The nursing care plan addresses labor pain experienced by a mother during delivery. The objectives are to help the mother effectively deliver her baby and reduce anxiety within 8 hours of labor through pain management techniques. The plan involves monitoring vital signs, administering medications, encouraging breathing exercises and proper pushing, and allowing rest periods to relieve pain and aid delivery. The expected outcome is that the mother will be able to deliver a healthy baby while maintaining manageable pain levels.
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The nursing care plan addresses labor pain experienced by a mother during delivery. The objectives are to help the mother effectively deliver her baby and reduce anxiety within 8 hours of labor through pain management techniques. The plan involves monitoring vital signs, administering medications, encouraging breathing exercises and proper pushing, and allowing rest periods to relieve pain and aid delivery. The expected outcome is that the mother will be able to deliver a healthy baby while maintaining manageable pain levels.
The nursing care plan addresses labor pain experienced by a mother during delivery. The objectives are to help the mother effectively deliver her baby and reduce anxiety within 8 hours of labor through pain management techniques. The plan involves monitoring vital signs, administering medications, encouraging breathing exercises and proper pushing, and allowing rest periods to relieve pain and aid delivery. The expected outcome is that the mother will be able to deliver a healthy baby while maintaining manageable pain levels.
Copyright:
Attribution Non-Commercial (BY-NC)
Available Formats
Download as DOC, PDF, TXT or read online from Scribd
The nursing care plan addresses labor pain experienced by a mother during delivery. The objectives are to help the mother effectively deliver her baby and reduce anxiety within 8 hours of labor through pain management techniques. The plan involves monitoring vital signs, administering medications, encouraging breathing exercises and proper pushing, and allowing rest periods to relieve pain and aid delivery. The expected outcome is that the mother will be able to deliver a healthy baby while maintaining manageable pain levels.
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NURSING CARE PLAN
DELIVERY ROOM Problem: Labor Pain
Assessment Explanation of the Objectives Implementation Rationale Evaluation
Problem Subjective Labor pains are STO: Introduce self to the Builds rapport and after 8 hours of data: experienced when the within the hours client as student nurse reduces communication nursing “ Masakit na contraction of the of labor, 30 for the shift. barriers between client interventions talaga tyan ko” uterus becomes minutes to 8 and nurse the mother was As verbalized intense pressing on hours, the mother During labor able to With a pain the nerve endings will be instructed Gather baseline data Serves as an initial effectively scale of 9/10 located in the how to effectively such as temperature, assessment so as to know deliver a with the abdomen to the use her energy to respiratory rate, pulse where to start healthy baby highest at 10 lumbar area during perform rate and blood pressure intervention and which and was able to and lowest rate labor. It is not only techniques that include amount of things need to be follow the at 0. the contractions that will effectively bleeding (pads used) prioritized directions given stimulate the nerves deliver her baby and interval, frequency by the nurse Objective but also the size of and to reduce her and intensity of labor when bearing data: the fetus that will anxiety. contractions. down and -facial grimace pass through the breathing -guarding pelvic inlet of the LTO: Watch out for Meconium and fouls through pursed behavior mother. Within 8 hours meconium stained, foul smelling amniotic fluid is lip. -bears down When the pelvis, after the labor to smelling amniotic fluid indicative of high risk during perineum and the the delivery of the babies and needs to be The mother’s contractions uterus prepare fetus and placenta immediately endorsed for pain scale also -interval – themselves for the Mother’s pain immediate delivery or dropped down every 2- 3 expulsion of the fetus will be reduced to action. to 5 in a scale of minutes the contraction a manageable 0-10, with 10 -frequency – becomes frequent and scale of 5/10 in a Observe for nonverbal Nonverbal cues are often being the every 3 intensifies as the scale of 0- 10 cues such as facial seen in patients who are highest level minutes labor progresses. Pain with 10 as the expressions and body in pain, these will aid in after the -duration – 3 from the abdomen highest and 0 is movements to gather proper assessment since administration minutes due to the the lowest data about severity of some patients cannot of prescribed -irritability contractions radiate Through pain. describe what they feel drug, massages observed to the lumbar area following and and are more likely to and rest periods -restlessness where pain is also carrying out the become irritable and that allowed the noted felt. doctor’s orders restless. mother enough -tries to relieve about bed rest, IV time to regain self by mouth incorporation for Feel the intensity of Assessing the intensity, her strength breathing pain, diversional contractions on the frequency and duration after labor and -massages activities, health abdomen of the client of contractions will tell delivery. lumbar area teachings and to be sure when to ask the nurse what stage the -abdomen feels other types of the mother to bear mother is already in and rigid pain management. down if the mother is ready for -BOW delivery or not. ruptured
Nsg Dx: Massage in circular Massage is therapeutic, it
Abdominal motion the lumbar area can relieve the pain pain radiating of the client during through touch and help to lumbar area labor the blood circulate related to making a certain muscle continuous relax and stronger. uterine contraction and Perform nipple Nipple stimulation is passage of stimulation by gently effective with mothers fetus through massaging the nipples who have difficulty in pelvic inlet on the mother with labor due to less amount secondary to fingertips to release of oxytoxin the release of labor. oxytoxin the hormone will aid in dilation of the cervix for faster delivery.
Assist the attending Since nurses are not
physician when allowed to perform I.E, checking for the assisting the physician dilation of the cervix of and taking note of the the mother cervical dilation will also tell the nurse if mother is ready for delivery or needs more time for labor.
Encourage the mother Bearing down is effective
to bear down when she in the expulsion of the feels the contraction of fetus during delivery, her uterus during during labor it is being delivery taught to the mother so she will have an idea when to bear down during delivery.
Encourage the mother Purse lip breathing will
to do purse lip minimize the use of breathing during labor energy while in labor and and delivery during delivery Of the baby
During delivery Due to the large size of
Assist the mother to the abdomen of the assume lithotomy mother, assisting her to position on the delivery assume a lithotomy table position on the delivery table will make the mother feel comfortable.
Gather baseline data The baseline data will
particularly vital signs serve as an assessment for the status of the mother and maybe essential to know if there are any deviations to be reported to the attending physician
Incorporate oxytoxin Hyosine and oxytocin
in D5LRS x 1l as will aid in the dilation of prescribed by the the cervix to lessen the doctor time of labor
Administer 2 ampules This medication will
HNBB intermuscularly soften the cervix further to aid in the dilation of the cervix
Allow the mother to Rest periods will make
rest when tired of the mother gain energy to bearing down continue with the bearing down and to make the mother comfortable during delivery
Remind mother to bear Reminding the mother to
down only when bear down only when contraction is felt there is contraction to make the delivery of the baby more effective and will cause less pain and less effort during delivery.
Remind mother again Remember to remind the
about mouth breathing mother about purse lip Or pursed lip breathing breathing so as to conserve energy during labor and delivery
After Delivery After care and perineal
Perform after care care will make the mother comfortable and will prepare the mother to be transferred to the ward so she will have bedrest according to the advise of the physician.
Apply diaper to mother The diaper will catch all
after perineal care and secretions and blood episiotomy from the mother to serve as a basis for blood lost after birth
Record time of Proper documentation
delivery, sex of baby, will serve as a legal and date of delivery document for the making of birth certificates and other documentations needed. ward give the mother Do not give the mother prescription drugs anything that is not depending on the need prescribed by the and as prescribed by physician. Prescription the physician drugs will also lessen the pain the mother is feeling after giving birth.
massage the fundus of Massaging the fundus
the mother every now after giving birth will and then to make it make the uterus firm and contracted contracted thus lessening the bleeding and lessening the opportunity for shock
advise the mother not Bedrest will make the
to get up but to stay in mother regain her bed for the following strength after the delivery hours as prescribed by and this will also the attending physician minimize the bleeding.
assess the mothers Assessing signs for shock
circulation and vital will help prevent it as signs while taking into soon as possible consideration signs of shock
provide comfort Comfort measures will
measures – extra help the mother have blanket, quiet more relaxation time and environment, dim will also make the lighted room or mother regain most of surrounding her lost energy during labor and delivery endorse client to family Significant others can or significant others take part in the patient and to staff nurse care thus maximing well being of the client due to the involvement of the family. This can also reduce anxiety on the part of the client.
record and document Records and documents
observations and data serves as legal basis and about client and client as a report about the care. patient’s condition.
Advising the client about
Include health certain things that needed teachings that will to be done after birth make the client especially breastfeeding understand and aim for will help the mother lose her well being such as weigth, have a healthier diet, lifestyle, lifestyle and not get breastfeeding and pregnant for a few activities months after birth thuis giving herself and her baby good health.