The Growing Family Clinical Case Study

NURS 333- The Growing Family

Purpose of Assignment
The purpose of this paper is for the student to conduct an in-depth assessment of a
childbearing woman and her family in order to plan nursing care specific to that client, based on
nursing research and AWHONN Standards of Care. The assessment will include the appropriate
physiological, psychological, social, cultural, and environmental influences pertaining to the
client and her family as it relates to preconception, conception, antepartum, intrapartum,
postpartum and neonatal care.

Student Approach to Assignment

The patient chosen for this case study was my first OB patient while in this clinical
rotation with an extensive history and a list of risk factors that were considered dangerous. She
was a 20-year-old who presented to the unit for a repeat cesarean; she had tested positive for
gestational diabetes at a prenatal checkup, and they found that she had an excessive amount of
amniotic fluid, or polyhydramnios. At 39 weeks 0 days’ gestation, the baby was measuring a
week ahead, so they decided to take him a week early. The baby arrived LGA and was sent to the
special care nursery. Because I was not only involved in the mother’s care, but also the baby’s, I
developed a unique understanding for what the mom was going through, but also of what the
baby was going through by being separated from mom. The focus of this case study was to
discuss each stage of the labor process while also discussing interventions for the patient and the
baby to ensure proper nursing care.

Reason for Inclusion of the Assignment in the Portfolio

This assignment is included in the portfolio because it highlights the oversee of care I provided
for both the mother and the baby, who were both high risk for possible complications following a
diagnosis of gestational diabetes and polyhydramnios

 Critical Thinking
 Uses decision-making skills in making clinical or professional judgments.
 Example: In this paper, I utilized my decision-making skills to ensure both the mother
and the baby had a decrease in negative outcomes following the high risk
complications. Considering the baby was measuring a week ahead of time, we made a
clinical judgement to schedule the mom’s cesarean a week early to try to prevent
LGA. Using my professional judgement, I discussed the possible complications of
gestational diabetes and we decided that the baby would may have to spend some
time in the special care nursery for proper monitoring. From this, I learned the
importance of judgement calls, and how necessary they are in the career of nursing.
  Evaluates nursing care outcomes through the acquisition of data and the questioning of
inconsistencies.
 Example: In this paper, I discussed multiple nursing diagnoses for both mom and
baby following the cesarean related to the separation. I concluded that there was a
risk for impaired parent/infant attachment, ineffective breastfeeding, and anxiety and
fear. Although the mom was still available to visit her baby boy at any time, her
behavior was inconsistent showing that she was struggling with finding time to bond
when her baby was in a separate room. To enhance patient understanding, we
discussed the importance of bonding and how she was able to visit anytime she felt
comfortable; after that, she seemed more at ease.
 Revises actions and goals based on evidence rather than conjecture
 Example: In this paper, I discussed how her goals were to have a cesarean while
minimizing the complications of her diagnoses. After the birth, her goals were
changed based on evidence, or current literature, related to the separation of her and
her baby. I discussed the current literature on the importance of mother/baby bonding
and promoting breastfeeding when/if a separation does occur, and how it could affect
the relationship between them.

 Nursing Practice
 Implements traditional nursing care practices as appropriate to provide holistic health
care to diverse populations across the life span.
 Example: The traditional nursing care discussed in this case study included
administering medications, providing privacy, and listening to her concerns while
providing proper education. The patient of this case study was a young adult; her
mom, boyfriend, and friends were all there to provide support.
 Demonstrates an awareness of complementary modalities and their usefulness in
promoting health.
 Example: I demonstrated awareness of complementary modalities and their
usefulness in promoting health by discussing mother/baby bonding, as well as the
promoting breastfeeding. In this paper, these were both supported by nursing research
that describes the positive benefits that can come from each on both mom and baby.

 Communication
 Uses therapeutic communication within the nurse-patient relationship.
 Example: In this case study, I discussed how simply being a good listener can be a
form of therapeutic communication and suggesting another source of information be
involved when explaining what was going on. The RN and I actively listened to the
patient’s concerns of missing out on the bonding time in the first few days of life, and
offered support through quiet time and privacy.
 Teaching
 Provides relevant and sensitive health education information and counseling to patients,
and families, in a variety of situations and settings
 In this paper, I discussed the current literature on the importance of bonding and
breastfeeding, and provided simple education on how to achieve both. I mentioned
that both of these could be achieved by encouraging her to visit with her baby and
how supporting skin to skin time is so significant. In this situation, although the baby
was in the SCN, it was like the mother was experiencing a loss, so it was important to
provide education on why it was necessary for the baby to be there and how to
prevent any complications from this separation. I also discussed the proper education
on the effects of gestational diabetes to mom and her family.

 Research
 Differentiates between descriptive nursing literature and published reports of nursing
research.
 Example: In this case study, I used the nursing literature to support the practice of
treating gestational diabetes through diet and nutritional management, as well as
using insulin, glyburide and metformin. I also used published reports of nursing
research to support the practice of mother/baby bonding and promoting breastfeeding
to prevent any complications from the separation.

 Professionalism
 Differentiates between general, institutional, and specialty-specific standards of practice
to guide nursing care.
 Example: Nursing care provided by the registered nurse and I were guided by the
AWHONN Standards of Care. We appropriately discussed the need for leadership to
help set the tone of the unit and to help with the nurse/patient relationship; we
discussed the need for collegiality to help with the professional growth and evolution
from sharing knowledge and skills with others who maybe strive to be as good as
them one day; we discussed the need for education in order to provide appropriate
care to mom and baby.
 Understands the effect of legal and regulatory processes on nursing practice and health
care delivery, as well as limits to one’s own scope of practice.
 Example: Administering 2 units of packed red blood cells and placing the patient on
close observation was in the nurse’s scope of practice. During the cesarean, the
patient had lost 800 cc of blood and her H&H was 9.0/24.4%, as well as her RBC
count at 3.08, so the patient was given 2 units of PRBCs. This was our job to replace
the blood lost during the procedure and to closely monitor her for any type of
reaction.
 Culture
 Articulates an understanding of how human behavior is affected by culture, race,
religion, gender, lifestyle and age.
 Example: In this paper, I discussed how young the patient was, as well as her
boyfriend, and I found this to be one of the reasons she had a hard time understanding
why the baby was being taken to the SCN. Her young mind-set was unable to
understand that the baby was solely being taken for close monitoring. She had also
previously had a healthy baby, so this too effected the way she behaved toward this
experience of it not being the same as the last time.