Antepartum Patient

Antepartum Patient

1. 32 yo F G2P0 admitted on 2/1 for PROM 6 days ago

   • Hx: Previous abortion, obesity (BMI 46.8)
   • NKDA
   • Fetus diagnosed w/ fetal dysplasia, not compatible with life; polyhydramnious. Pt previously reported wanting baby to be "as god intended" and decided to carry pregnancy.
     • Planned induction and amnioreduction (on care day)
       • Pt reports anxiety for procedure
         • Risk for emotional and spiritual distress
           • r/t probable loss of fetus, anxiety, and possible guilt from previous abortion
           • Goal: The patient will vebalize acceptance of situation and present an adequate support system before induction procedure
             • Intervention (1): Assess the patient's support system and ability to cope with the current health situation (Ackley 10th edition, p.762)
               • Intervention (2): Assess for cues that the patient may have difficulties dealing with the current situation (Ackley 10th edition, p.762)
                 • Intervention (3): Refer the patient to counseling and/or spiritual support leaders for assistance (Ackley 10th edition, p.763)
                   • Intervention (4): Allow time and space for the patient to grieve and process (Ackley 10th edition, p.763)
                     • Intervention (5): Pertaining to the patient's culture, expect a spiritual, religious, faith-based approach to be most effective for emotional and spiritual crisis (Ackley 10th edition, p.763)
                       • Evaluation: Partly met. The patient expressed having come to terms with the situation and expressed a desire for all resucitation attempts for the child, after receiving support from the hospital's chaplain service and in-house counseling. However, she still expressed anxiety about the birth, especially after the procedure was delayed once again.
       • Risk for infection
         • r/t rupture of amniotic membrane, planned invasive procedure
           • Goal: the patient will maintain a temperature below 100 F for the duration of the shift
             • Intervention (1): Assess temperature every 2 hours (Ackley 10th edition, p.481)
               • Intervention (2): Administer prophylactic antibiotics as prescribed (Ackley 10th edition, p.481)
                 • Intervention (3): Use agressive PPE and transmission based precautions as indicated to reduce the spread and exposure to harmful pathogens (Ackley 10th edition, p.482)
                   • Intervention (4): Teach patient to maintain a clean environment in genital area and to empty bladder regularly to avoid introduction of pathogens (Ackley 10th edition, p.484)
                     • Intervention (5): Assess for any other signs of infection including redness, warmth, discharge, and pain (Ackley 10th edition, p.481)
                       • Evaluation: The patien's temperature was monitored every 2 hours and remained below 100 F. The patient also did not present any other signs of infection, and thus the goal was met.
   • Meds: Amoxicillin, Docusate Sodium, Ferrous Sulfate, Heparin, Prenatal Vitamin
   • VS: 117/67, HR 100, RR 20, Temp 98.0 F, Pain 0/10
   • Labs: RBC urine 4
     • Risk for infection
   • Risk for infection