Mackenzie Hawk

February 5, 2020
St. Joseph Warren Hospital
7am- 1pm Tuesday

To begin the day on the Labor and Delivery Unit, we all gathered around to obtain a brief
report on our pa ent assignments. I was assigned two post-partum pa ents this week, and had
quite a few things to do for the day. I started by introducing myself to the nurse assigned to my
pa ents as the student nurse helping to take care of them. She was happy to hear she had some
help, and immediately gave me some more informa on on the care plans for my pa ents. The
rst one we went to see was a young woman who was gravida 1 para 0 on her second post-
opera ve day from an unscheduled C-sec on, delivering a 9lb 1 oz baby girl at 16:57 the day
before. She had planned to do a spontaneous vaginal delivery, but she was found upon prenatal
visits to have a bicornuate uterus and was at 40 weeks and 5 days. A bicornuate uterus is a
congenital abnormality that results in the fundus of the uterus having a large indenta on,
causing it to be in a heart shape and mildly unfavorable to pregnancies. Studies show that 90%
of women with this condi on successfully carry a pregnancy to term, but only about 60%
successfully deliver a live child. This is because this condi on causes a higher risk of cervical
incompetence during labor, which proved true in my pa ent’s case. I was able to administer her
Tdap shot, and do some pa ent teaching on the importance of anyone in direct care of the baby
having this vaccina on as well. I was also able to show her educa onal videos regarding shaken
baby syndrome and safe sleep prac ces. The pa ent verbalized understanding of the teaching,
and I was able to answer ques ons she had about taking care of her incision site. A relevant
nursing diagnosis to use in her care plan would be risk for impaired paren ng related to her
recent cigare e and marijuana abuse. The other pa ent I had was an Amish young woman
gravida 3 para 2, and she had given birth to a healthy baby boy by induced vaginal delivery at
40 weeks and 2 days. She refused her vaccina ons, and wanted to wait un l her family had le
to watch the educa onal videos. She was showered, dressed, and expressed her desire to be
discharged when we entered the room, but we explained that since she had elected for her baby
to be circumcised, it was in her best interest to wait un l they were both discharged to go home.
The nurse also explained that they would not discharge her un l she had scheduled a follow up

fi
ti
ti
tt
ti

ti
ti
ti

ti
ti
ti
ti
ti
ti
ti
ti
ti
ti
ti
ti
ti
ti
ti
ti
ti
ti
ft
 visit in the next few days to see her OB/GYN and the baby’s pediatrician. There was not much in
her chart regarding her prenatal, social, or medical history due to her culture. She did report
taking prenatal vitamins, and receiving regular ultrasounds throughout her pregnancy. A good
nursing diagnosis to use in her care plan would be disturbance in sleep pa erns, not only
because she now has a newborn, but also because she has a one and ve year old daughters at
home that she is primary caregiver for due to her Amish culture.
One course objec ve that applies to this clinical experience is the evalua on of how
legal, ethical, poli cal, cultural, economic, and safety issues a ect the health care needs of both
mothers and their infants in this case. The use of recrea onal drugs by a mother can have direct
implica ons on her paren ng methods, just as well as the Amish culture directly impacts the
delivery of healthcare to pa ents that subscribe to that lifestyle. In this example, it was out of
the cultural norm to accept vaccina ons that are normally required in our school systems, so we
have to tailor our pa ent educa on and interven ons to be er suit her and her family.
The most signi cant learning experience of the day was looking up the health history of
my rst pa ent, and learning how the condi ons and complica ons a ected her physiologically
and mentally. I was able to learn more about why a seemingly simple pregnancy had such a
dras c outcome, and how it made it hard for her to cope with the damage that interven ons
had brought to her body she had not planned for. Regardless, she was ready to learn what was
expected of her in terms of self-care, and was very ac ve in the process. I was also able to
conduct my rst full head to toe post-partum assessment on both of my pa ents, which helped
me ful ll the hands-on component to my learning process.



fi
ti
fi
ti

ti
fi
ti
ti
fi
ti
ti
ti
ti
ti
ti
ti
ti
ti

tt
ff
ti

ff
fi
tt
ti
ti

ti