large meals

high protein and high calcium diet is needed to improve the growth of the fetus

as weight is not adequate ,daily intake of food should be increased to attain a reasonable weight gain

A decrease in weight should be reported as it

can be due to loss of amniotic fluid and can be

fatal.

Evaluation: Mother has increased her intake of diet.

3. Nursing diagnosis : Deficient fluid intake, less than requirement related to low amount of liquor as evidenced by low abdominal girth=30 inches, and low AFI = 2 and also NPO status of mother before surgery.


Mother verbalizes that her abdomen size is very small

AFI is very low, 2 and low abdominal girth=30 inches I=NPO, O=500ml

DESIRED GOAL/ OUTCOME to increase the fluid intake in order to improve the amniotic fluid volume


Patient intak output maintained

-Vitals monitored -Catherization prior to

the surgery

- Patient kept npo.

Patient intak output maintained

-Vitals monitored -Catherization done prior to the

surgery

-Iv fludies stated RL/ NS.

Patient kept npo.

intake of fluid helps in production of more liquor

liquor is needed to transport the nutrients to

fetus and excretion of waste

Evaluation: Mother understood the importance of liquor for fetal well being

4. Nursing diagnosis : Knowledge deficit related to care and management of IUGR neonate


Mother verbalizes that she would not be able

to care for a baby of small size

Mother has doubts and less knowledge

regarding care of IUGR neonate


- to improve her knowledge regarding neonatal care.


explain the importance of exclusive breast feeding for neonatal health and disease

prevention advised to get the baby

immunized as per schedule

explain methods of providing eye care, cord

care and personal hygiene of child

-protect the child from cold as IUGR have inadequate thermoregulation

keep her breast dry and clean to avoid infection

to the child

maintain personal hygiene and handling of

mother was explained the importance of exclusive breast feeding for neonatal health and disease prevention

-she was advised to get the baby immunized as per

schedule she was explained methods of

providing eye care, cord care and personal hygiene of child

-she was advised to protect the child from cold as IUGR have

inadequate thermoregulation

she was advised that the baby

would be kept in nursery for few days until the child is healthy enough for discharge

she was advised to keep her

breast dry and clean to avoid infection to the child

she was advised to maintain

Mother’ milk contains all essential amino acids needed for newborn’s growth and

immunoglobulin’s to prevent neonatal infection

prevent infection.

-timely immunization

would help in preventing known diseases.

-proper care and personal hygiene is necessary to

prevent infection.

-IUGR babies have underdeveloped thermoregulation mechanism; proper care should be taken for such

babies.

-personal hygiene of mother is also essential

baby after proper hand washing to avoid infection

personal hygiene and handling of baby after proper hand washing to avoid infection

Evaluation: Mother’s knowledge increased as she explains the care of baby after birth.

5. Nursing diagnosis : Knowledge deficit related to care and management of IUGR neonate


Mother verbalizes that she would not be able to care for a baby of small size

Mother has doubts and less knowledge regarding care of IUGR neonate

DESIRED GOAL/ OUTCOME to help the mother develop confidence regarding care of the baby - to improve her knowledge regarding neonatal care.


Explain the importance

of exclusive breast feeding for neonatal

health and disease prevention

advise to get the baby immunized as per

schedule explain methods of

providing eye care, cord care and personal hygiene of child

advise to protect the child from cold as IUGR have inadequate thermoregulation

advise that the baby

would be kept in nursery for few days

until the child is healthy enough for discharge

advise to keep her breast dry and clean to

avoid infection to the

mother was explained the

importance of exclusive breast feeding for neonatal health and

disease prevention -she was advised to get the

baby immunized as per schedule

she was explained methods of providing eye care, cord care

and personal hygiene of child

-she was advised to protect the child from cold as IUGR have inadequate thermoregulation

she was advised that the baby would be kept in nursery for few days until the child is healthy enough for discharge

she was advised to keep her breast dry and clean to avoid

infection to the child

she was advised to maintain personal hygiene and handling of baby after proper hand

washing to avoid infection

Mother’ milk contains all

essential amino acids needed for newborn’s

growth and immunoglobulin’s to

prevent neonatal infection prevent infection.

-timely immunization would help in preventing

known diseases.

-proper care and personal hygiene is necessary to prevent infection.

-IUGR babies have underdeveloped thermoregulation mechanism; proper care should be taken for such babies.

-personal hygiene of mother is also essential

child

Evaluation: Mother’s knowledge increased as she explains the care of baby after birth.

6. Nursing diagnosis : Acute pain related to abdominal incision secondary to surgery.

SUBJECTIVE DATA OBJECTIVE DATA Patient complains of pain in abdomen. Facial expression shows grimace and depression.


Patient will be relieved of pain to some extent.


Assess the intensity of pain

-Give an analgesic as prescribed

-give a comfortable

position. -diversional therapies

can be helpful. Deep breathing

exercises can be taught.

She is having dull pain over the lower abdomen

comfortable left lateral position has been given.

-mind has been diverted by

asking some questions to the patient.

-deep breathing exercises has been taught to the patient.

Assess the intensity of pain. -To relieve the pain. -it will prevent the pain. -Helps in relaxation

&diversion of mind from

pain. -It helps in relaxation of

muscles.

Evaluation: Pain is reduced to some extent as patient looks comfortable & reports some relief

7. Nursing diagnosis : Fluid volume deficit related to blood loss during cesarean section and

NPO status.


Patient feels thirsty and weak. Patient’s tongue is coated and looks dehydrated. Lips are also dry.


The patient will attain normal fluid volume.


Monitor I/O chart. -Assess B.P & pulse.

-Administer Iv fluids as

-I/O chart is maintained. -B.P- 110/70 mmHg

Pulase- 86/min

help in analyzing fluid balance & degree of

deficit.

ordered by the physician.

-Place client in recumbent position.

-Allow oral sips as tolerated and ordered by the physician

-IVF RL & DNS are administered as prescribed.

-patient is placed in supine position with legs slightly elevated.

-Hypotension, tachycardia may reflect hypovolemia.

-Helps re establish circulating blood volume & replaces loss.

Optimizes cerebral blood flow.

Evaluation: Normal urine output and patient is taking orally.

8. Nursing diagnosis: Risk for constipation R/T immobility as evidenced by client’s verbalizes of

the physical discomfort.


Patient told that she has not passed stool after surgery & feeling uncomfortable.

Abdomen looks distended and patient looks uncomfortable


Preventing The risk of constipation & establish a normal bowel pattern.

PLANNING IMPLEMENTATION RATIONALE Client is encouraged to take

more fluids in diet.

-Client also encouraged to mobilize.

-Assisting the client while walking.

-Patient was encouraged to take fruits in diet.

Some laxatives may be

provided if prescribed..

Client is encouraged to take more fluids in diet.

-Client also encouraged to mobilize.

-Assisting the client while walking.

-Patient was encouraged to take fruits in diet.

-Some laxatives may be

provided if prescribed.

To increase circulating volume and prevent

shock & to reduce thirst. -Help in softening of

stool. -It will help in retaining

bowel movement.

-laxatives will help in

softening of stool.

Evaluation: Patient is feeling the bowel movement & added the roughage to diet.

She is feeling defecate now.

9. Nursing diagnosis: Self care deficit R/T post operative condition following caesarean section.

SUBJECTIVE DATA OBJECTIVE DATA Patient complains that she is unable to get up to

perform activity and is unable to breastfeed properly.

Patient looks helpless and need

assistance.


-Note any orders regarding positioning.

-Reposition client every 1-2 hrs & assist client with ambulation & leg exercises

etc.

patient is advised to lie down in supine position & given sponge bath.

-Patient is advised to change positions and

encouraged in leg movements.

-patient is assisted in changing clothes and

perineal care. -Patient is assisted in

breast feeding the child. -Analgesics are

administered as prescribed.

-Family support is encouraged.

Client’s under S.A need to lie flat or without pillow 6-8hrs.

-Prevent surgical complications such as

phlebitis. -Increase feeling of well

being. - Improves self esteem &

client gains confidence in caring for the baby.

-Reduces discomfort. -Promotes sense of well

being.

Evaluation: Patient can perform self care activities.

10. Nursing diagnosis: Knowledge deficit R/T new born care.


Patient asks so many questions regarding how

to care for the baby.

Patient looks anxious.


Patient verbalizes understanding of, & demonstrate the tasks related to new born care.


-Advise mother to wash

hands everytime before feeding the baby.

-Advise for exclusive breastfeed till 6 months.

-Instruct parents regarding positioning of baby after

feed & advise about burping & its importance.

-Advise mother to always

wash hands before touching the baby.

-Advise for exclusive breastfeed till 6 months

and its importance. -Advise to burp the baby

for 10 min after each feed and lay baby in right lateral

To protect child from

infection.

-Breast milk is the complete food for the

baby. -Positioning new born on

the side reduces risk of aspiration.


To initiate in client’s care of self.

-Demonstrate & supervise infant care activities like feeding and holding, diapering, clothing.

-Instruct parents regarding special care of diapers, recognition of rashes and appropriate treatment.

position after feeding. -Parents were informed to

change diapers immediately after soiling and dry the area & not to use nylon or plastic tight diapers. Inspect the perineal area daily for

redness and induration -Advised to come for

immunization of the baby at 1-1/2 months & its importance.

-Parents are encouraged to verbalize feelings.

-Promotes understanding of new born care; fosters parent’s skill as caregivers.

-Napkin rash is common occurring due to prolonged wet nappies and may cause perianal

dermatitis. -Immunisation is

important and it will prevent infant from many diseases.

-Parents need to recover from the stressful events surrounding child birth.

Evaluation: Mother DemonstrateCorrect feeding technique and burping after feeding.

11. Nursing diagnosis : Risk of Infection related to L.S.C.S., presence of urinary catheter and I.V.

cannula


Patient complains of itching at the episiotomy site, redness at cannula site.

Redness at the episiotomy site; presence of urinary catheter; and cannula site; W.B.C.= 13,000 mg/dl

DESIRED GOAL/ OUTCOME To reduce level of infection so that patient don’t have any complication


Taught patient about episiotomy care

Maintain hygiene Vitals checked daily

Perineal care giving and catheter care given using sterile

techniques Change pad as needed

Checked the sit of the cannula INJampi500mg T.D.S. given to

the patient for 5 days Removed cannula as advised by

the doctor

Removed urinary catheter Vitals checked daily

To reduce level of infection

Antibiotics reduce infection.

I.V. injections have been stopped.

Evaluation: Patient redness is reduced and itching also reduced

NURSING PROCESS FOR BABY:

1. Nursing diagnosis : Altered nutrition less than body requirements R/T inability of mother to

breast fed.


n/a Weak sucking reflex present and output is not proper.

DESIRED GOAL/ OUTCOME To maintain optimum nutritional status.

PLANNING IMPLEMENTATION RATIONALE Assess weight of the infant daily. -Assess infant for possible regurgitation. -Assess condition of fontanels, skin turgor etc. -Note frequency, amount and description of stool and urine. -Assess mothers feeding practices and knowledge. -Advice the mother for exclusive breast feeding and techniques of breast feeding. Assess the reflexes associated with feeding also.

Baby’s weight is 2.2 kg. -Assess the baby’s sucking and swallowing reflexes while feeding. -Fontanels are open and skin turgor is assessed. -Meconium is passed thrice. -Mother’s knowledge on breast feeding is assessed. -Mother is encouraged for exclusive breast feeding. -Taught the mother signs of good attachment & technique of breast feeding.

-To assess nutrient needs. -To check whether the baby is able to take milk or not. -Depressed fontanels, decreased skin turgor may indicate dehydration. -Evaluates adequacy of oral intake. -Knowledgeable parents are better prepared and respond to feeding needs. -For effective breast feeding.

EVALUATION OF GOAL Nutritional status of baby is maintained. Baby is passing urine & stool properly.

2. Nursing diagnosis : Risk for altered body temperature related to immature thermoregulation.


n/a n/a

DESIRED GOAL/ OUTCOME Baby maintains temperature within normal limits 36.5-37.5oC.

PLANNING IMPLEMENTATION RATIONALE Maintain ambient

temperature at 24oC. -Monitor vital signs. -Keep the baby dry and

wrap in prewarmed blanket.

-Postpone initial bath until body temperature is stable.

-Avoid unnecessary exposure of the infant while changing clothes or diapers.

-Encourage the mother to continue breast feeding.

Normal room temperature is maintained by closing doors and windows.

-Vital signs are monitored and assessed for the signs of hypothermia.

-The baby is properly wrapped in blanket.

-Bath is postponed. -Care was taken not to over

exposed the baby, while changing clothes or diaper.

-Mother is encouraged for exclusive breast feeding upto 6 months of age and explained the importance of skin to skin contact.

-To prevent heat loss of baby. -To assess for any changes in

temperature/Hypothermia. -prevent heat loss through

radiation, evaporation. -Helps to prevent further heat

loss due to evaporation. -To prevent heat loss. -To provide maternal warmth

to baby & eliminate the risk of hypothermia due to

Hypoglycemia.

EVALUATION OF GOAL Infant’s temperature Is stable i.e 37.5oC.

3. Nursing diagnosis : Risk for infection R/T immature defence mechanism.


n/a n/a

DESIRED GOAL/ OUTCOME New-born will be free from the signs of infection.

PLANNING IMPLEMENTATION RATIONALE -Assess the vital signs. -Wash hands properly before handling the infant. -assess the cord and skin area at base of cord daily for redness, odor, discharge. -maintain individual equipment and supplies for each patient. -Ensure that the parents

Vitals are assessed. -Hands are washed before handling baby. -Skin is inspected daily for rashes. Bath is given with mild soap. -Cord is assessed for odor, discharge etc. diaper is folded below the cord stump. -Separate articles are maintained for separate infant. -Parents and visitors are advised to

To note signs of infection like hyperthermia. -Prevent spread of germs. -To prevent spread of infection through umbilicus. -Helps in prevent cross contamination of infants. -Helps in preventing spread of infection to new born.

and visitors to handle the baby with care. -Encourage exclusive breast feeding till 6 months.

handle the baby with care. -Breast feeding is advised.

-Provides immunity to the baby.

EVALUATION OF GOAL No signs of infection are observed.

HEALTH EDUCATION: IN WARD –

Patient is advised to take rest for few days from strenuous activities & also encouraged for early ambulation.

Diet

a. Advised mother to take daily protein like egg, milk and milk products, b. Advised mother to take usual salt but not in excess c. Fluid restriction is not advised

d. Advised mother to take energy and iron rich foods like jiggery spinach, green leafy vegetables, Bengal gram etc.

e. Advised mother to avoid unsaturated fats like ghee and butter.

Advised mother to take sitz bath. She is advised to take her medicines on time and not to skip any dose. She is advised to maintain proper hygiene especially genitals.

Post natal exercises Should not lie crossed leg. Should not carry out heavy lifting of objects till one month.

Initially, she is taught breathing exercise and leg movements lying in bed. Gradually, she is instructed to tone up the abdominal and perineal muscles and to

correct the postural defect. The exercise should be continued for at least 3 months.

The common exercises prescribed are: To tone up the pelvic floor muscles: The patient is asked to contract the pelvic

muscles in a manner to withhold the act of defecation or urination and then to

relax. The process is to be repeated as often as possible each day. To tone up the abdominal muscles: The patient is to lie in dorsal position with the

knees bent and the feet flat on the bed. The abdominal muscles are contracted

and relaxed alternately and the process is to be repeated several times a day. To tone up the back muscles: The patient is to lie on her face with the arms by

her side. The head and the shoulders are slowly moved up and down. The procedure is to be repeated 3–4 times a day and gradually increased each day.

Sexual activity to be resumed (after 6 weeks) when the perineum is comfortable and bleeding has stopped.

DISCHARGE INSTRUCTIONS: Sheis not yet discharged. But health education planned on discharge: Advised to avoid sexual intercourse for atleast 6 weeks.

Family support is encouraged and patient is given psychological support. Advised for exclusive breast feeding till 6 months. Explained about medications how to take & what time.

Explained about immunization of the child till 5 years of age. f. Breast feeding

Advised her to give exclusive breastfeeding for 6 month.

Told her the importance of breast feed for the baby, mother and the society.

Contraception Family planning advice and guidance — o Told mother that the method of contraception will depend upon breastfeeding status,

state of health and number of children.

o Natural methods cannot be used until menstrual cycles are regular. Exclusive breastfeeding provides 98% contraceptive protection for 6 months. Barrier methods may be used. Steroidal contraception — combined preparations are suitable for no

lactating women and should be started 3 weeks after. In lactating women it is avoided due to its suppressive effects. Progestin only pill may be a better choice for them. IUDs are also a satisfactory method irrespective of breastfeeding status.

Sterilization (puerperal) is suitable for those who have completed their families. Planning for future pregnancy: If patient plan’s for second pregnancy she should gap of 2-3 yrs. and should have regular antenatal the checkups to reduce high risk pregnancy.

PROGRESS NOTES: Patient improved very well from her condition. She is able to walk with assistance now

and also able to do her self-care activities also. She progressed well from her disease state. Intake output maintained and vitals are stables. Pain reduced. No signs of infection. She understood how to breast feed and importance of breast feed. No further

complaints. PROBLEMFACED BY THE PATIENT AND STUDENT

The mother verbalized that there was no one to comfort her in labor room during the labor pains. She was only given the gown once and no food was given to her. She also said that 2-3 patients are together given one bed.

There is no privacy for antenatal palpation in the ward. There is overcrowding of patient attendants. Sometimes there is lack of supplies e.g. disposable bed sheet for providing care for the client.

PERSONAL OPINION AND ACHIEVEMENTS. The case study I took was MOTHER WITH OLIGOHYDRAMNIOS AND IUGR. The care for the mother diagnosed with OLIGOHYDRAMNIOS AND IUGR is similar in regard to the

treatment and there is no complication. Patient was a registered case in antenatal clinic. Her diagnosis was done at the earliest and treatment given according to theory. She stood all the treatment and gave birth to a 1.8 KG boy baby at 1:26 pm on 3/8/2016 by

emergency L.S.C.S under spinal anesthesia. She along with her baby received adequate medical and nursing assistance and was recovering well. She was not yet discharged till my posting.

RECOMMENDATIONS Each individual experiences of pregnant mother are unique and care is to be

provided by keeping that in mind

The treatment for each different abnormal conditions are specific, thus care should be prioritized as per the need

Not only physical care but emphasis should also be given to the emotional and psychological aspect of care in mother

The support and involvement of family members are required and should be

encouraged. SUMMARY AND CONCLUSION:

I got the patient, Mrs Dolly W/O Sunny, aged 20yr/f on 2/8/2016 in ward-4. She came in the opd with diagnosis Primi with 38+1 wks with oligohydramnios & IUGR for she admitted to ward-4. Emergency LSCS was done on 3/8/2016 and delivered a boy baby

with 1.8 kg birth weight at 1:26 pm. I care her for 5 days. It was a very nice experience for me. I was able to plan nursing activities and was able to carry out and evaluate them effectively. The condition of my patient improved after my nursing care. She and her baby are healthy without developing any complications.

care plan on oligohydramnios with iugr

Health & Medicine