Postnatal Depression Is Public Health Nursing Issue Essay Paper

Consideration Of The Facts From The Patient Or Situation

Clinical reasoning cycle is an important term in healthcare which helps to evaluate a patient’s healthcare issues and supports by providing right care plan (Smith, Loftus & Levett-Jones, 2013). In this essay, care plan for a specific patient will be illustrated with the use of clinical reasoning cycle. A woman was suffering from some post partum issues and she was under the clinical treatment process following the clinical reasoning cycle. The paper at first focuses to collect data about the past medical history of the patient. After identifying the problem of the patient, some goals will be set considering the issues and according to that necessary actions will be planned. The paper will also reflect how the plan is evaluated and what outcomes of it are. Finally, the paper will conclude with the brief summary of the whole cycle and it will assess whether the complete cycle was helpful for the patient.

At the 38 weeks gestation, a 42 year old woman Candace Evans was brought to the operation theatre for admission purpose. Primarily she was diagnosed with Placentra Previa and under the spinal anaesthesia she was admitted for elective LUCS which is better known as Lower Uterine Caesarean Section. In Placentra Previa, the opening of the uterus is blocked partially or completely which becomes the barrier in the delivery process and resists the normal delivery of the child (Clouse et al., 2013). As Candace was having Placentra Previa, so normal delivery was not possible and the doctors had to choose caesarean delivery in her case. Postnatal Depression Is Public Health Nursing Issue Essay Paper  The issues regarding Placentra Previa can be identified when vagina starts bleeding at the 20^th week of the gestation period (Glavin & Leahy-Warren, 2013). Before preparing a nursing care plan, it is necessary to have a good knowledge about the patients’ medical history and background. So, all the necessary information will be collected in case of Candace to proceed further with the treatment process.

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It was her second pregnancy and during her first pregnancy, she underwent various issues like

• Gestational diabetes
• Anxiety
• Post-natal depression

Her first pregnancy was about 5 years ago and the diabetes during her first pregnancy disappeared after the birth of the child and did not come back again. Her anxiety was due to her fear of first experience about the delivery of a child. She also suffered from post-natal depression at that time. But, in this pregnancy the main issue is she was suffering from Placentra previa and it was disappointing as well as frustrating. However, after the uneventful delivery of a male child, after the anaesthetic recovery, Candace was brought to Post Anaesthetic Recovery Room PACU. The APGARS rate of the new-born baby was determined and checked as it helps in identifying its health condition in the womb and after the delivery (Lipman, Carvalho, Cohen, Druzin & Daniels, 2013). APGARS rate stands for Appearance, Pulse, Grimace, Activity, and Respiration. The APGARS rate for this baby was

• 8 at 1 minute
• 10 at 5 min

Collection Of Information

The APGARS rate which is checked at the first minute after birth generally indicates the condition of the baby inside the mother’s womb and the APGARS rate checked at fifth minute indicates the health condition of the child outside the mother’s womb. In some cases, the APGARS rate of a new born baby is also helpful in determining the condition of the mother (Tse, Ali, Prasad, Vassiliou & Raphael, 2015). It is genuine for both normal as well as caesarean delivery that some amount of blood is lost at the intraoperative period. In the case of Candace, the amount of blood loss was 150 ml during the intraoperative period.

APGARS rate is the indicator of the health condition of the baby. It is also assumed, if the APGARS rate lies from 7 to 10, then the baby is absolutely good (Holm, Thomsen, Norgaard & Langhoff-Roos, 2015). So, here also the condition of the baby was fine as the rate at 1 minute and at 5 minute lied between 7 and 10. Again, if the amount of intraoperative blood loss up to 500 or even 700 ml is considered as normal and here in case of Candace the lost was 150 ml which is absolutely normal as well (Yaju, Kataoka, Eto, Horiuchi, & Mori, 2013). Again, PACU did some assessment on the condition of the patient and the outcome is as follows:

• Pain- 0/10
• Dermatome level T3- stable
• Heart rate- 88
• Temperature-  36.9 degree Celsius
• Blood pressure- 104/76
• SpO_2- 97%
• Intravenous therapy of Oxytocin in CSL running at 250mL/hour.

The pain level was zero so it was assumed that the mother was not having any pain. Again the dermatome level T3 was found to be stable for Candace. The heart rate of normal person lies from 76 to 100 and in case of Candace it was 88 which was also normal (Katz & Gagnon, 2016). The temperature checked also produced a normal result for the patient. The blood pressure was quite low for Candace and the systolic pressure was found to be lower than usual. The normal range of SpO₂ rate is 98-100% and even 96% or 97% rate also considered as genuine among the mothers (Collins, Abdul?Kadir, Thachil & Subcommittees on Women’s Health Issues in Thrombosis and Haemostasis and on Disseminated Intravascular Coagulation, 2016). So, in case of Candace it was just fine. She also underwent the intravenous therapy of oxytocin in CSL at a rate of 250 mL/hour. The assessment at PACU also produced the result that her lower uterine dressing was dry and intact but the catheter inserted inside the bladder was containing 100ml of rose coloured blood which was a matter of concern. The rose coloured blood sometimes indicates infectious bladder. Red urine in the in-dwelling catheter also can be an indicator of bladder injury and it requires attention to prevent further issues.

Processing Gathered Information

Candace Evans came to PACU for her post-partum analysis and during the assessment process at PACU several major and minor problems have been identified. These problems should be treated with high care to avoid any kind of future problem. The problems which are identified at the assessment are mentioned below as per their priority.  Postnatal Depression Is Public Health Nursing Issue Essay Paper

• Catheter containing rose coloured urine
• Slightly lower BP especially the systolic pressure was low
• Post-partum fatigue

1. Establish goals

The main task was to establish some goals which would address all the issues identified at PACU. Her main problem was blood coloured urine and in this purpose the catheter needs to be changed and checked in order to avoid any kind of infection. Apart from that, she was having lower systolic blood pressure. But, as it was not so much different than normal so no any specific medicine was required. Post-partum fatigue is quite common and it can be cured with proper rest and some healthy living habits and diet plan (Jones, Chandra, Dazzan & Howard, 2014). Even after few weeks of birth it can stay among the mothers. Intake of some nutritional food after the delivery of baby can be helpful in recovering the issue.

The first action which needs to be taken was checking the vaginal blood loss of the patient. In order to check her vaginal pad which was soaked with frank blood as well as some blood clots, the curtains were kept hanged and her husband and new born baby were there in the other side of the curtain. It was necessary to maintain the privacy of the patient which is the primary ethics for any healthcare organization (McKenzie-McHarg et al., 2015). To address the issue related to lower BP and fatigue, Candace was instructed to take proper rest and to have a healthy diet containing foods with high nutritional value. She was also told to undergo a counselling in order to overcome all the mental issues regarding depression and anxiety at post-partum period.

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The nursing plan was implemented in order to address the health related issues of the patient during the post-partum period. The health status and condition will be improved with the integration of these nursing plans into her medication process (Mansori, Hanis & Shadmani, 2017). Changing of catheter and providing instruction to recover the fatigue and low blood pressure issue will be helpful for the patient. However, if there would be any psychiatrist advice regarding other mental issues of post-partum period then that would be very much helpful for the patient in overcoming all the issues.

Identifying The Problem

Conclusion

Candace Evans came to PACU after her anaesthetic recovery and she came for the analysis of her health. The assessment of the health condition of Candace reflected various issues related to post-partum. Some issues were not so major but if the health issues are not addressed properly then that could create serious health hazards in future. This paper thoroughly represented the clinical reasoning cycle of the patient. It gathered information from the patient’s background medical history and also assessed the current status. The paper identified the main problems of the patient and according to that nursing care plans were provided after establishing goals. The actions taken are also reflected in the paper and finally the paper reflected the outcome of the patient after the evaluation of the nursing care plan.

References

Clouse, K., Pettifor, A., Shearer, K., Maskew, M., Bassett, J., Larson, B., … & Fox, M. P. (2013). Loss to follow?up before and after delivery among women testing HIV positive during pregnancy in Johannesburg, South Africa. Tropical Medicine & International Health, 18(4), 451-460.

Collins, P., Abdul?Kadir, R., Thachil, J., & Subcommittees on Women’s Health Issues in Thrombosis and Haemostasis and on Disseminated Intravascular Coagulation. (2016). Management of coagulopathy associated with postpartum hemorrhage: guidance from the SSC of the ISTH. Journal of Thrombosis and Haemostasis, 14(1), 205-210.

Glavin, K., & Leahy-Warren, P. (2013). Postnatal depression is a public health nursing issue: perspectives from Norway and Ireland. Nursing research and practice, 2013.

Holm, C., Thomsen, L. L., Norgaard, A., & Langhoff-Roos, J. (2015). Intravenous iron isomaltoside 1000 administered by high single-dose infusions or standard medical care for the treatment of fatigue in women after postpartum haemorrhage: study protocol for a randomised controlled trial. Trials, 16(1), 5.

Jones, I., Chandra, P. S., Dazzan, P., & Howard, L. M. (2014). Bipolar disorder, affective psychosis, and schizophrenia in pregnancy and the post-partum period. The Lancet, 384(9956), 1789-1799.

Katz, D., & Gagnon, A. J. (2016). Evidence of adequacy of postpartum care for immigrant women. Canadian Journal of Nursing Research Archive, 34(4).

Lipman, S. S., Carvalho, B., Cohen, S. E., Druzin, M. L., & Daniels, K. (2013). Response times for emergency cesarean delivery: use of simulation drills to assess and improve obstetric team performance. Journal of Perinatology, 33(4), 259.

Mansori, K., Hanis, S. M., & Shadmani, F. K. (2017). Postpartum modern contraceptive use in northern Ethiopia: prevalence and associated factors-methodological issues in this cross-sectional study. Epidemiology and health, 39.

McKenzie-McHarg, K., Ayers, S., Ford, E., Horsch, A., Jomeen, J., Sawyer, A., … & Slade, P. (2015). Post-traumatic stress disorder following childbirth: an update of current issues and recommendations for future research. Journal of Reproductive and Infant Psychology, 33(3), 219-237.  Postnatal Depression Is Public Health Nursing Issue Essay Paper