College

We appreciate your visit to Marcia is a 28 year old gravida 1 para 1 who had a spontaneous vaginal delivery 3 hours ago and has now arrived at her. This page offers clear insights and highlights the essential aspects of the topic. Our goal is to provide a helpful and engaging learning experience. Explore the content and find the answers you need!

Marcia is a 28-year-old gravida 1, para 1 who had a spontaneous vaginal delivery 3 hours ago and has now arrived at her postpartum room.

**Medical Surgical History:** Negative

**Family History:** Negative

**Social History:** Married, 8th-grade teacher, no history of depression, no history of substance abuse or domestic violence, planned and desired pregnancy

**Prenatal History:** Normal, no complications

**Prenatal Laboratory Work:**
- Group B streptococcus: negative
- Blood type: O negative; received RhoGAM at 28 weeks’ gestation
- Pap test: normal
- Testing for gonorrhea and Chlamydia: negative
- Human immunodeficiency virus: negative
- Hepatitis B: negative
- No anemia or gestational diabetes
- Non-immune to rubella; immune to varicella

**Labor and Delivery Course:**
- 14 hours of labor; epidural anesthesia used
- Membranes ruptured for 6 hours, clear fluid
- Normal spontaneous vaginal delivery of 9-pound infant girl
- Apgar score: 9 and 9
- Mother with third-degree perineal laceration repaired
- Estimated blood loss at delivery: 350 cc

**Current Vital Signs:**
- Temperature: 100.2° F
- Pulse: 100 bpm
- Respirations: 20 breaths/min

---

1. What aspects of Marcia’s history and vital signs are most significant at this time?

2. How should the nurse address her vital signs at this time?

3. How should Marcia be taught to care for the third-degree perineal laceration during her hospital stay?

4. Marcia is very tired, and after one successful nursing event of her infant, she requests that the nurse watch the infant for a while. She is not interested in learning infant care or self-care at this time. She does not want to get up to try and void and requests a bedpan instead. How should the nurse respond?

5. Before discharge, Marcia’s physician has ordered an influenza vaccine and a tetanus, diphtheria, and pertussis (Tdap) vaccine. What are the purposes of these vaccines?

6. What RN intervention and teaching is required for Marcia’s rubella result?

Answer :

Marcia's post-delivery care includes monitoring her vital signs for infection, managing her third-degree perineal laceration, and administering flu and Tdap vaccines. Encourage gradual self-care and infant care despite her fatigue. Address her non-immunity to rubella with education and vaccination.

Let's address each point of Marcia's situation systematically:

1. Significant Aspects of Marcia's History and Vital Signs

  • The most significant aspects include her third-degree perineal laceration, her blood type being O negative, and her slightly elevated temperature of 100.2°F. Additionally, her pulse of 100 bpm is higher than average, which is typical post-delivery but needs monitoring.

2. Addressing Vital Signs

  • The nurse should monitor Marcia’s temperature for any increase, indicating potential infection, and keep an eye on her pulse and blood pressure. Ensure that she remains hydrated and assess for any signs of postpartum hemorrhage.

3. Care for Perineal Laceration

  • Marcia should be instructed to keep the area clean and dry, use a squirt bottle with warm water to cleanse the area after using the restroom, and avoid strenuous activity. Cold packs can help reduce swelling, and pain relief can be managed through prescribed medication.

4. Responding to Marcia's Requests

  • The nurse should acknowledge her fatigue and arrange for a brief rest, but encourage her to engage in self-care activities like voiding in the restroom to prevent complications like urinary retention. Gradually encourage her participation in infant care and self-care once she feels more rested.

5. Purpose of Vaccines

  • The influenza vaccine helps protect against the flu, which can be particularly risky postpartum due to a weakened immune system. The Tdap vaccine protects against tetanus, diphtheria, and pertussis (whooping cough) – crucial to protect both Marcia and her newborn.

6. Rubella Result Intervention and Teaching

  • Marcia needs to be educated about her non-immunity to rubella and the importance of receiving the MMR vaccine before hospital discharge to protect future pregnancies.

Thanks for taking the time to read Marcia is a 28 year old gravida 1 para 1 who had a spontaneous vaginal delivery 3 hours ago and has now arrived at her. We hope the insights shared have been valuable and enhanced your understanding of the topic. Don�t hesitate to browse our website for more informative and engaging content!

Rewritten by : Barada