MATERNAL NURSING 230 Breastfeeding Newborn Unfolding Reasoning Case Study- Amanda Stevens, 26 years old and baby Grace

Copyright © 2018 Keith Rischer, d/b/a KeithRN.com. All Rights reserved.

Breastfeeding Newborn

UNFOLDING Reasoning

Amanda Stevens, 26 years old and baby Grace

Primary Concept

Reproduction

Interrelated Concepts (In order of emphasis)

• Pain

• Patient Education

• Clinical Judgment

• Communication

• Collaboration

NCLEX Client Need Categories Percentage of Items from Each

Category/Subcategory

Covered in

Case Study

Safe and Effective Care Environment

• Management of Care 17-23% ✓

• Safety and Infection Control 9-15%

Health Promotion and Maintenance 6-12% ✓

Psychosocial Integrity 6-12% ✓

Physiological Integrity

• Basic Care and Comfort 6-12% ✓

• Pharmacological and Parenteral Therapies 12-18% ✓

• Reduction of Risk Potential 9-15% ✓

• Physiological Adaptation 11-17% ✓

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Copyright © 2018 Keith Rischer, d/b/a KeithRN.com. All Rights reserved.

History of Present Problem:

Amanda Stevens is a 26-year-old female, G1 P1, accompanied by her husband, Brad. She presented to the

maternity unit complaining of contractions every five minutes for the past three hours. She was dilated to 6 cm,

50% effaced, -2 station and admitted for labor. Brad was very supportive throughout her labor. She received an

epidural for pain control and delivered by spontaneous vaginal delivery (SVD) a baby girl 12 hours later at 39

5/7 weeks gestation. Amanda’s blood type is A+ and is Group B strep (GBS) negative.

 Baby Grace was 7 pounds 8 ounces (3.4 kg), 20 inches (50.8 cm) long with APGARS of 9 at one minute

and 9 at 5 minutes. Delayed cord clamping for one minute occurred and then she immediately went to breast

and latched with minimal assist and nursed for ten minutes. Initial newborn assessment was completed with no

abnormal findings. Her vital signs at birth were HR: 158, R: 54 T: 98.1 F/36.7 C axillary.

Personal/Social History:

Amanda and Brad have been married for two years and live 15 miles from the hospital in a small, rural

community. Brad is a security guard at a prison located 30 miles from home and Amanda is a preschool

teacher for the local preschool in her town. She will be taking eight weeks off from work before returning full

time.

 Amanda’s parents live two hours away and will be coming tomorrow to stay with Amanda for a few days

when she and the baby are discharged. Brad’s parents live out of state and will be coming to visit next month.

Amanda’s sister lives an hour away and has a toddler and has offered to help Amanda if she needs it. Amanda

and Brad just moved to their home six months ago and do not have many friends in the area.

What data from the histories are RELEVANT and must be interpreted as clinically significant by the nurse?

RELEVANT Data from Present Problem: Clinical Significance:

RELEVANT Data from Social History: Clinical Significance:

Patient Care Begins One Hour After Delivery:

What data from report is RELEVANT and must be interpreted as clinically significant by the nurse?

RELEVANT REPORT DATA: CLINICAL SIGNIFICANCE

You received shift report on Amanda and Grace and are about to go in and complete your

morning assessments. The night nurse reported Grace has not breastfed well since the initial

feeding after birth. Amanda has difficulty getting Grace to latch. Once she does latch, she only

sucks a few times and pulls off. Amanda is not able to express any colostrum. She doesn’t ask

for help with nursing and states that Grace must not be hungry. Grace has not voided since

delivery and had one small meconium stool since birth.

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