POSTNATAL ASSESSMENT PATIENT IDENTIFICATION Name Age Ward Religion Date of admission Date of delivery Type of delivery Indication

Diagnosis Obstetrical score Date of care started Date of care ended INTRODUCTION During my posting in St Marys Hospital I was posted in postoperative ward and I took Mrs. Manjulla post natal mother for care study .She delivered a male baby with birth weight 2900 gms on 24/9/12 at 1.30 pm by caesarean section. I introduced myself to her and explained how I will be helping her cope with postnatal problem : : : : : : : : : : : : Mrs. Manjulla 25 years Post operative ward Hindu 22/9/12 24/9/12 Caesarean section Previous caesarean section Hbs AG positive G2P2L2A0 23/9/12 3/10/12

FAMILY HISTORY Mrs. Manjulla has no family history of Diabetes mellitus, Hypertenssion, multiple pregnancy, cardiac problem, and psychiatry problems. But the patient is suffering with chronic hepatitis B. SOCIO-ECONOMIC STATUS She belongs to lower class family. They live in house of their own with all minimum basic requirements such as electricity, water supply. Her husband is the bread winner of her family. PERSONAL HISTORY Diet: She is taking mixed diet Hygiene : She is not maintaining good personal hygiene Sleep : She used to sleep 8 hours at night and 2 hours in day time. She has no sleeping disturbance Bowel and bladder : No history of bowel and bladder pattern disturbance. Habits: She has no bad habits like chewing tobacco or drinking alcohol MENSTRUAL HISTORY She attained menarche at the age of 14 years . She is having regular cycle of 28 days with moderate flow. Her menstrual flow lasts for 4-5 days. MARITAL HISTORY She got married at the age of20 years. Her marital life is 5 years and her marriage is non consanguinous marriage.

PAST MEDICAL HISTORY Mrs. Manjulla is known Hbs Ag positive patient. PAST SURGICAL HISTORY She underwent LSCS 2 years back. OBSTETRICAL HISTORY Past obstetrical history

No.Of pregnancis

Gestationa l weeks

Course of pregnancy

LSCS

2010 38

Girl baby with 2500 gms

Uneventful

Mother and the baby were healthy

Present obstetrical history Obstetrical score : LMP EDD Gestational age Ist trimester 12/2/12 She had ante natal : : : G2P2L2A0 23/12/11 30/9/12 39 weeks IInd trimester 20/5/12 Had ante natal IIIrd trimester 12/8/12 Had ante natal visits.

Remarks

Type of delivery

Baby

Date

visit regularly. Taken folic acid tablets. No exposure to radiations. She had vomiting from 3rd week up to 8thth week Body weight:45kg Haemoglobin: 10 gms% First trimester was uneventful

visit. Taken Iron, Folic acid and Calcium tablets regularly. Fetal movements were felt. Inj.T.T taken. Body weight:50kg Haemoglobin: 9.9gms% Second trimester was uneventful

Taken iron folic acid and calcium tablets.

Inj. T.T taken Fetal movements was good

Body weight:54kg Haemoglobin : 9.9 gms% Third trimester was uneventful

REASON FOR CAESAREAN SECTION Previous LSCS and Hbs Ag positive PHYSICAL EXAMINATION Vital signs Temp Pulse Respiration BP : : : : 99.90 F 86 b/m 24 br/m 120/70mmHg

Weight Height General appearance Mood HEAD TO FOT EXAMINATION Head Face Skin Eyes Ear Nose Mouth Teeth Neck Chest CVS Breast Abdomen : : : : : : : : : : : : :

: : : :

50kg 162cm Moderately built Cheerful

Healthy hair. Clean scalp. No dandruff or lesions No edema, rashes on the face Acne vulgarise is present all over the body Conjunctiva pale in colour, normal vision Hearing normal, no abnormal discharge No septal deviation , no abnormal discharge Lips and tongue are dry No dental carries No thyroid and lymph node enlargement Expansion of the chest is normal S1and S2 heard Soft, nipple erect, no cracks , no tenderness on palpation On inspection linear nigra and stria gravid present LSCS incision present .

On palpation uterus well contracted. bowel and bladder : Genitalia Extremities negative : : she passed urine and bowel sounds are normal Lochia rubra present Normal range of motion, no oedema , human sign is

INVESTIGATIONS

Date

Name investigation

of

Patient value AB + ve 9.9gm/dl

Normal value

Remark

20/5/12 20/5/12

Blood grouping Hb%

13-14mg/dl

She

is

an

anaemic mother 20/5/12 RBS 120mg/dl 80-120mg/dl She is not a diabetic mother 20/5/12 20/5/12 Hbs Ag HIV Positive Negative Negative Negative

MEDICATION

Indicati ons

Inj .Taxim

IV

1.5gm BD

Bind to bacterial cell wall membrane causing cell death

Skin and skin infections, prophylactic for surgery Perioperative prophylactic, intra abdominal infection GERD, gastritis

GI effects; anaphylactic shock (rare).

Inj. Metrogyl

IV

500 gm

BD

Disrupts DNA and protein synthesis in susceptible organisms

Inj. pantop

IV

40 mg BD

Inj .Tromdal

IV

50 mg HS

Binds to an enzyme in the presence of acidic gastric Ph, preventing the final transport of hydrogen ions in to the gastric lumen Inhibits reuptake of serotonin and nor epinephrine in CNS

Head ache, anorexia, nausea, rashes, phlebitis at IV site, unpleasant taste Head ache, abdominal pain, diarrhoea, flatulence, hyper glycemia Dizziness, head ache, somnolence, vaso dilation, constipation, nausea

Allergy or hypersensiti vity to cephalospor ins. Hypersensit ivity, first trimester of pregnancy Hypersensit ivity, pregnancy

Moderate to moderately severe pain

Alcohol intoxication , opioid dependence

Contra indicati ons

Freque ncy

Action

Side effects

Route

Drug name

Sl no

Doze

DELIVERY NOTES Mrs.Manjulla was admitted on 22/9/12 due to previous

LSCS. She was taken for LSCS on 24/9/12. Inj. Taxim 1 gm IV, Inj emest 2mg and Inj Pantop 40 mg IV given. Folys catheter inserted. Pre preparations given and she was taken to OT at 1.15 PM. Spinal anaesthesia is given by using 5ml of Buppivaccaine 25%. A Boy baby with birth weight 2900 gms was extracted by LSCS AT 1.30 pm . Baby cried immediately after the birth. Post partum sterilisation was done. Wound sutured with 2.0 catgut and 1.0 polypropylene suture and sterile dressing given. She was shifted to post operative unit at 2.00 pm. IV fluids were continued. She was kept nil per oral for next 24 hrs. Fluids were given after that and oral food intake started after checking bowel sounds.

POST NATAL MIOTHER WITH HBSAG POSITIVE INTRODUCTION Hepatitis B virus (HBV) is a blood borne and sexually transmitted virus. Rates of new infection and acute disease are highest among adults, but chronic infection is more likely to occur in persons infected as infants or young children. Before hepatitis B vaccination programs became routine in the United States, an estimated 30%40% of chronic infections are believed to have resulted from perinatal or early childhood transmission, even though <10% of reported cases of hepatitis B occurred in children aged <10 years Chronically infected persons are at increased lifetime risk for cirrhosis and hepato cellular carcinoma (HCC) and also serve as the main reservoir for continued HBV transmission. HEPATITIS The term 'hepatitis' simply means inflammation of the liver. Hepatitis may be caused by a virus or a toxin such as alcohol. Other viruses that can cause injury to liver cells include the hepatitis A and hepatitis C viruses. These viruses are not related to each other or to hepatitis B virus and differ in their structure, the ways they are spread among individuals, the severity of symptoms they can cause, the way they are treated, and the outcome of the infection. HEPATITIS B Hepatitis B is an infection of the liver caused by the hepatitis B virus (HBV). It is estimated that 350 million individuals worldwide are infected with the virus, which causes 620,000 deaths worldwide each year.

The hepatitis B virus is a DNA virus, meaning that its genetic material is made up of deoxyribonucleic acids. It belongs to a family of viruses known as Hepadnaviridae. The virus is primarily found in the liver but is also present in the blood and certain body fluids. INCUBATION PERIOD The average incubation period is 90 days from time of exposure to onset of symptoms, but may vary from 6 weeks to 6 months TRANSMISSION OF HEPATITS B VIRUS Hepatitis B is spread mainly by exposure to infected blood or body secretions. Hepatitis B is not spread through food, water, or by casual contact. BOOK PICTURE Semen, vaginal and saliva Blood and blood products Sexual contact Using contaminated needles Mrs.Manjulla got hepatitis B due to contaminated needles. Tattooing Body piercing Sharing toothbrushes and razors discharge, breast milk, PATIENT PICTURE

contaminated with infected fluids or blood.

Infected mothers to their babies at birth Donated livers , and other organs However, blood and organ donors are routinely screened for hepatitis which typically prevents this type of transmission.

HIGH RISK PERSONS The high risk persons getting hepatitis B includes

Health care workers Dentists Intimate and household contacts of patients with chronic hepatitis B infection Public safety workers who may be exposed to blood Men who have sex with men Individuals with multiple sexual partners Dialysis patients Injection drug users Persons with chronic liver disease Residents and staff in institutions that care for persons with developmental disabilities Persons infected with HIV Persons who require repeated transfusions or blood products.

THE SYMPTOMS OF ACUTE HEPATITIS B Acute hepatitis B is the period of illness that occurs during the first one to four months after acquiring the virus. Only 30% to 50% of adults develop significant symptoms during acute infection. Early symptoms may be non-specific, including fever, a flu-like illness, and joint pains.

BOOK PICTURE Fatigue Loss of appetite Nausea Jaundice Pain in the right upper abdomen (due to inflammated liver)

PATIENT PICTURE Fatigue present

Pain in the abdomen

THE SYMPTOMS OF CHRONIC HEPATITIS B The liver is a vital organ that has many functions. These include a role in the immune system, production of clotting factors, producing bile for digestion, and breaking down toxic substances, etc. Patients with chronic hepatitis B develop symptoms in proportion to the degree of abnormalities in these functions. The signs and symptoms of chronic hepatitis B vary widely depending on the severity of the liver damage. They range from few and relatively mild signs and symptoms to signs and symptoms of severe liver disease such as cirrhosis or liver failure.

Book picture Because of chronic hepatitis the patient is feeling fatigue , puss formed at the surgical wound and got difficulty to heal the wound . Baby is diagnosed with jaundice.

Cirrhosis of the liver due to hepatitis B Inflammation from chronic hepatitis B can progress to cirrhosis of the liver. Significant Symptoms may include:

Weakness, Fatigue, Loss of appetite, Weight loss, Breast enlargement in men, Rash on the palms, Difficulty with blood clotting, and

DIAGNOSTIC MEASURES Book picture History collection Physical examination Patient picture Information through history collection

For detection of hepatitis B virus infection Blood test shows mother is HbsAg positive involve serum or blood tests that detect either viral antigens (proteins produced by the virus) or antibodies produced by the host Liver biopsy examined under microscopy

MEDICATIONS

prednisone: used to treat many diseases, including asthma, inflammatory bowel disease, and certain types of skin disease and arthritis

methotrexate (Rheumatrex, Trexall): used to treat certain types of skin disease, arthritis, and cancer;

cyclophosphamide (Cytoxan): used to treat some cancers.

PREVENTION OF PERINATAL HBV INFECTION AND MANAGEMENT OF PREGNANT WOMEN Treatment Acute hepatitis B usually resolves on its own and does not require medical treatment. If very severe, symptoms such as vomiting or diarrhoea are present, the affected person may require treatment to restore fluids and electrolytes. There are no medications that can prevent acute hepatitis B from becoming chronic. If a person has chronic hepatitis B, they should see their health care provider regularly Prevention Two available hepatitis B vaccines for immunization are Recombivax HB and Engerix-B

Pregnancy is not a contraindication to vaccination.

For vaccination of adults 20 years of age and older:

1-mL dose by intramuscular injection into the deltoid muscle, at initial visit, then one month and six months after the first dose, for a total of three doses

After Exposure to Persons Who Have Acute Hepatitis B When exposure has occurred as a result of sexual contact within 14 days after the most recent sexual contact administer A course of HBV vaccine into the deltoid as above A dose of Hepatitis B immune globulin (HBIG) 0.06 mL/kg IM For prophylaxis after percutaneous or mucous membrane injury, a second dose of HBIG should be given 1 month later.

Exposure to Persons Who Have Chronic HBV Infection Active post exposure prophylaxis with hepatitis B vaccine alone is recommended for sex or needle-sharing partners and non-sexual household contacts of persons with chronic HBV infection Ante partum

At time of admission for delivery o o Review hepatitis B surface antigen (HBsAg) status of all pregnant women. Record maternal HBsAg test results on both labor and delivery record and on infants delivery summary sheet. Perform HBsAg testing as soon as possible on women who do not have a documented HBsAg test result, were at risk for HBV infection during pregnancy (e.g., more than one sex partner in the previous 6 months, evaluation or treatment for a sexually transmitted disease, recent or current injection-drug use, or HBsAg-positive sex partner), or had clinical hepatitis since previous testing

Pregnant Hepatitis B carriers should be advised to

Obtain vaccination against hepatitis viruses as indicated. Abstain form alcohol use Avoid hepato toxic drugs such as acetaminophen (Tylenol) that may worsen liver damage.

Not donate blood, body organs, or other tissue. Not share any personal items that may have blood on them (e.g., toothbrushes and razors).

Inform the infants pediatrician, OB/GYN, and labor staff that they are a hepatitis B carrier.

Make sure their baby receives hepatitis B vaccine at birth, one month, and six months of age as well as H-BIG at birth.

Be seen at least annually by their regular medical doctor.

DELIVERY

BOOK PICTURE Although cesarean delivery has been

PATIENT PICTURE LSCS

proposed as a means of reducing mother to child transmission (MCT) of HBV The mode of delivery does not appear to have a significant effect on the interruption of HBV maternal-baby transmission by immune prophylaxis. Delivery by cesarean section for the purpose of reducing MCT of HBV is note presently recommended

CARE OF THE NEWBORN BABY BOOK PICTURE Standard precautions should be utilised when handling the baby The skin at the injection site should be cleaned with soap and water or with an alcohol swab before administering hepatitis B vaccine, immunoglobulin and vitamin K The baby should remain in the birthing room Followed Followed PATIENT PICTURE

until transfer to the ward unless transfer to the nursery is indicated Babies direct rooming in with their mother may be cared for in the ward nursery as require Breastfeeding is encouraged The baby is sucking Give hepatitis B immune globulin and hepatitis B within 12 hours of birth Immunisation given Practised

For preterm infants weighing <2,000 g, the initial vaccine dose (birth dose) should not be counted as part of the vaccine series because of the potentially reduced immunogenicity of hepatitis B vaccine in these infants; 3 additional doses of vaccine (for a total of 4 doses) should be administered beginning when the infant reaches age 1 month POST PARTUM PERIOD. BOOK PICTURE
Provide information regarding hepatitis B to

PATIENT PICTURE Information given

HBsAg positive mothers, including advice that they may breast feed their infants upon delivery; modes of HBV transmission; need for vaccination of their susceptible household, sexual, and needle-sharing contacts; need for substance abuse treatment, if appropriate At time infant is discharged

Information given
Provide infants immunization record to mother

and remind her to take it to the infants first visit to paediatric health-care provider

Mothers with unknown HBsAg status and their infants Administer single-antigen hepatitis B vaccine (without HBIG) to all infants born to mothers with unknown HBsAg status <12 hours after birth and record date and time of administration of hepatitis B vaccine on infants medical record. Alert infants paediatric health-care provider if an infant is discharged before the mothers HBsAg test result is available; if the mother is determined to be HBsAg positive, HBIG should be administered to the infant as soon as possible, but no later than age 7 days. All mothers and their infants Administer a dose of single-antigen hepatitis B vaccine to all infants weighing >2,000 g. Ensure that all mothers have been tested for HBsAg prenatally or at the timeof admission for delivery and document test results.

PROBLEMS IDENTIFIED Pain Impaired skin integrity and spread of sepsis Insomnia Risk for fluid volume imbalance Risk for impaired infant parent attachment

NURSIND DIAGNOSIS Acute pain related to surgical incision. Impaired skin integrity and spread of sepsis due to chronic infection Disturbed sleep pattern related to hospitalisation. Risk for fluid volume imbalance related to nill per oral status. Risk for impaired parent attachment due to presence of infection

ASSESSMENT

NURSING DIAGNOS IS

EXPECT ED OUTCO ME

INTERVENTION

RATIONALE

IMPLEMENTATION

EVALU ATION

Subjective data: The mother says that she has pain over the incision site. Objective data: The mother has difficulty to get up from the bed and walk. Her facial expression shows that she is having severe pain. She is having pain score 8 in pain scale.

Acute pain relate to surgical incision.

Mother experiences less pain with in 2 hrs as evidence by relaxed facial expression.

Provide comfortable position. Instruct the mother to do deep breathing and coughing exercise

To relieve tension over the incision. For pulmonary ventilation especially to remove stress and promote relaxation To relieve tension over the incision.

Provided comfortable position Instructed the mother to do deep breathing and coughing exercise

Advice to support the incision area with pillow while coughing or sneezing or moving Ensure adequate rest

Advised to support the incision site with pillow while sneezing or coughing. Ensured adequate rest.

To reduce pain due to movement. To promote circulation ,to prevent venous thrombosis and reduce pressure on the surgical site To reduce perception of pain.

She got slight relief from the pain after 2 hours. Pain scale score reduced to 4

Provide divertional activities Initiate active range of motion exercise and walking

Provided divertional activities Initiated active range of motion exercise and walking

Administer medications as per order

Administered inj. tremadol

ASSESSMENT

NURSIN G DIAGNO SIS

EXPEC TED OUTCO ME

INTERVENTION

RATIONALE

IMPLEMENTATION

EVALUA TION

Subjective data Mother says I am having fever and pain on the surgical site Objective data The unhealed wound and puss formation at the surgical site. Increased body temperature

Impaired skin integrity and spread of sepsis due to chronic infection

The mother achieves timely healing and free of additional complication as evidence by heeling wound and normal body temperature.

Demonstrate strict hand washing policy for patient ,visitors and staff. Provide proper contamination of infected material Clean the surgical site with Betadine solution and apply sterile dressing Demonstrate proper fundal massage Monitor the vital signs

Hand washing prevent cross infection

Demonstrated strict hand washing policy for patient ,visitors and staff. Provided proper contamination of infected material Cleaned the surgical site with Betadine solution and applied sterile dressing Demonstrated proper fundal massage Monitored the vital signs Monitored oral intake and output and encouraged the mother to take more fluids Administered proper antibiotics to mother

The mother maintained normal skin integrity as evidenced by healed wound within 6 days

It prevent the spread of infection

It reduce the growth of the bacteria and virus

Monitor oral intake and output and encourage the mother to take more fluids Administer proper antibiotics to mother

It helps in involution of the uterus and remove retained content To identify the fluctuations in the temperature level Increased intake replaces the losses and enhance circulation

To reduce growth of the micro organism

ASSESSMENT

NURSIN G DIAGNO SIS

EXPEC TED OUTCO ME

INTERVENTION

RATIONALE

IMPLEMENTATION

EVALUA TION

Subjective data: Mother says that she cant sleep last night because of pain Subjective data: She looks very tired . Falling asleep in between feeding the baby.

Disturbe d sleep pattern related to hospitali sation .

Mother experie nces better sleep with in 24 hrs as evidenc e by verbal express ion.

Provide comfortable position for sleep

Enhance relaxation.

Provided comfortable position for sleep.

She had better sleeping pattern on the next day.

Advice to take sleep when baby sleeps.

To avoid interruption in sleep due to babys cry and feeding

Advised to take sleep while baby sleeps.

Provide calm environment in the ward.

To avoid sleep disturbance

Provided calm environment in the ward by limiting the visitors and by putting curtains around the bed.

Provide comfort devices like pillows while positioning the mother To get more comfort. Kept pillows at back to position the mother.

ASSESSMENT

NURSIN G DIAGNO SIS

EXPEC TED OUTCO ME

INTERVENTION

RATIONALE

IMPLEMENTATION

EVALUA TION

Objective data : Chronic infection of mother Jaundice of the baby

Risk for impaired parent attachment due to presence of infection

The mother experiences comfort parenting as evidence by good parent infant attachment.

Observe the maternal and infant interaction Provide opportunity for maternal and infant contact whenever possible Monitor mothers emotional response to illness and separation from infant

To identify copying pattern of the mother It will improve the bonding between mother and the baby

Observed the maternal and infant interaction Provided opportunity for maternal and infant contact whenever possible Monitored mothers emotional response to illness and separation from infant

The mother maintained good attachment with the baby as evidenced frequent feeding .

It helps in identify the mothers problem and protect the mother from getting post partum depression Feeding will improve the bonding between mother and the baby It helps to maintain time for spending the time with the baby. To prevent Hbs Ag transmission from mother to child

Encourage the mother to feed the baby whenever possible Discuss the availability of supportive system in the home setting Administer Hepatitis B immune globulin

Encouraged the mother to feed the baby whenever possible Discussed the availability of supportive system in the home setting Administered Hepatitis B immune globulin

NEW BORN ASSESSMENT

Name of the baby Sex Date of birth Birth weight Apgar score Head circumference Chest circumference Length Skin Head palpable. Nose Mouth Eyes : : : : :

: : : : : : : :

B/O Manjulla Boy baby 24/9/12 2900gm 7 at 1 minute and 9 at5 minutes . 34cm 32cm 50cm

Pink in colour, vernix caseosa present Anterior frontenella and posterior frontenalla

No deviated septum, milia present Pink in colour, no cleft lip or cleft palate No discharges, symmetry in size and shape, yellowish discolouration

Ears Neck

: :

Corrected placement, no discharges No swellings, normal range of motion

Chest` Heart rate Respiratory rate Abdomen Bowel pattern Bladder pattern Genitalia Extremities REFLEXES Rooting Sucking Swallowing Sneezing and coughing Gagging Blinking Dolls eye movement Palmar grasp Plantar grasp reflex Moro reflex

: : :

Symmetric chest movement nipple prominent 130 b/mt 40 b/mt

: Round and dome shape : Meconium passed : : Urine voided Testis descend to scrotum, no abnormalities

: No congenital malformations, flexed position

: : : : : : : : : :

Present present present present present present present present present present

PROBLEMS IDENTIFIED Risk for ineffective breast feeding Risk for hypoglycaemia Risk for impaired skin integrity

NURSIND DIAGNOSIS Risk for infection related to immature immune system. Risk for ineffective breast feeding related to maternal infection Risk for hypoglycaemia related to ineffective feeding. Risk for impaired skin integrity related to side effects of phototherapy.

ASSESSMENT

NURSING DIAGNOS IS

EXPECT ED OUTCO ME

PLAN OF ACTION

RATIONALE

IMPLEMENTATION

EVALUA TION

Subjective data: Mother asks whether her baby will get any infection from hospital. Objective data: The babys immune system is immature.

Risk for infection related to immature immune system.

The baby remains free from infection

Educate mother about keeping the umbilical cord stump clean.

To prevent cord contamination.

Educated the mother about keeping umbilical cord stump clean and avoid touching it with hand. Advised to reduce the number of visitors. Advised to change the soiled diaper frequently. Educated mother about need for hourly feeding

The baby has no signs of infection

Advice to reduce the number of visitors. Advice to change the soiled diaper frequently. Ensure hourly breast feeding.

To prevent cross infection. To prevent urinary infection and skin rashes. Breast milk adds to infants immunity.

Ensure the breast hygiene of the mother. Administer Hepatitis B immune globulin

Advised mother to keep her breast clean before and after feeding the baby. To prevent the Administered Hepatitis B transmission of mother to immune globulin the baby To prevent the transfer of micro organisms.

ASSESSMENT

NURSIN G DIAGNO SIS

EXPEC TED OUTCO ME

INTERVENTION

RATIONALE

IMPLEMENTATION

EVALUA TION

Subjective data: Mother says that baby is crying when she try to give breast feed. Objective data : Mother not holding the baby properly during breast feeding. Baby is not attached to the breast properly. Baby looks sleepy.

Baby remains Teach proper feeding techniques. hypoglycaemia free from the Risk for related to ineffective feeding risk for hypoglycaem ia during the period of hospitalisatio n. Advice the mother to feed the baby in time. Advice the mother to wake up the baby if he sleeps in between feeding. Teach the mother the importance of breast feeding. Assist the mother in feeding the baby.

To help her to feed baby properly To avoid risk for hypoglycaemia. To avoid baby going to hypoglycaemia.

Taught proper positions for feeding Advised mother to feed the baby atleast 2 hourly. Adviced mother to keep the baby awake during feeding by ticling on sole or ears. Educated mother about importance of breast feeding. Assisted mother in feeding the baby.

Baby had no hypoglyc aemia and the baby is active.

To make her to breast feed the baby properly.

To make sure that the mother is feeding baby properly. Help to take necessary interventions.

Teach the mother the signs of hypoglycaemia of baby.

Educated mother to notice weather the baby is drowsy or always sleeping.

ASSESSMENT

NURSIN G DIAGNO SIS

EXPEC TED OUTCO ME

INTERVENTION

RATIONALE

IMPLEMENTATION

EVALUA TION

Objective data: Continuous phototherapy and fluorescent lights

Risk for impaired skin integrity related to side effects of phototherapy.

The baby maintains normal skin integrity as evidenced by proper phototherapy

Measure the quality of photo energy of fluorescent bulbs

The intensity of blue light striking the skin surface from blue light

Measured the quality of photo energy of fluorescent bulbs

The baby maintain normal skin integrity as

Apply patches to closed eyes and inspect eyes every 2 hours

To prevent the damage of Applied patches to closed eyes the retina from high density of light and inspect eyes every 2 hours

evidenced by proper phototherapy treatment

Monitor skin temperature every 2 hours.

To know the fluctuations in the body temperature

Monitored skin temperature every 2 hours.

Reposition the infant every 2 hours

To allow equal exposure to fluorescent light

Repositioned the infant every 2 hours

Monitor fluid intake and output It helps in prevention of and provide breast milk dehydration and maintain good attachment

Monitored fluid intake and output and provided breast milk

SUat 1.3MMARY I took Mrs. Manjulla a 25 year old post natal mother during my clinical posting in cooperation hospital, as a part of my clinical requirement. She was on her third post natal day. She underwent caesarean section on 24/9/11 at 1.30 pm and delivered a male baby with birth weight 2900 gms. I collected her health history and performed post natal examination. She was having problems like pain, insomnia, nutritional imbalance and wound infection. Her baby was having problems like, jaundice ,risk for infection and in adequate breast feeding. I tried to solve their problems by giving health educations and advising her about necessary interventions. Some of her problems like pain and insomnia has reduced with the interventions. Her surgical site stitches were removed on 9th postoperative day. She acquired adequate knowledge regarding wound care new born care and she started breast feeding the baby properly. CONCLUSION I took Mrs. Manjulla Hbs Ag positive mother as my postnatal care study. She underwent caesarean section on 24/9/12 at 1.30pm and delivered a boy baby with birth weight 2900 gms. I was able to study about the care of a postnatal patient who has undergone a caesarean section and her baby and to provide care for her. REFERENCES DuttaD.C . Text Book Of Obstetrics Including Perinatology And Contraception. VIth ed .Culcutta :New Central Book Agency ; 2004. P 145-54 Carepostnatal and puerperium. Amarson collections. Available at

:http://www.planbaby.com/care%20post%20PUER HTM

Deglin J H, Vallerant A H. Drug guides for nurses. 9th ed. Davis publications;philadalphia:2005. P 127, 395, 856,960, 734

Doenges M. MoorhouseM. Maternal and newborn plans of care. 3rd edition. USA;FA Davis company. Philadelphia. 1994

Hepatitis B in pregnancy . Available from:http://www.perinatology.com/exposures/Infection/HepatitisB.htm

Hepatitis B immunization .Available from: http://www.immunize.org.

UNIVERSAL COLLEGE OF NURSING

POSTNATAL CASE STUDY