Running head: OBSTETRIC ASSESSMENT

Obstetric Assessment Katie D. VanderVelde Ferris State University

OBSTETRIC ASSESSMENT
Assessment

OBSTETRIC ASSESSMENT

OBSTETRIC ASSESSMENT

OBSTETRIC ASSESSMENT

OBSTETRIC ASSESSMENT

OBSTETRIC ASSESSMENT

OBSTETRIC ASSESSMENT

OBSTETRIC ASSESSMENT Educational Needs/Interventions Table

Necessary Assessments/Interventions 1.Anxiety r/t unknown future 1. -Assess the clients level of anxiety and physical reactions 2.Sleep deprivation r/t to anxiety, like nonverbal uncomfortable pregnancy state expressions of anxiety, tachycardia, or increased 3. Fatigue r/t increased blood pressure. energy demands - If irrational thought or fears are present, offer the client accurate information about labor and delivery, and encourage her to talk about the meaning of events contributing to the anxiety. -Offer the client information about labor and delivery to assure that she will be more prepared. -Encourage the client to use positive self-talk such as, I am doing what I can to make sure the baby is healthy, I can do this one step at a time (Ladwig & Ackley, 2011). 2.-Obtain a sleep history including bedtime routines, sleep patterns, use of alternative practices, and responsibilities that limit sleep time. -Encourage to start Kegel exercises to help with bladder control during the night. -Establish a sleeping and waking routine with regular times for sleeping and waking to use the restroom. -Use a heating pad to help with cramping in abdomen. Use calming techniques to reduce the pain in abdomen

Nursing Diagnosis

Rationale 1. The client should know that what happened in her mothers pregnancies may not be the same for her. Every pregnancy is different, and having anxiety about it may make pregnancy worse. Findings support the possibility that a decline in stress responses during pregnancy may help to protect mother and fetus from adverse influences associated with predicting preterm delivery (Glynn, Schetter, Hobel, & Sandman, 2008). K.K. may be scared about having problems the same as her mother did in her pregnancy, however, worrying about it could cause problems in her pregnancy. Relaxing the client and encouraging selftalk will hopefully decrease her levels of anxiety, especially if she knows more about the pregnancy process. Knowing what is causing the anxiety helps identify what needs to be educated on or how to help reduce her anxiety. Care for the emotional state of pregnant women remains a neglected aspect of obstetric medicine. Many studies have shown that, if a mother is depressed, anxious, or stressed while pregnant, this increases the risk for her child having a wide range of adverse outcomes, including emotional problems, symptoms of

OBSTETRIC ASSESSMENT while sleeping. -Minimize as many disturbances that limit the amount of sleep. Keep the sleep environment quiet and mask noise in sleep area if it cannot be eliminated (Ladwig & Ackley, 2011).

10 attention deficit hyperactivity disorder, or impaired cognitive development (Glover, 2013).

2. K.K. stated that she was interrupted by sleep because of frequent urination and pain in the abdomen. Assessing her sleep schedule and routines 3. -Assess severity of fatigue will help distinguished what on a scale of 1 to 10; assess needs to be changed or done to frequency of fatigue, activities help with getting enough and symptoms associated with sleep. Limiting disturbances increased fatigue. that can be changed more -Help the client identify easily should be minimized, sources of support and like noise. The use of Kegel essential and nonessential exercises can improve tasks to determine which tasks incontinence and frequent can be delegated to whom. urination that occurs with -Encourage the client to keep pregnancy. One trial a journal of activities, demonstrated that pregnant symptoms of fatigue, and women who followed a 12feelings, including how week course of regular fatigue affects the clients exercise including pelvic floor normal activities and roles. muscle strengthening were -Evaluate adequacy of less likely to report urinary nutrition and sleep hygiene, incontinence than women like inability to stay asleep. given standard care (Stafne, Encourage client to get Salvesen, Romundstad, adequate rest, use a routine Torjusen, & Mrkved, 2012). sleep/wake schedule, and eat a If the exercises do not seem to well-balanced diet with at work having a sleep wake least eight glasses of water a cycle can help K.K. start a day (Ladwig & Ackley, 2011). routine that helps her get the sleep she needs. In addition, uses a heating pad or wash cloth on the abdomen may relieve pain. By applying heat on the abdomen or lumbar region, 63% of subjects felt relief of abdominal pains (Hosono, Takashima, Morita, Nishimura, Sugita, Isami, & Suzuki, 2010). 3. Being fatigued can cause

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11 many problems for K.K. while she is pregnant. One review examined the relationship between three major causes of fatigue, which were sleep factors, circadian influences and task effects. The review demonstrated clear evidence for sleep effects producing impaired performance and accidents (Williamson, Lombardi, Folkard, Stutts, Courtney, & Connor, 2011). Along with being pregnant, K.K.s sleep disturbances are playing a big role in being fatigued. Assessing the clients fatigue level and encouraging keeping a journal helps identify what is causing the fatigue. If the fatigue gets to be troubling referring her to a specialist may have to occur. K.K. needs to make sure she is getting the rest and energy she needs otherwise her safety could be at risk. Also, a journal will help identify what major activities are causing her to have the level of fatigue she is in. K.K has a lot on her shoulders with working 8 to 4 each day, moving into a new house, and being pregnant. Not to mention, not getting along with some of her coworkers can me mentally straining. During this time, her supportive husband and friends should help throughout the pregnancy. As stated in the assessment, she has a very supportive husband who is willing to help. In addition, eating well-balanced meals can enhance energy levels.

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12 Individuals with fatigue are more prone to have poor nutritional status and those with poor nutritional status are at greater risk of fatigue (Westergren, 2008). It is important for K.K. to eat the right food, especially not junk food, in order to keep the baby safe, and to have enough energy to get through her busy days.

OBSTETRIC ASSESSMENT References

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Glover, V. (2013). Maternal depression, anxiety and stress during pregnancy and child outcome: What needs to be done. Best Practice & Research Clinical Obstetrics & Gynaecology. http://dx.doi.org/10.1016/j.bpobgyn.2013.08.017 Glynn, L. M., Schetter, C. D., Hobel, C. J., & Sandman, C. A. (2008). Pattern of perceived stress and anxiety in pregnancy predicts preterm birth. Health Psychology, 27(1), 43. doi: 10.1037/0278-6133.27.1.43 Hosono, T., Takashima, Y., Morita, Y., Nishimura, Y., Sugita, Y., Isami, C., & Suzuki, A. (2010). Effects of a heatand steamgenerating sheet on relieving symptoms of primary dysmenorrhea in young women. Journal of Obstetrics and Gynaecology Research, 36(4), 818-824. doi: 10.1111/j.1447-0756.2010.01237.x Ladwig, G.B., & Ackley, B.J. (2011). Mosbys guide to nursing diagnosis (3rd Ed.). Maryland Heights, MO: Mosby Elsevier Stafne, S., Salvesen, K., Romundstad, P., Torjusen, I. and Mrkved, S. (2012). Does regular exercise including pelvic floor muscle training prevent urinary and anal incontinence during pregnancy? A randomized controlled trial. BJOG: An International Journal of Obstetrics & Gynaecology, 119(10), 12701280. doi: 10.1111/j.1471-0528.2012.03426.x Westergren, A. (2008). Nutrition and its relation to mealtime preparation, eating, fatigue and mood among stroke survivors after discharge from hospital-a pilot study. The Open Nursing Journal, 2(15). doi: 10.2174/1874434600802010015

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Williamson, A., Lombardi, D. A., Folkard, S., Stutts, J., Courtney, T. K., & Connor, J. L. (2011). The link between fatigue and safety. Accident Analysis & Prevention, 43(2), 498-515. http://dx.doi.org/10.1016/j.aap.2009.11.011