AMANDA STEVENS, 26 YEARS OLD AND BABY GRACE BREAST FEEDING NEWBORN UNFOLDING REASONING.

AMANDA STEVENS, 26 YEARS OLD AND BABY GRACE BREAST FEEDING NEWBORN UNFOLDING REASONING. lOM oA R c P S D| Breastfeeding Newborn UNFOLDING Reasoning Amanda Stevens, 26 years old and baby Grace Primary Concept Reproduction Interrelated Concepts (In order of emphasis) • Pain • Patient Education • Clinical Judgment • Communication • Collaboration NCLEX Client Need Categories Percentage of Items from Each Category/Subcategory Covered in Case Study Safe and Effective Care Environment • Management of Care 17-23% • Safety and Infection Control 9-15% Health Promotion and Maintenance 6-12% Psychosocial Integrity 6-12% Physiological Integrity • Basic Care and Comfort 6-12% • Pharmacological and Parenteral Therapies 12-18% • Reduction of Risk Potential 9-15% Copyright © 2018 Keith Rischer, d/b/a KeithRN.com. All Rights reserved. lOM oA R c P S D| Copyright © 2018 Keith Rischer, d/b/a KeithRN.com. All Rights reserved. You received shift report on Amanda and Grace and are about to go in and complete your morning assessments. The night nurse reported Grace has not breastfed well since the initial feeding after birth. Amanda has difficulty getting Grace to latch. Once she does latch, she only • Physiological Adaptation 11-17% History of Present Problem: Amanda Stevens is a 26-year-old female, G1 P1, accompanied by her husband, Brad. She presented to the maternity unit complaining of contractions every five minutes for the past three hours. She was dilated to 6 cm, 50% effaced, -2 station and admitted for labor. Brad was very supportive throughout her labor. She received an epidural for pain control and delivered by spontaneous vaginal delivery (SVD) a baby girl 12 hours later at 39 5/7 weeks gestation. Amanda’s blood type is A+ and is Group B strep (GBS) negative. Baby Grace was 7 pounds 8 ounces (3.4 kg), 20 inches (50.8 cm) long with APGARS of 9 at one minute and 9 at 5 minutes. Delayed cord clamping for one minute occurred and then she immediately went to breast and latched with minimal assist and nursed for ten minutes. Initial newborn assessment was completed with no abnormal findings. Her vital signs at birth were HR: 158, R: 54 T: 98.1 F/36.7 C axillary. Personal/Social History: Amanda and Brad have been married for two years and live 15 miles from the hospital in a small, rural community. Brad is a security guard at a prison located 30 miles from home and Amanda is a preschool teacher for the local preschool in her town. She will be taking eight weeks off from work before returning full time. Amanda’s parents live two hours away and will be coming tomorrow to stay with Amanda for a few days when she and the baby are discharged. Brad’s parents live out of state and will be coming to visit next month. Amanda’s sister lives an hour away and has a toddler and has offered to help Amanda if she needs it. Amanda and Brad just moved to their home six months ago and do not have many friends in the area. What data from the histories are RELEVANT and must be interpreted as clinically significant by the nurse? RELEVANT Data from Present Problem: Clinical Significance: 26y/o, G1P1 CTX q 5min x 3 hrs. Epidural SVD GBSAPGAR 9/9 Latched and Nursed x 10 mins Baby WNL Relevant medical history for mom and baby RELEVANT Data from Social History: Clinical Significance: Supportive husband x 2 yrs Small, Rural community 8 Weeks Maternity Leave Amanda’s Parents 2 hours away Brad parents out of state Amanda’s sister an hour away Recently moved into home Not many friends in area Shows that the new family has minimalsupport outside of their house. Family coming but will not be around long term. Family may benefit from support group in the area. Patient Care Begins One Hour After Delivery: lOM oA R c P S D| Copyright © 2018 Keith Rischer, d/b/a KeithRN.com. All Rights reserved. What data from report is RELEVANT and must be interpreted as clinically significant by the nurse? RELEVANT REPORT DATA: CLINICAL SIGNIFICANCE -Baby Grace not feeding – Difficulty latching -Baby Grace has not voided since delivery -Mom thinks baby is not hungry - May benefit from lacatation consultant or nurse assistance - Baby dehydrated - Mom needs education on newborn feeding patterns Current VS: Amanda P-Q-R-S-T Pain Assessment: T: 99.0 F/37.2 C Provoking/Palliative: When infant breastfeeds P: 78 (regular) Quality: Cramps R: 18 Region/Radiation: Abdominal BP: 110/68 Severity: 4/10 O2 sat: 98% on room air Timing: Constant cramping but worsens with breastfeeding What VS data are RELEVANT and must be interpreted as clinically significant by the nurse? RELEVANT VS Data: Clinical Significance: -Cramping with Breastfeeding -Mom may not be interested in breastf