Family Assessment Paper
Shana Porter
Indiana University School of Nursing
A family’s first child is an incredibly beautiful and overwhelming event for new parents. Many physical and social changes accompany a couple’s first child. The physical changes that occur in the mother’s body after birth can cause a longer hospital stay than expected and frustrate the mother as she tries to adapt to motherhood. The family as a whole needs to be cared for as roles change and new challenges arise (Zwelling & Phillips, 2001). Nurses have the opportunity to provide family-centered care with new mothers and fathers in all types of family structures. Including family members, especially secondary immediate caregivers, can decrease the stress on the mother and provide a bonding opportunity for other caregivers. Ensuring that supportive people for the mother understand what care she needs is helpful and can provide a person to remember future appointments and run errands for the new mother. As a nurse, it is important to assess the family structure of the patient so that care is holistic and individual. I had the opportunity to provide care for a family that just had their first child, and to consider their care as a family.
The patient that I took care of on the mother/baby unit is 33 and has no known allergies. The patient has been pregnant twice, has had one term baby, has had one preterm baby, has had one miscarriage, and has one living, which is her most recent pregnancy. The gestational age of this pregnancy was 40 weeks. She gave birth on February 12 and the date I took care of her was February 18. She began her prenatal care in June of 2015 and attended all appointments and classes recommended. She had no previous significant medical or surgical history except for having a previous miscarriage. I was not able to gather the year or information about that miscarriage. She is currently on Zosyn, Motrin and iron and does not smoke or drink alcohol. She gained 30 pounds during pregnancy and her estimated delivery date was February 9. The glucose tolerance test was negative and she does not have gestational diabetes. She is Rh positive, HIV negative and immune to rubella. She has no other outstanding medical histories or complications.
She came to the hospital on February 11 because her membranes ruptured and she waited over 48 hours to come in. Her contractions were augmented/spontaneous. She had a normal CDC upon admission and for anesthesia she received Ropivacaine 0.2% and fentanyl. During labor, the patient pushed for five hours and the baby was not progressing, so a cesarean section became necessary. Her husband was with her during labor, and has been with her since. She delivered on February 12 at 23:18 via cesarean section. She had 600 mL of estimated blood loss. There was no neonatal resuscitation team at delivery.
Upon assessment at 0800 when I took care of her, her fundus was at her umbilicus, and she was with her husband. She was taking Motrin for pain, and was given iron and Zosyn. She had a postpartum CBC because her membranes ruptured and it was over 48 hours before she came in to the hospital. She is finishing the antibiotics, which were necessary due to the extended time her membranes were ruptured before she came into the hospital. There was no growth indicated in the results of her CBC. The Edinburgh postnatal depression screen was completed and she had a score of 5, which indicates she is not suffering from depression. Her vitals and physical assessment findings were all within normal limits, except she had 4+ pitting edema on her feet and lower legs, which is why she had to stay. She said it does not cause pain it is just uncomfortable. She was on fluid restrictions and her physician was monitoring the edema.
The infant weighed 8 pounds 10 ounces and was 37.5 cm long at birth, and is a male. His initial Apgar score was 8 and moved to a 9 upon reassessment. The infant is being breast-fed and is feeding well. The only concern with feeding is that because the mother is still receiving treatment for fluid excess she has been interrupted quite a bit and the feeding schedule is irregular She lives with her husband in Bloomington, and they are both employed. She plans on going back to work in the fall. She has a strong support system of friends in town and her physical and emotional needs are being met currently. The patient is originally from Spain and her husband is American. They are very well adjusted to life and culture in Bloomington and said they enjoy living here.
There were some issues of miscommunication with this patient and the nurse the night previous. From the information I gathered at handoff, the patient did not want to take the antibiotics and did not want anything that was not “natural.” She appeared to have no problem with the medications when I passed them, and understood why she needed them. I believe it was only miscommunication between the previous nurse and the patient because there were no compliance issues when I provided care.
The patient’s husband was assisting her with everything she needed and was taking care of the infant while she rests. It is clear to me that the patient and her husband have a very functional and healthy communication flow by the way they interacted. The family is progressing steadily towards independence from the clinical setting and discharge for the mother. The infant is doing very well and is experiencing no complications from birth. Breastfeeding for the infant should improve when the mother is at home and has a more regular schedule. I recommend the mother and father reach out to family or friends as they adjust to life at home with a newborn and may need extra help with the baby as the mother continues to rest and manage the edema. It may be beneficial to have friends or family make them a few meals as they adjust to life at home, and help around the home and with errands. As a nurse, it is vital that I consider the patient’s care in light of the family as a whole, and that I include every aspect of my patient’s family into care.
Nursing Care Plan:
Nursing Diagnosis: Desired patient outcomes: Interventions & Education: Resources:
Excess fluid volume
(Mother, patient) • Decline in weight toward client’s normal weight
• B/P and pulse within normal range for client and stable with position change
• Balanced intake and output
• Serum sodium returns toward normal range for patient
• All of these outcomes need to be met by client D/C from mother baby unit • Restrict sodium intake
• Maintain fluid restrictions per MD orders
• Administer diuretics as ordered
• Try to mobilize the fluid by elevating legs
• Education needs to be provided on what makes up a low sodium diet while on sodium restrictions, the importance of the medications ordered to help bring the fluid volume down, and how to mobilize legs/feet.
Online resource: (EHS: Nursing Care Planning Guides, 2012)
Ineffective Breast Feeding Patterns
(Infant) • Infant’s weight will be within normal limits
• Infant’s blood glucose will be within normal limits
• Infant will have sufficient nutrition
• All of these outcomes need to be met by mother D/C from mother baby unit • Lactation consultant will assist mother with breastfeeding methods
• Nursing staff and support will decrease interruptions by doing interventions together to allow bonding time and time to feed
• Nursing staff will provide patient with a suggested schedule for feeding
Online resource:
(Newborn Nursing Diagnosis, 2016)
Risk for caregiver role strain
(Family) • Mother and father will both participate in infant care
• Father will assist while mother is receiving care and resting for treatment of fluid excess
• Open communication will be utilized by mother and father
• All of these outcomes need to be met by mother D/C from mother baby unit
• Nurse will provide education about the importance of co-parenting
• Nurse will provide education on how to communicate openly
• Nurse will offer to call family and friends to help care for infant if stress is a problem Online Resource
(EHS: Nursing Diagnoses, Outcomes, and Interventions, 2012)
Resources
EHS: Nursing Care Planning Guides – Care Planner: Diagnosis: Altered fluid and electrolyte
balance. (2012). Retrieved April 14, 2016, from http://www1.us.elsevierhealth.com/SIMON/Ulrich/Constructor/diagnoses.cfm?did=321|322|323|
EHS: Nursing Diagnoses, Outcomes, and Interventions – Nursing Diagnosis: Family Coping:
Compromised, Ineffective. (2012). Retrieved April 12, 2016, from
http://www1.us.elsevierhealth.com/MERLIN/Johnson/linkage/linkages-Family_Coping_Compromised_Ineffective.html
Newborn Nursing Diagnosis. (2016). Retrieved April 13, 2016, from
http://www.nandanursingdiagnosislist.org/newborn-nursing-diagnosis/
Zwelling, E., & Phillips, C. (2001). Family-centered maternity care in the new
millennium: is it real or is it imagined?. Journal Of Perinatal & Neonatal Nursing, 15(3), 1-12 12p.