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Nursing Care Plan 3 Risk for Altered Parenting

Nursing Care Plan 3 Risk for Altered Parenting



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Published by dbryant0101
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Published by: dbryant0101 on Dec 08, 2008
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Case Scenario # 6Perinatal Nursing
INSTRUCTIONS: For this case scenario, you will develop a Nursing Care Plan using SNL, the Standardized Nursing Languages of  NANDA, NOCand NIC(NNN).
You will be completing the blank care plan thataccompanies this scenario.T. S. is a 30-year-old primigravida presenting for inpatient care at 37 weeks gestation followingnonreassuring fetal testing. She is a Type I diabetic of 20 years duration. She has receivedprenatal care in the antepartum diabetes clinic and was hospitalized twice in the first trimesterof pregnancy, once in diabetic ketoacidosis. Blood glucose levels and hemoglobin A1c have beenessentially within normal limits since then, though insulin needs have decreased in the last week,indicating compromised placental function. Serial ultrasounds of the fetus have indicated noidentified cardiac or CNS anomalies and fetal weight at the time of admission is estimated atthe 40
percentile for gestational age.
Functional Health Patterns
Nursing assessment data is organized by functional health patterns as well as by initial physicalassessment at the time of admission. Relevant FHP data for T.S. are: Nutritional/metabolic: 2200 Cal. ADA diet in pregnancyInsulin: NPH qhs, regular insulin to scale ac, hs, 3 AMLast meal: breakfast, with 6u regular insulin (time now 11AM) Activity/exercise: Activity ad lib until one week ago, then bedrest at home forincreasing blood pressure Cognitive/perceptual: Did not finish childbirth preparation classes r/t bedrestDecreasing visual acuity r/t diabetic retinopathy(uses magnifying glass on syringe to draw up insulin) Role/relationship: “I hope my baby is OK” Sexuality/reproductive: Planned pregnancy after preconception counseling andachievement of euglycemia prior to conception Coping/stress tolerance: “I’m scared about labor.”Self-perception/self-concept: re: concerns about self: “I hope I live long enough to see my babygrow up.”
Admission Physical Assessment
Temp. 37C, P 80, BP 150/102, R 18. (lungs clear to auscultation)Baseline fetal heart rate per continuous external monitoring: 122; no accelerations,minimal baseline variability, questionable subtle late deceleration with rare uterinecontractions of mild intensityCervical exam: 1-2 cm. Dilated, minimally effaced, vertex at –1 station.Membranes intactDeep tendon/patellar reflexes: 3+Pain: Headache since 3 AM pain scale 3/10; no epigastric painEdema: 3+ pretibial; patient reports face “puffy” since 2-3 days ago
Step 1: Choosing the Nursing Diagnoses
nursing diagnoses
include, but may not be limited to, the following:
Nursing Diagnosis: Childbearing, maladaptive: antepartum/intrapartum status
Defining characteristics:
There is a deviation from physiologic adaptive changes thatsupport the health of mother and/or fetus during pregnancy
Related factors:
Maternal vascular compromise related to long-term diabetesexacerbation of maternal carbohydrate intolerance/insulinresistance related to Type I diabetes of long duration
Fetal compromise secondary to decreasing placental function
Nursing Diagnosis: Risk for altered parenting
Defining characteristics:
Risk for inability of the primary caretaker to create, maintain,or regain an environment that promotes the optimum growthand development of the child.
Related factors:
Physical illnessFor purposes of working through this exercise, the second diagnosis, 
Risk for Altered Parenting
be used.
On the nursing careplan form, write in the nursing diagnosis, the defining characteristics & relatedfactors.
Step 2: Choosing the Nursing Outcomes (NOCs):
The next step is to select the
nursing outcomes
that can best affect this nursing diagnosis.
Listed below are two appropriate nursing outcomes for the diagnosis
Risk for Altered ParentingNOCParent-Infant Attachment
Parents verbalize positive feelings toward infantParents touch/stroke/pat infantParents use eye contactParents respond to infant cuesParents console/sooth infant
Identifies effective coping patternsUses effective coping strategiesAdapts to developmental changesUses available social support
Select ONE of the above-listed nursing outcomes for this care plan exercise, go to thenursing care plan and check the indicators that you think will best measure your patient’sprogress toward the outcome that you’ve chosen.
You will need toRATEyour patient’s current status, according to the assessment dataprovided, for each indicator you have just selected.
Date and initial the outcome section of the care plan.

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