OB Concept Map FINAL

Interprofessional Consults & Discharge Referrals Right after the c-section, the anesthesiologist will manage the patients pain for the next 24 hours (ATI Nursing, 2016). The obstetrician is the only one permitted to c ...

Interprofessional Consults & Discharge Referrals Right after the c-section, the anesthesiologist will manage the patients pain for the next 24 hours (ATI Nursing, 2016). The obstetrician is the only one permitted to change the patients first pad after surgery after that the nurses take over (ATI Nursing, 2016). The patient will also have consultation with the obstetrician doctor to discuss any complications that can occur after discharge and what needs to be reported to the doctor immediately. The doctor will also go over types of contraception and if the mother is willing to adhere to it. Nutrition is a huge part of postpartum care, especially if the mother decides to breastfeed. Having a consultation with the dietician can be beneficial because the dietician can inform the patient on how many extra calories she will need to consume, what types of foods to eat to ensure a balanced diet, and how many calories to consume to remain healthy. The patient can also see a lactation consultant who can help her if she is having difficulties with latching, pain during breastfeeding and low milk production. The nurse will continue to care for the patient and baby by completing assessments, providing education, and providing comfort measures. Concept Map Student Name: Janet Fofie Instructor: Lourdes Jamison Diagnostic Test/ Lab Results with dates and Normal Ranges (3) All labs were collected on 02/31/2020 Test Current Value RPR/VDRL Non-reactive (NR) Rubella immune HbsAg negative GBS unknown HIV negative GC negative Chlm negative Tox negative HPV Positive Patient was tested positive for human papillomavirus (HPV). HPV is a sexually transmitted infection (STI). HPV can spread by having vaginal, anal, or oral sex with a partner who has the virus (Deeksha et al., 2019). Patients with HVP can remain asymptomatic and may not even be aware that they have the infection. Often times, the infection can go away by itself but when it does not, it can cause several types of cancers. The infection can cause cancers of the cervix, vagina, and vulva in women and penis in men (Deeksha et al., 2019). It can also cause anal and throat cancer (Deeksha et al., 2019). HPV can also cause genital warts. The affected patient should can tell her health care provider to remove the warts to reduce discomfort and decrease bleeding during a vaginal birth (Deeksha et al., 2019). It is very rare for women to transmit genital warts to the fetus during a vaginal birth but if it does happen serious medical conditions such as respiratory distress and developmental disabilities can occur (Deeksha et al., 2019). It has been tested that women with HPV have a higher incidence of having preterm prelabor rupture of membranes (PROM) (Deeksha et al., 2019). The best protection is to get the HPV vaccine and get annual Pap test. (More information on page 3) Medical Management/ Orders/ Medications & Allergies (2) Name Dose RT Freq. MOA RN Considerations Cephalexin 400 mg IV Q12h Cephalexin is a semisynthetic cephalosporin antibacterial drug used to treat bacterial infections (Nurses Handbook, 2019). Continued CBC testing. Ensure patient finishes dosage. Assess for adverse side effects. Metronidazole 50 mg PO Q6h Metronidazole belongs to a drug class called nitroimidazole antimicrobials. This medication relieves infection by killing the bacteria and or other organisms that can cause an infection (Nurses Handbook, 2019). Assess for serious side effects such as seizures, encephalopathy, dizziness, headache, confusion, and ataxia. Ensure patient completes prescribed dosage. Colace 100 mg PO PRN Colace is a stool softener and aids the bowel in passage of feces (Nurses Handbook, 2019). Assess for stomach cramps. Ensure patient is well hydrated. Increase patient’s intake in fiber and roughage. Erickson’s Developmental Stage Related to pt. & Cite References (1) Patient is at intimacy vs. isolation. This stage occurs from young adulthood from ages 18 to 40 years. The major conflict in this stage includes forming loving relationships with other beings. In this stage, people will share their selves more intimately with others and want to explore relationships that are long-term. Successful completion of this stage is characterized as happy relationships and sense of commitment, care, and safety within a relationship. Keeping away from intimacy, fearing of commitment and relationships will lead to loneliness, isolation, and depression. Success of cultivating an intimacy relationship will lead to the virtue of love (McLeod, 2018). I would say that this patient meets success in this stage because she has developed a close committed relationship with her boyfriend for over 5 years. I say this because she has 2 other children with him. The age of the children are 5 and 2 years old. Patient stated that her boyfriend was there throughout the entire pregnancy and delivery process of all 3 children. During postpartum, the patients father came to visit and seemed overjoyed to have another grandchild. He seemed eager and enthusiastic when it came to taking care of the baby. I add this because it shows that the type of relationship, she has with her father is a positive and loving one. Patient Information (1) Name: H.S. Age: 33 years old Height: 5 foot 3 inches Pregnancy Weight: 160 lbs. Pre-pregnancy Weight: 120 lbs. Allergies: NKA Gestational Age: 38 weeks And 1 day Chief Complaint Patient came in with chief complaint of pregnancy induced hypertension (PIH). PIH is also called toxemia or preeclampsia. This type of hypertension is only seen during pregnancy. It develops after 20th weeks of pregnancy and can be a serious problem for both mother and fetus because it can lead to death (MOD, 2017). Patient will have increased blood pressure in the 140- 150/90. Patients lab values will also change. Changes can be seen in complete blood count (CBC), a decrease in platelets and red blood cells (RBC’s) (MOD, 2017). Liver enzymes will be increased. A urine analysis will show 3+ to 5+ protein in the urine (MOD, 2017). Admitting Diagnosis (see pg. 3) Admitting Dx (Cite References) Medical, Surgical, Social History and OB History H.S. is a 33-year-old Caucasian female who was admitted to Palm Desert Regional Hospital on February 29, 2020 at 1903 for a scheduled cesarean delivery due to pregnancy induced hypertension (PIH). The neonatal ICU is what brought her to this particular hospital. Patient is G6P3. Patient is 38 weeks and 1-day gestational age according to last menstrual period (LMP) is May/30/2019. Her estimated date of confinement (EDC) is MAR/5/2020. Patient has had 2 previous c-sections in the past and had complications with the first one (infection at the lining at the uterus), but not the second. All of her births have been premature. Her first born, who is a boy was premature at 35 weeks and 3 days. The other, a girl was premature at 37 weeks and 5 days. This may be due to her being a smoker and/or poor nutrition either before and/or during pregnancy. The patient’s pre-pregnancy weight was 120 lbs. and gained a total of 40 lbs. throughout her pregnancy. In the past, patient has had 2 spontaneous abortions and 1 termination. The first miscarriage happened at 10-week gestation, the second occurred at 18-week gestation. Patient had termination at 6 weeks. Patient was tested for syphilis and the results came back as non-reactive. She was also tested for rubella, hepatis B, HIV, gonorrhea, chlamydia, and a toxicology screen all which came back negative. Patient tested positive for human papillomavirus (HPV). Patients group B streptococcus (GBS) status is unknown. Patient seems to be healthy and has no other known illness or diseases. Patient does not have any history of postpartum depression. Patient will be discharged two days after delivery. Surgical History Patient has had no other surgical history besides the 2 previous cesarean sections. Patient states that she had difficulties and complications with her first c-section and developed an infection at the lining of her uterus. Patient had anesthesia and an epidural prior to her surgeries. Her other c-section went as planned with no medical complications. Social History Patient is very social. States that she goes out often. Smokes daily, about ½ to 1 pack of cigarettes a day. Patient is a non-drinker. Obstetric History GTPAL Gravidity: 6 Term Births: 3