PURPOSE: To use nursing process and critical thinking, describe nursing care and interventions, and teach relevant infor

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PURPOSE: To use nursing process and critical thinking,
describe nursing care and interventions, and teach relevant
information to a postpartum client.
DIRECTIONS: Read the following case study. Complete all
questions.
Lonnie is a 17 year-old who has just delivered her first
child vaginally (3:00 p.m.). She labored 19 hours and pushed 2
hours. She had an episiotomy that was repaired. You are the
nurse for the immediate postpartum period. She is holding the baby
and is planning on breastfeeding. Her major concern at this time is
her hunger. She also asks you “how long the bleeding is going to
occur and if she could have a tampon”.
What is the immediate threat? What should you do
first?
Where would you expect to find her fundus at this
time?
3. What factors might influence the position of her
fundus?
4. What are the practice standards of vital signs during
this stage?
5. How would you explain lochia?
What would you teach her about perineal
care?
Within 30 minutes the baby is nuzzling at Lonnie’s
breast; however Lonnie is more intent on finishing her
sandwich.
What can you do to help Lonnie during this initial
feeding?
During the feeding Lonnie complains of “severe
contractions” and doesn’t want to continue.
What can you teach Lonnie about the contractions? What
type of nursing interventions and collaborative interventions might
be appropriate?
The baby is sleeping contently in the grandmother’s arms
after feeding 20 minutes. Lonnie has been complaining more and more
about her perineum hurting. You assess her fundus to be +1above the
umbilicus and firm.
9. What would be the best nursing intervention to use in
this situation?
Lonnie has been sleeping for about an hour when she
wakes up in a pool of blood. Nursing assessment at this time
reveals fundus at +3 above the umbilicus and deviated to the right.
Lochia is large rubra with small clots being passed. Vital signs
are: BP 90/50 (down from the previous reading of 110/60), P. 120,
R. 24. She complains of being cold and is visibly shivering and
shaking. Her perineum is swollen, especially on the right side. Her
IV with 10u of Pitocin in 1000cc LR is still infusing in the right
arm TKO.
What could be happening to Lonnie? Support your answer
with pertinent data.
What interventions should be done immediately and
why?
What is Pitocin used for in the immediate postpartum
period?
Lonnie is now one day post-partum. She asks you, her
nurse, to keep the baby in the nursery except for feeds. She has
had a lot of friends in to visit and is not interested in any
teaching. The grandmother has changed the baby and held it. Lonnie
insists on her mother staying overnight.
How would you react to the assessment data you have
collected? According to Rubin explain what phase Lonnie is going
through. What other factors in Lonnie’s history may impact her
attachment behaviors. Why?
She wakes up in the middle of the night soaked in
perspiration.
What would be your response to this situation? What
would you tell her?
The second day postpartum, Lonnie is eager to learn
about caring for her new baby. She watched the videos on infant
care and bathing and talked with the nurse regarding her own care.
Breastfeeding was going well except Lonnie’s nipples were starting
to feel sore. She asked her nurse how she should position the baby
and what she could do to heal the nipples.
What should her nurse tell her?
Lonnie is discharged. She will be living with her
mother. She plans to return to school to finish her senior year.
She thanks the nurses for all they have done.
15. What type of family is Lonnie’s family? What
are some resources that might be available to Lonnie
?