NU143CL Unit 7 Care Plan Example

Where Two Patients Meet at a Feed: A Couplet Care Plan for a Composite Mother on the First Day After a Cesarean for Breech, With Pain Rated Six, and Her Sleepy Son Who Has Fed Twice in Ten Hours

[Student Name]

Purdue University Global

NU143CL: Maternal Infant Nursing Clinical

Unit 7 Care Plan

[Instructor Name]

[Date]

The mother and newborn are composite; values are bracketed where illustrative, and medical orders are the providers'.

The Couplet

Mother: [Ms. W.], composite, 33, first baby, cesarean at [0830] yesterday for breech presentation. Pain [6] out of 10 at the incision, worse when she sits up or lifts the baby. She received an IV opioid at [0400] and is now on scheduled acetaminophen and ibuprofen with oral oxycodone as needed. Fundus firm at the umbilicus, lochia moderate. Urinary catheter removed at [0600]; she has voided once. She wants to breastfeed.

Baby: boy, [3,190] g, born at 39 weeks and 2 days. He has breastfed twice since birth, at [1000] and [1700] yesterday, each time falling asleep after a few minutes. Glucose checks were within range. Temperature [36.7] C. He is sleepy and has had one wet diaper and one meconium stool.

Where the Problems Meet

Her pain keeps her from positioning him comfortably, so feeds are short and infrequent. His sleepiness means he does not cue strongly, so feeds are not prompted. Her opioid may add to his drowsiness slightly through her milk, though small amounts at this stage are generally considered compatible with breastfeeding. Fewer feeds also mean less stimulation for her milk supply. The feed is where the two sets of problems join (Perry et al., 2022).

Treating her pain is also a feeding intervention, because a mother who can hold her baby without wincing will feed him more often.

Ranked Problems

Mother: 1. Acute pain related to the abdominal incision. 2. Risk for impaired breastfeeding related to pain and limited mobility. 3. Risk for bleeding and urinary retention after surgery, monitored routinely. Baby: 1. Ineffective feeding pattern related to sleepiness, as evidenced by two feeds in ten hours. 2. Risk for low glucose and dehydration if intake stays low.

Interventions That Serve Both

1. Time pain medicine about [30] to [45] minutes before planned feeds, so she is comfortable when he feeds; reassess pain after each dose, since scheduled non-opioid medicine with as-needed opioids gives more even control after surgery (Pasero & McCaffery, 2011).

2. Use the football hold or side-lying position, which keep the baby off her incision; place pillows to support her arm and his body.

3. Wake him for feeds at least every [three] hours: unwrap him, change his diaper, place him skin-to-skin; skin contact also helps him cue.

4. Hand expression after feeds, with the colostrum given by spoon if he feeds briefly, protecting both his intake and her supply.

5. Keep a shared log of feeds, diapers and pain doses at the bedside.

6. Help her walk to the bathroom every few hours, which supports bladder emptying and recovery and gives a natural time to wake him on her return.

Evaluation at 1600

Since [0800], he has breastfed [four] times, each for [10] to [15] minutes in the football hold, with swallowing heard; one wet diaper and one stool. Her pain before feeds was [3] to [4] after timed medicine. She voided twice. The plan continues, with the goal of eight feeds in 24 hours and a reweigh tomorrow, judged against curves for breastfed babies so a normal loss is not mistaken for failure (Flaherman et al., 2015).

Involving Her Partner

Her partner had been unsure how to help. He was shown how to bring the baby to her and position the pillows for the football hold, how to unwrap and change the baby to wake him for feeds, and how to fill in the log. When her pain made it hard to lift the baby from the bassinet, he became the person who handed him to her, which meant she did not have to twist her incision. By afternoon he was waking the baby on schedule without prompting.

Teaching for Home

Because recovery after a cesarean continues for weeks, the plan includes teaching that serves both patients at home. She is shown how to splint her incision with a pillow when coughing or getting up, told not to lift anything heavier than the baby for several weeks, and given the signs of wound infection to report. For the baby, the parents learn the expected number of feeds and diapers each day and the signs that he is not getting enough. Both patients' follow-up visits are booked for the same week, so the family makes fewer trips while she is still sore.

What the Plan Shows

Writing two separate care plans would have given her pain management and him feeding support without connecting them. The couplet plan shows that the most effective intervention for his feeding was managing her pain, and that the timing of her medicine was as important as the dose.

References

Flaherman, V. J., Schaefer, E. W., Kuzniewicz, M. W., Li, S. X., Walsh, E. M., & Paul, I. M. (2015). Early weight loss nomograms for exclusively breastfed newborns. Pediatrics, 135(1), e16-e23. https://doi.org/10.1542/peds.2014-1532

Pasero, C., & McCaffery, M. (2011). Pain assessment and pharmacologic management. Mosby.

Perry, S. E., Hockenberry, M. J., Cashion, K., Alden, K. R., Olshansky, E., & Lowdermilk, D. L. (2022). Maternal child nursing care (7th ed.). Elsevier.