Question

Antenatal Scenario

Sara Mohammed a 37- year old female pregnant came to hospital for follow up during 35 weeks gestation age.

She is G2p1A0.
Her LMP: 11/7/2019.

She had complaints of back pain , incontinence and constipation .

Past Obstetrical History:

-1 previous NSVD (Normal spontaneous vaginal delivery
-Last birth was 3 years ago by NSVD, weighed 3200 grams
-No previous obstetrical complications or morbidity

-No Past Medical Surgical History or Family history

Social History:

Patient lives with her husband in Riyadh . Denies any smoking, alcohol or other drug use during her pregnancy. Currently works as a housewife. Good economic status.

Physical exam :

Vital Signs: Stable (BP – 120/70, P – 72)
General Appearance: No apparent distress, appeared clinically stable
Uterine Height: 35cm
Fetal Lie: Longitudinal

Presentation: Cephalic

Position: Right

Contractions: Present
Fetal Heart Tones: 144 / minute

Questions:

- Develop nursing care plan ?

Answer 1

The nursing care plan includes 5 sequential steps, includes Assessment (Subjective and Objective), Diagnosis, Planning, implementation and evaluation.

I. Assessment : Subjective data is how the patient explains her feeling (Eg: Patient states I have back pain )and objective data is the observation made by the observer (Eg: On observation patient facial grimace and has a pain score of 7/10)

Actual Nursing Diagnosis

(NB: the Second bold part in the intervention is the rationale for that intervention and the past tense would be the implementation.)

1.Acute pain on back related to changes in posture secondary to pregnancy status.

1. Assess the location, severity and length of pain : Obtain baseline data
2. Monitor vital signs and pain score : Identify the severity of pain
3. Encourage patient to take adequate rest : Relieves pain
4. Teach relaxation techniques and deep breathing exercises : Reduces the intensity of pain.
5. Allow family members to be with patient : promote comfort
6. Administer analgesics as prescribed : Decreases pain

Evaluation : Patient experiences reduction in pain as evidenced by low pain score

2.Urinary incontinence related to increased pressure by enlarged uterus secondary to pregnancy status.

1. Assess the urinary pattern : Obtain baseline data
2. Maintain intake- output chart. Understands the condition
3. Encourage to go to toilet frequently : reduces episodes of incontinence
4. Advice to use incontinence pad: prevents uncomfortable situation
5. Reassure the patient that it is normal in pregnancy : promotes well being
6. Maintain good personal hygiene : improves comfort

Evaluation : Patient experiences relief from incontinence as evidenced by verbalization

3. constipation related to improper digestion and increased pressure on intestine secondary to enlarged uterus.

1. Assess the bowel pattern : Obtain baseline data
2. Maintain intake- output chart. Understands the bowel condition
3. Encourage to take fiber rich food : reduces episodes of constipation
4. Advice to drink lots of water: reduces constipation
5. Reassure the patient that it is normal in pregnancy : promotes well being.
6. Administer laxatives if needed : Relieves constipation

Evaluation : Patient experiences relief from constipation as evidenced by intake output chart

4.Anxiety related to hospitalization.

1. assess the anxiety level of patient: obtain the baseline data
2. provide reassurance to the patient : Reduces anxiety
3. Educate regarding the labour process: Decreases tension
4. encourage to do some relaxation techniques : Improves comfort
5. promote to verbalize own feelings and coping patterns: reliefs anxiety

Evaluation : Patient experiences reduction in anxiety as evidenced by verbalization

Potential Nursing diagnosis

1. Risk for impaired sleep pattern related to back pain.
2. Risk for ineffective role performance related to presence of pain.
3. Risk for low self esteem related to urinary incontinence.