Reference no: EM132635553
Case Study
Mrs. G., a twenty year old mother of a 2 year old is pregnant. English is not her primary language. She is recently married (one year) to a man in his early 40s who is not of her culture (She comes from Nigeria). The toddler is not this man's child. She had difficulty with her first pregnancy; high blood pressure and spotting.
As she goes through her pregnancy she finds that her first trimester is difficult managing her health and the toddler. She is not used to having children and finds the toddler challenging. She also finds that she is having some of the same symptoms as she did during her last pregnancy. She is not comfortable going to an American doctor and tells her husband that she can take care of herself as she did during her last pregnancy. He is not happy about this decision and tells her that she has to go. He takes her to the doctor several times during her pregnancy but is not sure his wife is following the medical instructions being given.
By the end of her pregnancy she has gained more weight than she had anticipated. She could not understand why as she was eating her native foods. The doctor told her that she had high blood pressure. She was not sure what that meant as she felt the same as she did during the first pregnancy.
Labor was painful, long and difficult and while she had a vaginal birth the baby was small and experienced some respiratory distress at birth. She decided to again breastfeed even though she could only do it for a few weeks the last time. She was told that she had a "small supply of milk".
In the first few weeks of taking care of the newborn, her husband wanted to be a part of the caring process and she was not happy as "men don't do that". She also found that with this baby she felt much more tired and had a hard time managing both children. In fact, the toddler became cranky and was aggressive to the newborn, trying to bite and scratch the new baby.
The husband again took her to the doctor after birth and then again for several months. He also insisted that she see a pediatrician for both children. At the doctor's offices they told her that they had to "assess" the children to be sure they were "normal". When she was told this, she was frightened.
As a few months passed, she became more lethargic and tired. Two children were more than she could deal with. Sometimes she could barely get out of bed. Yet, she knew that she was trying to do all of what she was told by both doctors and her husband. She really loved her children and respected her husband.
When her newborn was six months old she found out that she was pregnant again. She knew that it would be a mistake to have another child because her husband had just informed her that his two children from another marriage (6 and 12 years old who has asthma) was going to be living with them now and she would need to be taking care of them as well
In addition to reading the case study and addressing the focus of Communication please recognize this client has just delivered her 3rd baby vaginally.
What are her risk factors for postpartum hemorrhage?
If she is bleeding what is your initial response to her care?
What is your postpartum assessment after the delivery?
What medications may be used to prevent hemorrhage?
What support system can you identify for this client?
She has exhibited signs of postpartum depression in the past ? is she at risk? What behaviors would you expect to see? What interventions should you employ?
What discharge education should be included in her care planning?