The Nursing Intervention in Pregnancy and Childbirth

The pathophysiology of pregnancy includes fertilization of an egg with the sperm. Fertilization then takes place in the fallopian tube. The fertilized egg then travels into the uterus and will implant within seven to ten days. Once it is implanted in the uterus, the zygote becomes an embryo. This stage lasts three to eight weeks after fertilization. After this, the embryo becomes a fetus, which lasts from non weeks after fertilization until the baby is born (Upchurch, Henry, Pine,& Rickles, 2014).

During labor, electronic fetal heart monitoring and vaginal exams are standard practice. Forceps or a vacuum extraction can be used to help with vaginal delivery. An episiotomy can be done to widen the perineum to provide easier delivery. Epidural can be given as anesthesia for pain relief during labor. Oxytocin can also be given after the placenta is delivered to contract the uterus (Upchurch, Henry, Pine, & Rickles, 2014).

Family Centered Nursing Interventions

Family centered nursing interventions involve how members around the pregnancy. Nurses should assess bonding between mother and infant and father and infant. Nurses assess for eye contact, kissing and fondling the infant, smiling and talking to the infant, calling the infant by his or her name, and seeing no signs of negative statements. Nurses should promote bonding by ensuring that mother and father are comfortable, educating on skin to skin care,; praising positive parent behaviors, teaching when to pick up the infant if he or she is crying, and teaching how to soothe infants. It is important to help establish and see a growing relationship between family and infant (Upchurch, Henry, Pine, & Rickles, 2014). Nurses must not forget the father and help with identifying his role. It is important to include other children into this transition and to educate parents to devote time to the older sibling because he or she can begin to feel isolated. At this age, children notice the change in their mother’s appearance. They need their environment to stay the same. Nurses should also teach parents that they can include the child during infant feeding times, praise children for acting appropriately, and prepare small gifts so the child does not feel left out. The main priority is having all members included into the transition of having a new infant in the family (Perry et al., 2014).

Medications

There are many medications that are given to a other during childbirth. Benzocaine-menthol is a topical spray that is used as needed for pain levels of 1-3. This medication is used to ease pain and treat itching for perineal care after a vaginal birth. Docusate Sodium is a stool softener that is prescribed until the patient had a bowel movement. Its indication is for relief of constellation, to help produce a bowel movement, and to help prevent dry and hard stools. Ibuprofen is a non steroidal anti-inflammatory drug that reduces the hormones that cause inflammation and pain. This medication is to be taken with food as it is needed and for pain scores less than five. Oxycodone-Acetaminophen is a combination of oxycodone, which is an opioid, and acetaminophen, which is an analgesic to relieve moderate to severe pain. It is given if the pain scale is greater than five. It is important to know that the maximum adult dose of acetaminophen is 4000 m.g. for 24 hours. Witch Hazel-Glycerin is a combination of glycerin, which protects skin and creates a protective barrier over hemorrhoids to allow them to heal, and witch hazel, which is an astringent hat shrinks swollen tissues and provides relief for irritation or itching. Its indication is for hemorrhoids and for relieve of vaginal pain or discomfort after childbirth (Adams, Holland, & Urban, 2017). Zolpidem is a sedative that affects the unbalanced chemicals in the brain that cause insomnia. It is given at night to help treat insomnia. Oxytocin is a hormone that causes the uterus to contract. It induces labor and strengthens labor contractions (Adams, Holland, & Urban, 2017).

Labs and Diagnostics

Human chorionic gonadotropin is the earliest biologic marker for pregnancy. Pregnancy tests recognize hCG. The production of hCG begins as early as implantation and is detected in the blood or urine as early as seven to eight days after ovulation. Home pregnancy test kits use urine to test for pregnancy, and serum tests collect seven to ten milliliters of venous blood to test for pregnancy. The first presumptive sign that is detected by the woman is amenorrhea. Hearing fetal heart tones, visualizing the fetus, and feeling for fetal movement are all positive and objective signs of pregnancy (Perry et al., 2014). The labs that are taken are complete blood count and an RBC antibody screen. These labs are taken to look for the presence of infection and hemorrhage. RBC antibody and screen is used to identify the maternal blood type in case there is a need to administer blood products.

Patient Needs

After birth, the mother goes through many physical changes. The uterus returns to its nonpregnant state, which is called involution. There is a decrease in estrogen and progesterone which is called autolysis, which is the self destruction of excess hypertrophied tissue. Lochia, which is post birth uterine discharge, goes through three different stages as the woman’s body is returning to the non pregnant state. The abdominal wall is relaxed for two weeks after pregnancy but usually returns back to what it was before pregnancy. Striae is commonly still present after pregnancy. Breasts become fuller and heavier after birth because of milk production. Varicosities and hemorrhoids are also common. Ovulation and menses returns after birth. Mothers need comfort, rest, exercise, to be able to return to normal bowel and bladder function, and education on breastfeeding (Perry et al., 2014).

Mothers also have psychosocial needs. Ongoing support is very important along with discharge teaching and having their emotional needs met. Nurses have to assess maternal self image and sexuality. New parents can be reluctant to resume in sex because of the fear of pain or more damage to the peritoneum. It is important to discuss this topic with mothers. The nurse should also assess adaptation to parenthood, reactions to baby, and the establishment of positive relationships with the infant. Mothers can go through postpartum depression. There is no exact cause, but it can come from being emotional and physically vulnerable or feeling deprived of supportive care (Perry et al., 2014).

Health Promotion

Health promotion during the postpartum period includes promotion of ambulation, exercise, rest, nutrition, normal bowel and bladder function, breastfeeding, and vaccinations. During this time, it is important to teach new mothers the importance of ambulation for reduce the formation of venous thromboembolism and return strength to the lower extremities. This increases blood flow and prevents stasis. It is important to teach mothers about orthostatic hypotension and to dangle their legs at the edge of the bed before standing to avoid fainting or dizziness. Nurses should also promote exercise and teach patients postpartum exercises, which are simple exercises to strengthen muscle tone. Nurses can teach kegel exercises, abdominal breathing, leg and knee rolls, and buttocks lifts. Nurses should educate patients on postpartum fatigue, which can lead to depressive symptoms. Back rubs, medication, and comfort measures ca be used to promote sleep. Support reduces anxiety. Nurses also teach patients about nutrition. Patients should continue to use iron supplements and prenatal vitamins for six weeks after birth. Patients must maintain healthy dietary needs to privet anemia and constipation, promote healing, and support breastfeeding (Perry et al., 2014).

Nurses can also teach interventions to promote normal bladder and bowel activity. Nurses help patients to the bathroom for their first time voiding after birth. Running water, using warm water from a squeeze bottle over the perineum, and placing hands in warm water are all interventions to promote urination. Education on proper hydration, consuming adequate fiber, and ambulation are all interventions to help promote regular bowel movements. Initiating breastfeeding should be promoted as well. Nurses and lactation consultants help the mother by teaching breastfeeding techniques and provide instruction on how to facilitate breastfeeding. Ideally, breastfeeding should start an hour to two hours after birth. Finally, vaccines should be given for future pregnancies. The rubella vaccine should be given to prevent contracting rubella in future pregnancies. The varicella vaccine can be given as well. Tetanus-Diptheria-Acellular Pertussis canine protects the mother form pertussis and decreases the risk of the infant contracting pertussis. Rh immune globulin can also be given after birth to an Rh-negative mother who has had a fetomaternal transfusion of Rh-positive red blood cells from the infant (Perry et al., 2014).

Nursing Process Plan of Care

Risk for Constipation Related to Hemorrhoids as Evidenced by no Bowel Movements

Interventions. The nurse can give the prescribed medications like Colace to soften stool allowing defecation to be easier. The nurse can teach the patient to walk to help promote peristalsis. The nurse should encourage 2,000 to 3,000 mL a day to keep stool soft. Teach patients to eat at least 20 grams of fiber a day to add bulk to stool which makes defecation easier. Warm sits baths can help relax muscles and witch hazel pads will provide comfort for hemorrhoids. Give the patient privacy and have them sit upright when trying to go to the bathroom to allow gravity and the effect of the Vasalva maneuver to promote defecation (Ignatavicius & Workman, 2016).

Expected outcomes. Patient will have a bowel movement within two to three days after delivery. Patient will not experience a pain scale of greater than 3 or increasing discomfort from constipation. Patient will do interventions to relieve constipation (Ignatavicius & Workman, 2016).

Acute Pain Related to Postpartum Physiological Changes (Hemorrhoids, Breast Engorgement, Sore Nipples) as Evidenced by a Pain Scale of 4

Interventions. The nurse must first assess the location, quality, and type of pain to create a plan and know which interventions to do. Administer appropriate pain medications to provide pain relief. The nurse can provide ice packs to the perineal to reduce edema, irritation, and discomfort from trauma from birth and hemorrhoids. Teach to use cool sitz baths for the first 24 hours and warm sitz baths after the first 24 hours to reduce edema, promote circulation, and reduce discomfort. Teach and apply witch hazel compresses to reduce edema. Teach how to use topical sprays like Dermoplast to lower the response of the peripheral nerves. Teach mothers to apply ice packs to breasts after feeding if they are engorged, which will reduce the swelling of the tissue and promote milk flow. Mothers can also take warm showers before feeding to stimulate lactation. Nurses should teach to rub expressed milk on sore nipples to promote healing. Hydrogel pads can be used to provide comfort. Breast shells can be used to prevent irritation. Supportive bras, breast binders, and ice packs can be used to reduce swelling from engorgement. Nurses must assess how the infant is latching and his or her position during breastfeeding to prevent damage to nipples during feeding (Perry et al., 2014).

Expected outcomes. Patient will exhibit signs of decreased discomfort. Patient will state a pain level of less than 3 on the pain scale. Edema will decrease with the use of interventions (Perry et al., 2014).

Disturbed Sleep Pattern Related to Discomfort as Evidenced by Statement of “Feeling Tired More Often”

Interventions. The nurse should assess the patient’s regular sleep routine with the routine she is experiencing now to determine what is causing sleeping issues. Provide appropriate environment for sleep which includes darkness, quiet, warm room temperatures, and decrease of stimulus to give optimum conditions for sleep. The nurse can also provide back rubs, warm milk, soothing music, and teach relaxation techniques to provide good sleeping conditions. The nurse should teach to avoid things that interrupt with sleep like caffeine, fluids, extreme activity, lights, and noises to enhance the quality of sleep. Administer sleep or pain medications to enhance the quality of sleep. Teach patient to nap when infant is napping to decrease fatigue (Perry et al., 2014).

Expected outcomes. Patient will sleep 7-8 hours a day. Patient will have periods of uninterrupted sleep. Patient will report feeling rested after waking (Perry et al., 2014).