POSTPARTUM CARE PLAN Client Initials: TH Type of Delivery: Scheduled Cesarean Section Client history and assessment: TH is a 34 year

old female scheduled for a repeat cesarean section on 09/15/2009. The patient is a G3 P3, with both other children delivered by C-section, with the only complication in both being low birth weights. TH has a longstanding history of anorexia and OCD AEB multiple notes in the chart not to discuss weight during measurements obtained prior to MD exam in prenatal appointments, and lack of desire to gain weight during pregnancy despite knowledge of detrimental consequences to fetus. Additional health history includes a vitamin D deficiency, back surgery in 05/06 due to a herniated disc, and two previous cesarean sections. TH delivered a healthy baby boy weighing 6 lb. 2 ounces, with apgar scores of 8 and 9; the patient did well through delivery and during the postoperative stage. No lack of sensation or motor function following discontinuation of epidural anesthesia was noted. The two previous infants delivered without extreme difficulty, with the first born via c-section d/t fetal distress. Throughout the procedure and throughout the recovery stage, the patient had the positive support of husband. The incision site was clean with steri-strips covering, but without any signs of infection (no redness, swelling, drainage, or edema noted). The patient has no difficulties with breastfeeding, but a lack of nutrition was a possibility of great concern. The two previous infants were breast-fed by the patient, without any difficulty. TH was hesitant towards talking about food in general, and was seen to only eat 25% 50% of the small amounts of food ordered.

Diagnosis #1: Infection, Risk for r/t site for microorganism
invasion 2O cesarean section. Assessment Data: (please see client history and assessment for more information) with a history of malnutrition and an incision site, the increased possibility of infection needs to be take into account. Goals (measurable): The patient will not experience signs of infection by discharge. Interventions Rationale Outcome evaluation Wash hands before and after caring for patient, using gloves when indicated; no sharing of equipment Jones 1 Interventions help prevent the spread of pathogens between staff and patients. Goal Met: Patients remains free from symptoms of infection by discharge.

apologizing for her large size. This may be followed by purulent drainage and would dehiscence.5oC in a single measurement. Assess temperature Q4 hours orally. Ensure the client’s room and bathroom is cleaned frequently and appropriately. Interventions Rationale Outcome evaluation Jones 2 . and temperature values can have important consequences for treatment decisions. or three temperatures of >38o C by discharge. and discontent for appearance. edges wellapproximated. edema. Maintain a clean environment. lack of interest in food. Goal Met: Incision is dry and intact. personal care supplies kept off floor. and a heightened interest in pounds gained throughout pregnancy. Assess lower abdominal incision noting if area under and around steri-strips is clean. Diagnosis #2: Nutrition. dry and intact. imbalanced: less than body requirements r/t inability to ingest/digest food or absorb nutrients because of psychological factors AEB aversion to eating. bed linens changed Qday or PRN through to discharge. distorted verbalizations of body image/size Assessment Data: (please see client history and assessment for more information) TH was offered assistance on multiple occasions throughout care to order food without any peak of interest.with other units. ecchymosis. Fever may be the first sign of infection in the obstetrics patient. and abdominal assessment. The patient has a history of anorexia with a history of decreased weight in previous deliveries due to a lack of weight gain during pregnancy. and approximation. drainage. During examination of patient. A clean environment may discourage the growth of microorganisms. Goal Met: Linens separated r/t dirty and clean in restroom. Goals: The patient will recognize three factors contributing to underweight and will remain free of signs of malnutrition by discharge. patient voiced feelings of obesity. if incisions exhibit redness. Goal Met: Patient without temperature >38. Assessment provides information about developing infection: Local inflammatory effects cause redness and edema. without redness or edema through to discharge.

eliciting a decrease in stress and an increase in appetite due to strengthened emotional support. Exercise. often members during mealtimes patients will eat to encourage nutritional more food if other intake with patients people are present consuming improved at mealtimes. It may be difficult to Goal Met: Patient interacted tell if the problem is with during mealtimes physical or throughout the day without psychological. with only depression. staff assisting patient were able to implement interventions to decrease additional risk contributing to infection risk. and it was noticeable the cause for may also be a difficulty with eating was symptom of psychological. Mealtime usually is Goal Met: Companionship a time for social provided by various staff interaction. and remain nonjudgmental. Establish trusting relationship with patient. Spend time with patient. The patient remained free of any signs or symptoms of infection by discharge. Goal Met: Assisted patient in . any interest in food at Refusing to eat may bedside unless the topic of be the only way the consumption was brought patient can express up. Attempt to separate physical from psychological causes for eating difficulty. Observe patient’s relationship to food. Establishment of Goal Met: establishment of trust promotes a trusting relationship with sense of safety and patient developed through support for the spending time with patient patient. Through observation it some control. Assist patient to Jones 3 Goal Met: Through a high index of suspicion of malnutrition. with times provided for mother/baby privacy while remaining nonjudgmental throughout care to discharge. Provide companionship at mealtime to encourage nutritional intake. amounts by discharge.Maintain a high index of suspicion of malnutrition as a contributing factor in infections. provide for privacy. This trusting relationship allowed the patient feelings of support and safety. Impaired immunity is a critical adjunct in malnutritionassociated infections in all age groups in all populations. minimal amount consumed by end of shift.

and exhibits of the infant regularly sucking and swallowing (appears content after feeding). and the infant latched on within the first two hours following delivery. and assist her in the eventual recovery process – but the patient will very reluctant to acknowledge a problem. the patient was able to verbalize various activities to assist her in stress reduction by discharge. the patient responded that she enjoyed the experience to bond with her child. exercise. Patient may have unrealistically high expectations for herself. etc. or may need “permission” to ask for help. Goals: Maternal-infant dyad continues to experience effective breastfeeding by day 3 following delivery. Effective r/t maternal-infant dyad satisfaction and success with breast-feeding process AEB patients report of satisfaction with breast-feeding process. Diagnosis #3: Breast-Feeding. with reevaluation two weeks following delivery. but with continued implementation of this intervention by various staff members it is possible to meet this goal by discharge. meditation.identify healthy behaviors she can use to reduce unavoidable stresses (i. relaxation techniques. Goal Not Met: The intervention was attempted to be provided as a tool to increase the patients understanding of anorexia. Due to interventions provided.e. Assessment Data: (please see client history and assessment for more information) When questioned regarding satisfaction with the breastfeeding status of the newborn. and relaxation techniques help to relieve stress and improve health. Interventions Rationale Outcome evaluation Jones 4 . Encourage patient to seek and accept social support with nutrition and psychosocial difficulties during the puerperium. identification of healthy behaviors which could be useful in the reduction of unfavorable stressors which could increase anxiety and depression causing a decrease in appetite or desire to eat.) meditation.

knowledge. as the patient desires. Social support is an important factor in the choice of breastfeeding and its success. Goal Met: Assessment of the patient’s previous experience. without problem upon reevaluation. The patient may benefit from current research findings. assessed with importance given to alleviation of misconceptions and social embarrassment associated with breastfeeding to given father Praise patient and infant for effective breast-feeding activity. Goal Met: Provided patient and infant praise for effective breastfeeding activity with evident increase in maternal confidence during praise. husband to TH and father to infant and patient’s other two children. Maternal confidence is an important factor in the continuation of breastfeeding. promoting rooming-in. Goal Met: Samples of formula upon discharge not offered. Interventions promote infant’s interest in nursing and allow frequent stimulation of the breasts. and skill (positioning. etc. knowledge and skill with breastfeeding illustrates sufficient understanding with ample time for questions or concerns provided by discharge. removal. Praise reinforces effective breastfeeding. Share current research findings as appropriate.. Assessment provides information about knowledge and skills. The more affirmation a mother receives from members of her social network the better she copes with Jones 5 . etc. and breastfeeding on demand allowed the mother and infant facilitation of continued effective breast-feeding until discharge. with continued growth of breast-feeding assurance upon discharge. Elicit questions or concerns. latch-on. Facilitate patient’s breast-feeding by not offering supplements to the infant.Assess patient’s previous experiences. Assess support person network.) with breast-feeding. encouragement of rooming-in. Goal Met: Support person.

Teach the patient the importance of maternal nutrition. or at least 8 feedings per 24 hours). Provide patient with written and verbal information about daily nutrient and caloric needs during lactation: PNV. Goal Met: The importance of maternal nutrition during lactation explained to the patient. Dieting during lactation can have a negative impact on milk production. In the first few days. and individual instruction promotes compliance. 5 servings dairy (1 quart milk). 4 servings protein.breastfeeding. with patient demonstrating and voicing understanding prior to discharge. Jones 6 . with suggestions regarding continued compliance in relation to increased newborn wellbeing by discharge. frequent and regular stimulation of the breasts is important to establish an adequate milk supply. Goal Met: Patient provided with simple written but individualized verbal information about daily nutrient and caloric needs during lactation. with patient’s verbalization of understanding prior to discharge. encouragement for support by discharge. with emphasis on lack of necessary milk nutrients and production provided to the infant. with importance of frequent and regular breastfeeding to promote the establishment of an adequate supply of milk. 2-3 quarts fluids. Goal Met: Frequency of feeding guidelines reviewed with patient. 2-3 servings fruit (2 vitamin C-rich). 2-3 servings vegetables (1+ green leafy). Written instruction allows patient to review material once she is discharged. Review guidelines for frequency of feedings (Q 2 – 3 hours.