Brandon Sparrer

Obstetric Case Study

NURS 333 – Clinical Management – The Growing Family

 

Purpose of the Assignment

The purpose of this paper is for the student to conduct an in-depth assessment of a childbearing woman and her family in order to plan nursing care specific to that client, based on nursing research and AWHONN Standards of Care.  The assessment will include the appropriate physiological, psychological, social, cultural, and environmental influences pertaining to the client and her family as it relates to preconception, conception, antepartum, intrapartum, postpartum and neonatal care.     

 

Student Approach to Assignment

This assignment allowed me to explore the interactions between the nurse and patient consisting of the mother, baby, and fellow family members during the perinatal time period.  During my time on the floor I had the opportunity to not only learn the intricacies of the obstetric environment, but also provide care to my patients during this life-changing phase.  While providing care to my patients I analyzed the various procedures and arts utilized in the perinatal process and examined their effectiveness through observation and concept exploration beyond the bedside. 

 

Reason for Inclusion of this Assignment in the Portfolio

This assignment allowed me to highlight my understanding of the perinatal and obstetric nursing field.  Additionally, this work details my abilities to evaluate evidence-based practice while also utilizing therapeutic communication techniques with my patient, her baby, and the rest of the family. 

 

Nursing Practice

• Performs therapeutic interventions that incorporate principles of quality management and proper safety techniques

  • Following birth of my client’s child, I participated in glucose checks before meals to assure that she was not experiencing continual diabetes mellitus symptoms.  Assuming that blood sugars were not within acceptable ranges, she would be administered insulin to combat hyperglycemic episodes which would be harmful to her health. 

• Implements traditional nursing care practices as appropriate to provide holistic health care to diverse populations across the lifespan

  • Approximately 30 minutes after the birth of my patient’s baby, she was encouraged to void to reduce the risk of hemorrhage and cardiac compromise as a result of additional fluid circulation during the pregnancy.  After birth, many mothers do not feel the urge to void due to numbness in that area; therefore, her nurse and I encouraged her to do so to prevent negative health outcomes as mentioned previously.  Furthermore, I participated in the assessment of the baby to yield Apgar scores of 8 and 9 following the birth.  Additionally, immediately after birth the baby was handed to the mother for skin-to-skin contact to promote bonding between the two. 

• Demonstrates an awareness of complementary modalities and their usefulness in promoting health

  • Immediately following the birth of the baby, my patient was encouraged to breastfeed as soon as possible and to have skin-to-skin contact to promote bonding between the two which can lower the pain perceived by the mother and help allay the need for additional analgesic medication while also bettering the mother-child bond.  Furthermore, while holding the child, the mother and father were encouraged to utilize the en face position to facilitate familiarity and bonding as well.

 

Communication

• Uses therapeutic communication within the nurse-patient relationship

  • During interaction two days following the birth of the mother’s baby, I encouraged the mother to share her feelings regarding her birth experience to promote “taking-in” the total experience which increases bonding while also allowing her to expound upon her previous and current emotional state regarding the pregnancy.  I utilized various techniques such as active listening, summarizing what was told to me, and allowing for silence to allow for her to formulate her thoughts and feelings. 

 

Research

• Evaluates research that focuses on the efficacy and effectiveness of nursing interventions

  • While examining the impact that gestational diabetes mellitus has on mothers, I sought research that discussed what interventions nurses may incorporate that contribute to the effective management of this condition.  I ultimately found that trained healthcare professional education concerning nutrition and medications is the most effective means to combat gestational diabetes symptomology.  Additionally, teach back and basic pathophysiological education contributes to a higher understanding and thus greater health outcomes. 

 

Leadership

• Assumes a leadership role within one’s scope of practice as a designer, manager, and coordinator of health care to meet the special needs of populations

  • During my time with this mother and her new baby I made sure to cluster care and assess at the beginning of my shift; however, I also implemented time in which bonding could occur by clustering care and decreasing unnecessary stimulation.  I also utilized medications available such as Lanolin to diminish the excoriations and irritation from breastfeeding the child.  Additionally, I provided teaching to reduce the amount of breastfeeding time to prevent this irritation as she was attempting to feed for as long as the latch was established (upwards of 45 minutes – 1 hour).

 

Professionalism

• Differentiates between general, institutional, and specialty-specific standards of practice to guide nursing care

  • While on the labor and delivery unit with my patient, I saw that general guidelines were implemented by healthcare team members and mainly physicians rather than midwives.  As a result, my patient was instructed to labor and push in the lithotomy position.  I am aware that other facilities implement other methods for laboring to better overall patient outcomes.  I also noticed differences in regard to the overall operation of the units when compared to other non-obstetric floors such as the utilization of AWHONN whereas other floors strictly utilize the ANA standards of practice guidelines.

• Advocates for professional standards of practice using organizational and political processes

  • I utilized the AWHONN standards of care in my own practice by assessing the patient before beginning the other aspects of the nursing process.  This allowed me to understand my patient and her baby’s condition and provide insight into how to manage their health.  My interventions were directly linked to my understanding of the patient’s condition as well as what I found during assessment.  I encouraged these in my own actions; however, all members of the nursing staff that I saw were already utilizing these principles in their own work.

 

Culture

• Demonstrates sensitivity to personal and cultural definitions of health, and how these beliefs influence an individual’s reactions to the illness experience and end of life.

  • I acknowledged that my patient exhibited a significant amount of stress with this pregnancy as she had miscarried in the past.  Additionally, she was exposed to parvovirus and experienced a syncopal episode soon before delivery.  While interviewing and assessing this mother I was sure to utilize therapeutic communication and provide anticipatory guidance in attempts to ease the mother’s mind to a greater extent.  In regard to the mother’s weight she felt as though she was healthy as she sought to manage her diet by monitoring carbohydrate intake to the best of her abilities. 

 

Honor Code

 

“I pledge to support the Honor System of Old Dominion University. I will refrain from any form of academic dishonesty or deception, such as cheating or plagiarism. I am aware that as a member of the academic community, it is my responsibility to turn in all suspected violators of the Honor Code. I will report to a hearing if summoned.”

 

• Brandon Sparrer

• February 25, 2020

• Signature: Brandon Sparrer