Nursing Care Plan 5-1. Desired Outcome: Post-delivery, the mother will re-establish a functional body fluid volume and a balanced input and output status. Coping/stress tolerance Class 1. This pregnancy is unplanned, and financial status is unstable. If he client presents with labor determine frequency, duration, and intensity of contractions. 6. Describe appropriate nursing interventions to address nonreassuring fetal heart rate patterns. Multiple gestation PL 2,3 j. Placental abnormalities PL 2,3 k. Pre-eclampsia, eclampsia PL 2,3 l. Chorioamnionitis PL 2,3 m. Polyhydramnios PL 2,3 n. Oligohydramnios PL 2,3 Transverse fetal lie; Extreme low birth weight; Fetal distress; Compound conditions, such as macrosomia and transverse lie. Nursing Care Plan for the clinical period from 23.02.2015 till 11.03.2015. Risk for Impaired gas exchange related to antepartum stress, excessive mucus production, and stress due to cold.. Goal: Free from signs of respiratory distress. Nursing Care Plan 2. Pathophysiology An acute lung condition evidenced by bilateral pulmonary infiltrates and refractory hypoxemia. Note: Once labor is diagnosed, if delivery has not occurred within 12 hr, and amniotomy and oxytocin have been used appropriately, then a cesarean delivery is recommended by some protocols. Obtain a complete obstetric history. The definition of refractory hypoxemia is hypoxemia that is unresponsive to treatment and a PaO2 level that remains low despite increasing FiO2. Nursing Diagnosis for Newborn. Etiology The diffuse damage and […] The woman is approaching her twenty-fourth week of gestation. Nursing Diagnosis For Hypoglycemia In Newborn - Healthcare Free Full Text Developing Nursing Standard Guidelines For Nurses In A Neonatal Intensive Care Unit A Delphi Study Html / Risk for altered cerebral tissue perfusion related to inadequate glucose supply to the brain.. 7. Explain the various comfort-promotion and … A multigravida (P2, G5) is 37 years old. Perform a complete maternal and fetal assessment. He is the first baby for his mother, Vicki. 1. Nursing Care Plan for: Ineffective Breathing Pattern, Dyspnea, Respiratory Distress Syndrome, Hypoxia, Acute Respiratory Failure, Hypoxemia, and Respiratory Illness If you want to view a video tutorial on how to construct a care plan in nursing school, please view the video below. Infants who initially undergo a stable transition to 14. Nursing Diagnosis: Deficient Fluid Volume related to active blood loss secondary to abruptio placentae, as evidenced by an average blood pressure level of 85/50, body weakness, decreased urinary output, decreased fetal heart rate, and pale, clammy skin Outline the nurse’s role in fetal assessment. Scenario. Ineffective health maintenance (Nursing care Plan) Ineffective health management ... Risk for disturbed maternal-fetal dyad NANDA Nursing Diagnosis Domain 9. Nursing Care Plan For Ineffective Breathing Pattern. She has cut down on smoking. Nursing Diagnosis: Risk for Deficient Fluid Volume related to heavy bleeding during delivery. f. Fetal distress during delivery PL 1,2,3 g. Postpartum maternal fever/infection PL 1,2,3 h. History of maternal GBS colonization/treatment PL 1,2,3 i. Abstract. Immediate cesarean birth is indicated for Bandl’s ring or fetal distress due to CPD. First Hours of Life (Marilynn E. Doenges and Mary Frances Moorhouse, 2001 in the Maternal Infant Care Plan, p. 558-566). internal fetal monitoring, including the appropriate use for each. Moral distress Impaired religiosity Risk for impaired religiosity This is measured with the PaO2/FiO2 ratio of <300 (mild), <200 (moderate), or <100 (severe). 1. 1. booklets, pamphlets and boosters for nurses to upgrading their knowledge about neonatal respiratory distress syndrome. 5. Fetal Well-Being. Nursing Care Plan 2. Fetal factors . Nursing Management .