N331 Obstetric Clinical Case Study

Purpose of the Assignment

This activity enables the student to conduct an in-depth assessment of a childbearing woman and
her family and plan nursing care specific to that client, based on nursing research and AWHONN
Standards of Care. The assessment will include the physiologic, psychologic, social, cultural,
and environmental influences pertaining to the client and her family.
Student Approach to Assignment
The clinical case study allowed for the opportunity to assess and provide care for an
entire family. This mother was chosen to be interviewed for the case study because she did not
have a planned or normal delivery. Through the interview with both parents, I was able to
understand how the mother and infants condition affected the entire family.
Reason for Inclusion of the Assignment in the Portfolio

Critical Thinking
o Uses decision-making skills in making clinical or professional judgments
Ex. As discussed in the Case Study, the RN and I were able to determine
the mothers level of anxiety regarding being discharged and breastfeeding
her daughter. Based on this information it was arranged for the mother to
have a courtesy stay so she could be with her infant, who would remain
hospitalized because of high levels of bilirubin. We were also able to set
up a lactation consultation to promote her decision to breastfeed.
Nursing Practice
o Applies appropriate knowledge of major health problems to guide nursing
practice
Ex. Knowledge about intrauterine growth restriction guided my nursing
practice because it provided information as to why an emergency cesarean
section was done preterm. Knowing how this affected the infants growth
and development in utero lead to understanding to why she had difficulties
latching onto the breast.
o Establishes and/or utilizes outcome measures to evaluate to effectiveness of care
Ex. The three nursing diagnoses that are discussed include interventions
and outcomes of the interventions. By evaluating the interventions
performed, I was able to determine if they were successful or if changes
needed to be made to resolve the diagnoses.
Communication
o Uses therapeutic communication within the nurse-patient relationship
Ex. Therapeutic communication was accomplished and demonstrated in
the case study because all of the information was obtained from the
mother. By asking so many questions, I was able to openly discuss her

fears of having a hospitalized, premature infant and how that affected her
ability to breastfeed.
o Accesses and utilizes data and information from a wide range of sources to
enhance patient and professional communication
Ex. The information collected for the case study was obtained directly
from the patient, from her medical records and through discussion with
other medical professionals. Data collected was then used to determine the
plan of care which was then communicated to both parents.
Teaching
o Provides teaching to patients and/or professionals about health care procedures
and technologies in preparation for and following nursing or medical
interventions
Ex. Education regarding breastfeeding techniques and the Supplemental
Nursing System were available to the parents. This was important because
the infant had difficulties latching, and staying latched, onto the breast.
With proper technique, such as different holds, and the use of the
Supplemental Nursing System, the infant was able to successfully nurse
and receive adequate calories.
o Provides relevant and sensitive health education information and counseling to
patients, and families, in a variety of situations and settings
Ex. Health education on intrauterine growth restriction was quickly
provided to the parents on admission, but during the interview, I was able
to better explain the need for an emergency cesarean section and how
preterm birth affected the infant.
Research
o Shares research findings with colleagues
Ex. Research articles presented in the case study discussed the benefits of
using Doppler sonography to detect intrauterine growth restriction and the
weight differences of infants with intrauterine growth restriction.
Relativity to the patient and her daughter was discussed in addition to the
research findings.
Culture
o Articulates an understanding of how human behavior is affected by culture, race,
religion, gender, lifestyle and age
Ex. The decision to breastfeed her child was affected by her own belief of
health and her lifestyle of being a stay at home mother. Being a younger
mother of 24 years, she has not had time in her life to build a substantial
savings account and living only on her husbands income she
acknowledged that breastfeeding would be beneficial to her family.
o Demonstrates sensitivity to personal and cultural definitions of health, and how
these beliefs influence an individuals reactions to the illness experience and end
of life

Ex. The early and unexpected delivery of the infant affected the parents
because they did not anticipate having a preterm child. Bonding was
demonstrated between the parents and infant, but the mother kept
repeating how all of her family has had bigger children and that she had
thought bigger babies looked healthier. Answering questions and
providing information about their daughters health eased some of the
parents concerns. Sensitivity to how the hospitalization affected the
family as a whole was demonstrated by listening and addressing their
concerns.