Postpartum Case Study
T.N. delivered a healthy male infant 2 hours ago. She had a midline episiotomy. This is her sixth pregnancy. Before this delivery, she was para 4014. She had an epidural block for her labor and delivery. She is now admitted to the postpartum unit.
1. What is important to note in the initial assessment? Describe the postpartum assessment. (Provide expected findings, rationale for the answer and describe how to perform each assessment using a table)
2. You find a boggy fundus during your assessment. What corrective measures can be instituted?
3. The patient complains of pain and discomfort in her perineal area. How will you respond? Describe perineal care
4. The nurse reviews the hospital security guidelines with T.N. The nurse points out that her baby has a special identification bracelet that matches a bracelet worn by T.N., and reviews other security procedures. Which statement by T.N. indicates a need for more teaching?
a) “If I have a question about someone’s identity, I can ask about it.”
b) “If someone comes to take my baby for an examination, that person will carry my baby to the examination room.”
c) “Nurses on this unit all wear the same purple uniforms.”
d) “Each staff member who takes my baby somewhere will have a picture identification badge.”
5. An hour after admission, you recheck T.N.’s perineal pad and find that there is a very small amount of drainage on the pad. What will you do next?
a) Ask T.N. to change her perineal pad
b) Check her perineal pad again in 1 hour
c) Check the pad underneath T.N.’s buttocks
d) Document the findings in T.N.’s medical record
6. That evening, the nursing assistive personnel assesses T.N.’s vital signs. Which vital signs would be of concern at this time? What will you do next?
7. After your prompt intervention, you need to document what happened. Write an example of a SBAR documentation entry describing this event to the upcoming nurse
8. Two hours later, you perform another perineal pad check and note the findings in the diagram. How will you describe the amount of drainage in your note? Include pictures of other types of drainage for lochia assessment.
9. T.N.’s condition is stable, and you prepare to provide patient teaching. What patient teaching is vital after delivery? (Choose one postpartum teaching point to focus on i.e. breastfeeding, Infection, Postpartum hemorrhage, Postpartum depression)
Newborn Case Study
Baby H. was just born in a hospital that provides single-room maternity care (SRMC). SRMC allows the infant to remain with the parents after birth. H.’s mother was in labor for 12 hours and gave birth vaginally. Baby H. is the first baby born to these parents. The nurse will complete the physical assessment and observe for physiologic changes in the infant’s transition from intrauterine to extra uterine life.
1. Describe the three phases that occur during this transition period and state an approximate time frame for each. What care is specific to the first period of reactivity?
2. The one-minute APGAR score of the newborn baby is assessed with these findings: heart rate 152, acrocyanosis; lusty cry, flexion of extremities. What is the baby’s APGAR score providing rationale? Explain Apgar Scoring, what is the scale used to determine the Apgar score. (Describe using a table)
3. The sleep phase and second reactive phase might occur in the SRMC or in the nursery. Identify five assessments or tasks that the nurse needs to do during the transitional care period.
4. Erythromycin ointment is instilled in both eyes to prevent which infections?
5. Which findings should the nurse expect during the physical assessment head to toe of a healthy newborn 4 hours after delivery ?
6. The laboratory performs a Coombs test on Baby H. What is the purpose of the Coombs test?
7. True or False: A phenylketonuria (PKU) blood test can be done any time before an infant is discharged to home. If false, explain your rationale.
Case Study Progress Baby H.’s mother has decided to breastfeed her infant. She asks for assistance.
8. Identify six important points to include in your teaching plan.
Case Study Progress You are meeting with Baby H.’s mother to review discharge instructions. She has many questions.
9. Baby H.’s mother asks you about cord care and circumcision care for her infant. What will you tell her?
10. After discharge, it is important for Baby H. to receive follow-up care. What should you teach the mother to help her understand the importance of regular visits?
Case Study Outcome Baby H. is discharged to home with his parents.