N 340 Women's Health & Illness in The Expanding Family & N345 Clinical Practicum

N 340 Postpartum Case Studies

Please copy these and bring to class. Thanks!

QSEN and CAS: Is the problem Simple, complicated or Complex.

Use the Fishbone Solution diagram to help identify pertinent areas.

Which case study will I be presenting??? It goes by your birth month!!

You will want to do some background preparation before class. Your groups will have some time in class to come up with a plan before you discuss with the rest of the class. You will get more out of the class if you have also read and thought about how you would "solve" the other case studies.

Born in: January, July or December: Ms. R. had her third baby four hours ago. She got up shortly after she delivered and voided 100 mls. You have been checking her periodically. Her VS have been normal and her uterus has stayed firm and at the umbilicus. You now check her and her fundus is somewhat firm, 2 fingers above her umbilicus and deviated slightly to the right. She has six visitors in the room including her two other children. She tells you she doesn't want to be bothered right now until her visitors leave.

What's going on? What would you do? Be specific as to the order you would do things in.

Born in February, August or November: Ms. M had her first baby one hour ago. It's a full moon and L&D is bursting at the seams. The L&D nurse wheels the patient over and tells you everything has been normal. She has an IV running (with pitocin in it) and this bag can be d'cd after it runs in. She's voided an adequate amount and is bleeding a normal amount. She had an episiotomy with a third degree extension. She plops the chart down and runs back to L&D. In about 20 minutes you go in to assess Ms. M. Her vital signs are 102/60, P 92, R 16. Her peri-pad is saturated, her fundus is firm and 1 below her umbilicus. Ms. M. states she has some throbbing "down there." What would you do? What could you do next time to prevent this confusing situation? What do you hope Ms. M has on her perineum?

Describe how you will assess her.

Born in March, May or September: Ms. B. had her second baby two days ago is planning to leave the hospital soon. The Family Practice MD has discharged both the mom and the baby after Ms. B. has her rhogam, rubella immunization and if her lab work comes back normal. Her CBC is: Hgb: 12.2 (12-16), HCT: 42 (37-47), WBCs: 21,000 (5,000-10,000). She has Norco ordered to take home. You go in and ask her if she would like you to call in her prescriptions to a pharmacy. She says she has had more uterine cramping (especially while nursing) with this baby then she did with her last delivery . She really needs the pain meds, but is hesitant to take them because she is breast feeding. She also doesn't want to get the rubella vaccination because she is breast feeding. Ms. B. asks why she needs the rhogam when she didn't need it last time.

What's up with the lab test results? What would you do? Why the rhogam and rubella? What would you do about her refusing to get the rubella vaccination? Why is she having more uterine cramping this time? How about pain medication and breast-feeding?

Born in April, June or October: Ms. S had her first baby at 6 this morning. She is transferred out to the postpartum unit at 8:30 and immediately gets on the phone with her friends and family talking about her labor. Her husband is sitting on the bed holding the baby. You go in at 10 with some breakfast and to do a quick check and she's still on the phone. When you go back in at 11 she's still on the phone giving a contraction by contraction description of pushing. You ask her to please get off the phone so you can check her and help her to the bathroom. Her husband is still holding the baby. You ask them what the baby's name is and they tell you they can't decide between Heather or Jennifer. The CNA working with you today is really upset about her behavior.

What's going on? Is it okay for her to be taking about her labor so much and ignoring the baby? What would you be looking as evidence of the mother bonding? How about the dad?