NURS381 Bowie State prenatal Intrapartal & Postpartal Care Plan Paper

FITSUM DERESA 1 Postpartum Nursing Care Plan NURS 381 PRENATAL/INTRAPARTAL/POSTPARTAL/ CARE PLAN FORMAT INTRODUCTION: FITSUM DERESA 2 Provide a brief introduction of your patient to include initials, age, blood type, PNC, GBS status, GTPAL, gestational weeks, decelerations, membrane rupture, labor induced or augmented, type of delivery- vaginal/cesarean. If cesarean, state the reason and type of incision, previous or

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intended contraceptive method, race, allergies, code status, past surgical history, reason for admission, fetal presentation and position, pre-pregnancy and total weight gain. Mrs. O.J is a 23-year-old African American woman who was admitted on 4/10/2019 at 1500 for worsening symptoms of preeclampsia. She is gravida 1, para 0 at 36 weeks gestation; has blood type O+. She currently weighs 110kg and has gained 3 pounds in one week. She has no known allergies. Pt is on room air, full code and no past surgical history. Presenting symptoms include epigastric pain and frontal headache rated 8/10 and 5/10 consecutively at pain scale of 0-10. Nausea and visual changes and blurred vision. +2 dependent edema, facial puffiness, chest tightness. Hyperactive deep tendon reflex graded to +4 and pt. shows sign of clonus. Elevated BP 171/103 mmHg, and pulse: 113b/minute, respiration: 22, and decreased Oxygen saturation of SPO2: 85%, temperature: 99◦F. She has tested negative for GBS, HIV, Gonorrhea, Chlamydia, Syphilis, Herpes and Hepatitis A, B and C. She does not smoke and has no history of alcohol consumption or substance use. The fetus is doing well and is active but there is a possibility of premature rupture of membranes. Vertex fetal presentation at -3 station, and the amniotic fluid was intact. No signs of fetal distress. fetal heart rate is within normal range of 154b/minute and fetal movement is felt. The cervix is 0% effaced and 0cm dilated. Perineum is intact, no blood or lochia on bed or bed pad. ASSESSMENT FITSUM DERESA 3 Integrate lab data, GYN, medical, and social histories where applicable notably: Hypertension, Diabetes, Heart Disease, COPD, smoking, alcohol, and substance abuse, etc. Note both physiological and psychological problems. Date of Patient Care: 4/10/2019 Vital Signs: BP: 171/103 mmHg, pulse: 113, respiration: 22, Temperature: 99◦F oral, SPO2: 85%, Epigastric pain level: 8 on a 0-10 scale. Headache pain level:7 on a 0-10 scale Problems in NANDA format: Stem & Etiology. Identify ALL applicable problems in each system Acute pain related to sensory disturbance as evidenced by the clients complaining of epigastric pain of 8 on a 010 scale. Neurological: Acute pain related to decreased blood perfusion to the Alert and oriented x4. Pt is oriented to person, time, place, and situation. brain as evidenced by pt complaining of frontal headache Her pupils are 6 mm, round and react to light bilaterally, corneal reflex pain of 7 on a 0-10 scale. is present, clear and effortless speech, and gag reflex is present. No history of mental disorders. Reports visual changes and blurred vision. Cardiovascular: Blood pressure of 171/103, pulse of 113, proteinuria, severe preeclampsia, no murmur or adventitious sound heard, below knee there is a moderate to severe pitting edema graded to +3, facial puffiness. Respiratory: Respiratory rate of 22 bpm, SpO2: 85% on room air, pain in the upper section of the stomach, denied any shortness of breath, and does not smoke. Crackle is present at both bases. -Decreased cardiac output related to increased peripheral vascular resistance secondary to hypertension as evidenced by blood pressure of 171/103. -Fluid volume deficit related to fluid shift out of vascular compartment as evidenced by edema and 3 lb weight gain in a week. Ineffective breathing pattern related epigastric pain and chest tightness as evidenced by RR 22 and SpO2 of 85% FITSUM DERESA 4 GI (Assess for bowl elimination and nutrition among others): Pt is PO On a regular diet, no change in appetite. Patient complains of nausea and upper stomach pain. Patient reports of epigastric pain. Pain related to sensory disturbance as evidenced by the clients complains of epigastric pain of 8 on a scale of 010. Patient may need a bedpan to meet elimination needs. GU: Amber color urine with painless urination. Bladder scan of 380ml. Protein deep stick is +4. Foley catheter was inserted for voiding. Impaired urinary elimination related to inability to initiate micturition appropriately as evidenced by clients need for catheterization. Musculoskeletal: Gait was not observed, below knee there is a moderate to severe pitting edema graded to +3. Due to her recent symptoms from severe preeclampsia, bed rest was recommended. Impaired physical mobility related to reduced range of motion as evidenced by pt being on bed rest. Integumentary Skin has normal elasticity and cool to touch, sweaty. No bruises, rashes, no sign of dehydration. No laceration, episiotomy, incision (labor didn’t take place). No vaginal hematoma or hemorrhoid. Risk for skin breakdown related to limited range of motion as evidenced by pt being on bed rest. FITSUM DERESA 5 Reproductive Pt is gravida 1 para 0. Perineum is intact. Uterus tone is moderate b/n contraction. No contraction is noted. The amniotic membrane is intact. The cervix is 0% effaced and 0cm dilated. She is not breastfeeding, no evidence of blood, lochia or fluid on the bed or bed pad. Delivery has not yet occurred. The breast in non-tender and there is no palpable masses. No evidence. Spiritual Patient is a Christian. Patient stated that her spiritual belief does not prevent her from receiving any medical care deemed appropriate for her heath and the fetus. No evidence. Sociocultural Patient is African American woman. She is unmarried. Her mother is providing social support. The father of the baby is not present. There is no information provided about her employment history or socioeconomic status. No evidence. Psychological (Include maternal-infant bonding behavior): Pt is anxious about current health status. Pt is asking questions about the care provided. Pt complained of presenting symptoms such as nausea. Anxiety related to current health status as evidenced by pt lack of knowledge about the care, signs and symptom of preeclampsia. FITSUM DERESA 6 Developmental Patient is 23-year-old so that puts her in Ericson 6th stage of psychosocial development which is Intimacy vs Isolation. The father of the baby is not present for unknown reason. It was only the mother who is there to give support and first-time expectant mother at 23 years of age without a father is stressful so I would put her in the category of Isolation if the expectant mother is neglected. However, there is no evidence why the father is not there. No evidence. Laboratory & Diagnostic Results: If lab/diagnostic data is not available, discuss expected normal values with rationales Lab Result 04/24/18 at 0713 Normal Value Implications/rationales RPR Non-reactive Non-reactive GBS Negative Negative Rapid Plasma Reagin test for the presence of syphilis. A reactive test could indicate a higher risk of preterm labor or miscarriage for mother and/or IUGR, preterm birth, stillbirth, or congenital infections for the baby. Test for the presence of Group B streptococcal bacteria. A positive test could mean baby has the possibilities of being infected. Mothers are given antibiotics and monitored for 48 hours after delivery. FITSUM DERESA 7 Rubella Immune 7 IU/mL or less (Negative) Hepatitis Negative Negative HIV Negative. Negative Chlamydia Negative Negative . Antibody titer indicates immunity to rubella, and a negative antibody titer means the mother is not immune. If mother is infected with rubella during first trimester, baby could be born with congenital infection. Tests for presence of the Hepatitis A.B and C surface antigen which indicates artificial immunity. Lack of immunity means the mother is more vulnerable to contracting the virus which could be transmitted to the baby during birth. Tests for the presence of HIV antibodies. A positive test would indicate presence of HIV antibodies in the mother’s blood and HIV infection that can be transmitted to the baby if adherence to ART is not met. This test for the presence of chlamydia bacteria. A positive test would indicate that mother is infected with chlamydia which can cause neonatal conjunctivitis in the newborn as the baby passes through the birth canal. FITSUM DERESA 8 Gonorrhea Negative Negative RBC 2 (low) (3.72-5.43*10/L) Hemoglobin 7.4 g/dL (Low) 11.1 – 15.9 g/dL Hematocrit 28.8 % (Low) 34.0– 46.6% Test for the presence of gonorrhea bacteria. A positive test would indicate that mother is infected with gonorrhea which can cause neonatal conjunctivitis in the newborn as it passes through the birth canal. Could also mean preterm birth or IUGR for the baby. Red blood cells are important delivering oxygen to the tissues and bringing CO2 back to the lung for exchange. Low RBC indicates patient’s oxygen delivery to the tissues is compromised Indicates O2 carrying capacity. A low value could indicate that mother is hypoxic or hypoxemic. This would mean low oxygenation for the baby as well which will put the baby in distress. Indicates proportion of RBCs to blood volume. Is normally FITSUM DERESA 9 Platelet 136 x 10(10-34 IU/L)3 cells/dL 150-379 x 103 cells/dL BUN 32 (High) (8-23mg/dL) Creatinine 2.6 (High) (0.8-1.4mg/dL) Albumin 3.5 (3.5-5.0g/dL) low during pregnancy due to physiological anemia. A low value indicates that mother is hypoxemic or hypoxic which can cause intrauterine growth restriction and distress to the baby during labor Indicates clotting ability. A higher than normal platelet count means that the mother is more prone to forming thrombi, which could harm the baby if mother develops a PE or if clot affects placental perfusion. A lower than normal count indicates that the mother is more prone to hemorrhage which can also harm baby due to hypo-perfusion of the placenta. This test in important because pregnant mothers are in a hypercoagulation state. To evaluate kidney function. Elevated BUN is generally caused by dehydration or urine flow is blocked. Elevated creatinine level indicates impaired kidney function. Pt may be diagnosed with acute kidney injury. Albumin level is used to assess patient’s liver or kidney FITSUM DERESA 10 ALT 40 (High) (8-37 IU/L) AST 42 (High) (10-34 IU/L) function and it is used to detect malnutrition. Used to assess liver function that is related to liver disease or muscle damage. Used to assess liver function that is related to liver disease or muscle damage. Medications: Include ALL applicable meds: Antibiotics, Antiviral, Tocolytics, Betamethasone, Induction/Augmentation meds, Comfort/Pain Management. (Extend table as needed) Generic/Trade Name Dosing/Safe Classification Reason for Use Side Effects FITSUM DERESA Promethazine Magnesium Sulfate Magnesium Sulfate Packed red blood cell 6.25mg (IVPB) 6gm/100 ml (IVPB) 11 Antiemetic. Anticonvulsant 20gm/500ml (continues infusion) Anticonvulsant 1 unit (350ml) Blood product Lactated ringer 125ml/hr To prevent nausea and vomiting Sedation and confusion, To stop seizure by means of cerebral arterial vasodilation which may relieve cerebral ischemia Heart disturbance, confusion, weakness, flushing, sweating. To stop seizure by means of cerebral arterial vasodilation which may relieve cerebral ischemia. It is also used in preterm labor to relax uterine muscle and stop contraction. Heart disturbance, confusion, weakness, flushing, sweating To improve hemoglobin and hematocrit count In case of allergic reaction, Fever and shivering. Isotonic IV infusion Replace electrolytes, and Pt don’t generally show side effects but hydration thus, it improve kidney in case of allergic reaction localized or function generalized hives and itching. FITSUM DERESA Labetalol 20mg (IVP) If SBP >170 and HR >60 Q4 PRN 12 Antihypertensive (Betablocker) To control BP and decrease vascular resistance Analgesics Relief pain, Headache Acetaminophen 650 mg Dizziness, bradycardia, hypotension. Abdominal discomfort loss of appetite, stomach pain, PRIORITIZED DIAGNOSES: Prioritize ALL the diagnosis from the assessment above. Extend the table as needed NANDA STEM ETIOLOGY (related to) S/S (as evidenced by) Ineffective breathing pattern related to related to epigastric pain and chest tightness As evidenced by RR 22 and SpO2 of 85% Fluid volume deficit related to fluid shift out of vascular compartment. As evidenced by edema and 3 lb weight gain in a week. Decreased cardiac output related to increased peripheral vascular resistance. As evidenced by blood pressure of 171/103. Acute pain. related to sensory disturbance As evidenced by the clients complaining of epigastric pain of 8 on a 0-10 scale. FITSUM DERESA 13 Impaired urinary elimination related to inability to initiate micturition appropriately. As evidenced by clients need for catheterization. Impaired physical mobility. related to reduced range of motion As evidenced by pt. being on bed rest. Risk for skin breakdown. related to limited range of motion As evidenced by pt. being on bed rest. Anxiety related to current health status Pt lack of knowledge about the care, signs and symptom of preeclampsia Using the pattern below, develop a nursing care plan for the problem with the highest priority. NURSING DIAGNOSIS #1 Nursing Diagnosis (State fully). Ineffective breathing pattern related to epigastric pain and chest tightness as evidenced by RR 22 and low SpO2 of 85% Goal: The patient maintains an effective breathing pattern as evidenced relaxed breathing at normal rate and maintain oxygen saturation >95%. Outcomes (3) Interventions with cited Rationales State enough Interventions for the 3 outcomes Evaluation Statement(s) supported with Patient’s Response (clinical data) to Interventions FITSUM DERESA 1. Pt respiratory rate remains with in normal limit. 14 1. Assess and document respiratory rate, rhythm and depth Q4hrs. Rationale: Respiratory rate and rhythm changes are early warning signs of respiratory distress. (Gulanick & Meyers, 2014, pg. 35). 2. Encourage to take deep breaths by using demonstration such as low inhalation, holding end inspiration for a few seconds, passive exhalation, and pursed – lip breathing; educate patient how to use incentive spirometer. Rationale: The use of these techniques promotes deep inspiration, which increases oxygenation and lung surface area. Controlled breathing techniques may also help slow respiration with patients with increased respiratory rate. (Gulanick & Meyers, 2014, pg. 35). 3. Auscultate breath sounds Rationale: listening patient lung for crackles, wheezing or diminished breath sounds to detect respiratory issues (Gulanick & Meyers, 2014, pg. 198). Patient had stable respiratory rate of 12 at the end of the shift. FITSUM DERESA 2. To have patient communicate a reduction in or absence of pain that is less than 3 on a scale of 010 by the end of the shift. 15 1.Conduct an extensive pain assessment using the appropriate tool. Rationale: pain can decrease the work of breathing and change breathing pattern. (Gulanick & Meyers, 2014, pg. 198). 2. Determine the optimal route of analgesic administration depending on the pain characteristics and condition of the pt. Rationale: each route has differing rates of onset and duration, but oral administration is often selected due to convenience and relative steady blood levels (Ackley & Ladwig et al., 2017, pg. 641). 3.Ensure that there is a rest period so that the pt. can relax and find comfort. Rationale: Fatigue and worry can exacerbate pain symptoms unable to participate with care. Encouraging the pt. to rest can therefore help to lessen pain symptoms (Potter et al, 2013, pg. 980). Patient was asked to rate pain level on a 0-10 scale. Patent rated a pain level of 2 and is breathing without difficulty by the end of the shift on 4/12/2019. FITSUM DERESA 3. Patient’s oxygen saturation level return to and remain within established limits 16 1. Monitor pulse oximetry Rationale: Frequent monitoring of oxygen saturation can alert healthcare provider if there is a change in patint’s condition (Gulanick & Meyers, 2014, pg. 578). 2. Assess skin color and temperature on all extremities Rationale: a change pt’s skin color to pale, blue or ashen shows increased concentration of deoxygenated blood and that shows ineffective breathing pattern (Gulanick & Meyers, 2014, pg. 198). 3.Provide supplemental oxygen therapy. Rationale: Restoring patient’s oxygen saturation to normal is crucial to increase cerebral perfusion (Gulanick & Meyers, 2014, pg. 578). . Patient SpO2 98% at the end of the shift. FITSUM DERESA 17 NURSING DIAGNOSIS #2 Nursing Diagnosis (State fully): Fluid volume deficit related to fluid shift out of vascular compartment as evidenced by edema and 3 lb weight gain in a week. Goal: For patient to be normovolemic by the end of the shift. Outcomes (3) 1. For the patient to attain a systolic BP greater than or to 90 mm Hg or the patient’s baseline. Interventions with cited Rationales State enough Interventions for the 3 outcomes 1.Perform a history of the patient to determine cause of fluid disturbance. Rationale: This is necessary to determine the proper interventions (Gulanick & Meyers, 2014, p. 76). 2.Assess the patient’s weight periodically at the same time each day ensuring that the same clothing is worn. Evaluation Statement(s) supported with Patient’s Response (clinical data) to Interventions An optimal systolic BP of 90 mm Hg was attained after 1 day. FITSUM DERESA 18 Rationale: This facilitates accurate measurement and assessment (Gulanick & Meyers, 2014, p. 76). 3.Evaluate fluid status in relation to dietary intake. Rationale: Most fluid enters the body through consumption of food and drink. Monitoring this helps to determine whether the patient’s diet is the cause (Gulanick & Meyers, 2014, p. 76). 4.Monitor and document BP and HR. Rationale: Increase in blood volume can lead to hypertension. Monitoring BP and HR are critical for timely interventions (Gulanick & Meyers, 2014, p. 76). 2. For urine output to be greater than 30 ml/hour. 1.Assess the color and amount of urine and report if less than 30 ml/hour for 2 consecutive hours. Adequate fluid balance was attained by the end of the shift as evidenced by patient received 1500 ml of LR and voided 1250ml. Rationale: concentrated urine is a sign of fluid deficit (Gulanick & Meyers, 2014, p. 77). 2. Monitor serum electrolytes and . osmolality of urine. Report if values are abnormal. FITSUM DERESA 19 Rationale: Elevated levels of blood urea nitrogen is a sign of fluid deficit (Gulanick & Meyers, 2014, p. 77). 3.Determine patient’s drink preferences such as type and hot or cold. Rationale: selecting and providing the patient’s preferred fluids can help to replace lost fluids (Gulanick & Meyers, 2014, p. 77). 3. Achieve normal skin turgor. 1.Assess skin turgor and mucous membrane for signs that dehydration is occurring. Rationale: If there is loss of interstitial fluid, this can lead to a loss of skin turgor (Gulanick & Meyers, 2014, p. 77). Normal skin turgor was achieved in 1 day. FITSUM DERESA 20 NURSING DIAGNOSIS #3 Nursing Diagnosis (State fully) Anxiety related to current health status as evidenced by pt lack of knowledge about the care, signs and symptom of preeclampsia Goal: To reduce the patient’s anxiety about the treatment of preeclampsia and the safe delivery of her baby. Outcomes (3) Interventions with cited Rationales State enough Interventions for the 3 outcomes Evaluation Statement(s) supported with Patient’s Response (clinical data) to Interventions . 1.Assess the patient’s anxiety level. 1.The patient uses effective coping mechanisms by the end of her treatment. Rationale: Knowing the patient’s level of anxiety can determine whether the person’s level of anxiety is mild, moderate or severe and helps to determine optimal treatment (Gulanick & Meyers, 2014, p. 17). 2.Use the State-Trait Anxiety Inventory to determine whether the patient’s anxiety is a temporary response to her circumstances or is a long-standing trait. Patient reported applying more effective coping mechanisms by the end of the treatment. FITSUM DERESA 21 Rationale: This is a definitive tool for measuring anxiety in adults and helps to determine proper treatment (Gulanick & Meyers, 2014, p. 17). 3.Determine how the patient uses coping strategies and defense mechanisms to cope and educate her on ways to strengthen them where needed. Rationale: Can help the patient to be proactive by journaling and helps patients to manage the symptoms of anxiety (Gulanick & Meyers, 2014, p. 17). Patient reported lower levels of anxiety 2.The patient can describe a reduction in 1.Maintain a calm manner during interactions with patient. by the end of the treatment. the level of anxiety as she experiences it by the end of her treatment. Rationale: This increases the patient’s sense of calm and stability and prevents transference of anxiety from provider to patient (Gulanick & Meyers, 2014, p. 18). 2.Help the patient get oriented to the new environment. Rationale: This can promote comfort, helps the patient to control environmental stimuli and reduces the FITSUM DERESA 22 patient’s feeling of advancing threats (Gulanick & Meyers, 2014, p. 18) 3.Reduce sensory stimuli by removing threatening equipment and maintaining a quiet environment. Rationale: Excessive noise, conversation and threatening equipment can contribute to the patient’s heightened anxiety (Gulanick & Meyers, 2014, p. 18). 3.The patient can function well in her role 1.Support the use of coping as expectant mother and can problem- mechanisms that have worked well in the past. solve by the end of her treatment. Rationale: This can enhance sense of self-mastery and increase the patient’s confidence (Gulanick & Meyers, 2014, p. 1). 2.Assist the patient in learning new skills such as relaxation, deepbreathing, and positive visualization. Rationale: Learning new skills provides the patient with more tools to manage her anxiety (Gulanick & Meyers, 2014, p. 18). Patient felt more prepared for motherhood and was more confident in problem solving at the end of her treatment. FITSUM DERESA . 23 3.Assist the patient in learning problem solving skills such as logical strategies in times of distress. Rationale: Learning how to identify a problem and assessing how to resolve it are key ways that patients can learn to function well in their roles and improve problem solving skills (Gulanick & Meyers, 2014, p. 18). REFERENCES: Ackley, B. J., Ladwig, G. B., & Makic, M. B. (2017). Nursing diagnosis handbook: An evidence-based guide to planning care. St. Louis: Elsevier. Gulanick, M., & Myers, J. L. (2014). Nursing care plans: Diagnoses, interventions, and outcomes. Elsevier: Mosby, St. Lois MO. Potter, P. A., Perry, A. G., Stockert, P. A. & Hall, A. M. (2013). Fundamentals of Nursing (8th Ed.). Elsevier: Mosby, St. Lois MO. FITSUM DERESA 24 Student:___FITSUM DERESA____ Date______________ Evaluator______________________________ Score_____% Criteria Below Average Average Excellent Client introduction data to include all assigned criteria. (10%) Client introduction includes 6 or less of 12 assigned criteria. Client introduction includes 9 or less of assigned criteria. (4-6%) Level 200/300 Client introduction includes ten (10) to twelve (12) assigned criteria. Holistic and comprehensive assessment data (20%) Six (6) or fewer areas of the assessment are complete with vital signs, pertinent medical and social histories, and incomplete list of all applicable problems. (problems not stated in NANDA format) (0-3%) Level 200/300 (7-10%) Level 200/300 Nine (9) or fewer areas of the assessment are complete with vital signs, pertinent medical and social histories, and incomplete list of all applicable problems (NANDA stem & etiology only) Ten (10) to twelve (12) areas of the assessment are complete with vital signs, pertinent medical and social histories, and list of all applicable problems (NANDA stem & etiology only) (16-18%) Level 200/300 (19-20%) Level 200/300 ½ of the nursing diagnoses are identified based on the holistic assessment. ¾ of the nursing diagnoses are identified based on the holistic assessment. All nursing diagnoses are identified based on the holistic assessment. (0-2%) Level 200/300 (3-4%) Level 200/300 (5%) Level 200/300 (0-15%) Level 200/300 Diagnoses (20%) Comments FITSUM DERESA Planning (10%) 25 ½ of the nursing diagnoses are correctly listed and prioritized. ¾ of the nursing All of the nursing diagnoses diagnoses are correctly are correctly listed and listed and prioritized. prioritized. (0-2%) Level 200/300 (3-4%) Level 200/300 ½ of the nursing ¾ of the nursing diagnoses are prioritized. diagnoses are prioritized. (0-2%) Level 200/300 (3-4%) Level 200/300 Diagnoses for the care Diagnoses for the care plan is missing two plan is missing one parts. part. (0-2%) Level 200/300 (3-4%) Level 200/300 Goal is appropriate for Goal is appropriate for the diagnosis and written the diagnosis and using SMART criteria. written using SMART criteria. The goal is not appropriate for the The goal is outcomes. appropriate for two (2) outcomes (0-3%) Level 200/300 (5%) Level 200/300 All of the nursing diagnoses are prioritized. (5%) Level 200/300 All parts of the diagnoses for the care plan are correct. (5%) Level 200/300 Goal is appropriate for the diagnosis and written using SMART criteria. The goal is appropriate for all three (3) outcomes. (7-10%) Level 200/300 (4-6%) Level 200/300 Interventions (18%) Only One (1) intervention is developed per outcome. Two (2) or fewer interventions are developed per outcome. Three (3) interventions are developed per outcome. FITSUM DERESA 26 (7-9%) Level 200/300 Rationales (10%) Evaluation (9%) References and Grammar (3%) (0-3%) Level 200/300 Three (3) interventions are stated using actions verbs. (0-1%) Level 200/300 Three or fewer rationales are not scientific and not cited per APA format. (4-6%) Level 200/300 Six (6) Interventions are stated using actions verbs. (2-6%) Level 200/300 Three (3) to six (6) of the interventions have scientific rationales with correct citation per APA format. (0-3%) Level 200/300 Evaluative statement as to whether goal is met, partially met or unmet is made for one or none of the outcomes. (4-6%) Level 200/300 Evaluative statement as to whether the goal is met, partially met or unmet is made for two of the outcomes. Re-plan statement(s) for improving the plan of care are not made for unmet and partially met outcomes Re-plan statement(s) for Re-plan statement(s) improving the plan of care are for improving the plan made for all unmet and of care are made for partially met outcomes. two unmet and partially met outcomes (0-3%) Level 200/300 References on the reference list are not all in the narrative and are not according to APA format. Nine (9) Interventions are stated using actions verbs. (7-9%) Level 200/300 Seven (7) to nine (9) interventions have scientific rationales with correct citation per APA format. (7-10%) Level 200/300 Evaluative statements per outcome stated goal is met, partially met or unmet is made for all three outcome. (4-8%) Level 200/300 (9%) Level 200/300 References in the reference list are not all in the narrative and are not according to APA format. References in the reference list are in the narrative and are according to APA format. Writing with correct spelling and grammar FITSUM DERESA 27 Writing with some correct spelling and grammar Writing with correct spelling and grammar (2%) Level 200/300 (0-1%) Level 200/300 Approved: Undergraduate Curriculum Committee 9-20-18 Faculty Organization 9-27-18 (3%) Level 200/300 1 2 3 4 5 6 všim Suggested Reading Pre-Simulation Quiz Post-Simulation Quiz Documentation Assignments Guided Reflection Questions Patient Introduction Ho Olivia Jones is a 23-year-old African-American female, G1PO at 36 weeks of gestation. She has been diagnosed with severe preeclampsia and is admitted to the labor and delivery unit for assessment and surveillance. 18 Pregnancy has been unremarkable until routine prenatal visit at 30 weeks with elevated blood pressure at 146/92 mm Hg, proteinuria, and developing mild preeclampsia. She has been on bed rest at home until prenatal visit today with increasing symptoms, resulting in admission. She has gained 3 pounds since prenatal visit 1 week ago. Protein dipstick is +4, negative ketones, negative glucose, +2 dependent edema, and facial puffiness. Ms. Jones is complaining of a headache that is not resolved with acetaminophen. She presents with nausea and fatigue and complaining of epigastric pain, visual changes, and chest tightness. The fetus is active; however, patient states that it is a bit quieter than normal. There is a possibility of premature rupture of membranes. An IV with lactated Ringer’s is running at 125 mL/hr. Labs were obtained. Ricci, S., Kyle, T., and Carman, S. (2017). Maternity and Pediatric Nursing, 3rd Edition. Maternity Nursing Care Hypertensive Disorders of Pregnancy, Chapter 19, pp. 707-716 自 Preeclampsia and Eclampsia, Chapter 19, pp. 708-716 and Laerdal e Wolters Kluwe Health helimeni Olivia Jones NIN Diagnosis: Severe Preeclampsia ur Nuning Location: Labor and Birthing room Olivia Jones is a 23-year-old African-American female, G1PO at 36 weeks of gestation. She has been diagnosed with severe preeclampsia and is admitted to the labor and delivery unit for assessment and surveillance. Pregnancy has been unremarkable until routine prenatal visit at 30 weeks with elevated blood pressure at 146/92 mm Hg, proteinuria, and developing mild preeclampsia. She has been on bed rest at home until prenatal visit today with increasing symptoms, resulting in admission. She has gained 3 pounds since prenatal visit 1 week ago. Protein dipstick is +4, negative ketones, negative glucose, +2 dependent edema, and facial puffiness. HELPFUL TIPS _O You have not yet completed this patient case. You are expected to use interprofessional communication when a situation deteriorates. Cuba de ruder Enable full screen mode (recommended) Go see this patient. PH. 19 e Laerdal 1. Wolters Kluwer helanch Health Olivia Jones NIN Diagnosis: Severe Preeclampsia National League Tor Nuning riskuLy nah usailuingiliai rawis VII IJULUS Higuala aLaL Ju ne elevated blood pressure at 146/92 mm Hg, proteinuria, and developing mild preeclampsia. She has been on bed rest at home until prenatal visit today with increasing symptoms, resulting in admission. She has gained 3 pounds since prenatal visit 1 week ago. Protein dipstick is +4, negative ketones, negative glucose, +2 dependent edema, and facial puffiness. Ms. Jones is complaining of a headache that is not resolved with acetaminophen. She presents with nausea and fatigue and complaining of epigastric pain, visual changes, and chest tightness. The fetus is active; however, patient states that it is a bit quieter than normal. There is a possibility of premature rupture of membranes. An IV with lactated Ringer’s is running at 125 ml/hr. Labs were obtained. HELPFUL TIPS You have not yet completed this patient case. < Actions are grouped under tabbed sections, such as Assessments and “Interventions,’ making it easier to find a specific action. V Enable full screen mode (recommended) Go see this patient. 19 A Olivia Jones Adm DX Severe Preeclampsia 500 Female Gender 168 cm No known DOB Height Weight 7/6/1995 (23y) Allergies Adm On 110 kg 4/19/2019 Patient Information Patient Log Diagnostics Clinical Observations Medication Chart Orders APR 19 Electrolytes 1500 (3.6-4.6 mEq/L) 4.6 Na+ (133-143 mEq/L) 140 Creatinine (0.8-1.4 mg/dL) CI- (101-111 mEq/L) Urea nitrogen (BUN) (8-23 mg/dL) 32 HCO3- (22-26 mEq/L) Calcium Total (8.5-10.9 mg/dL) Calcium lon. (0.2-3 mg/dL) Mg++ (1.5-2.5 mEq/L) 1.8 APR 19 Hepatic function 1500 1 4/ ELECTRONIC HEALTH RECOR MacBook Air
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