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Intrapartum Nursing Care Plan

The nursing care plan addresses a patient experiencing acute pain related to labor contractions. The plan includes assessing the patient's contractions, acknowledging their pain experience, encouraging rest, teaching breathing exercises, administering pain medications, notifying the physician if pain is not controlled, advising against strenuous tasks, and allowing the patient to find a comfortable position. The overall goal is to decrease the patient's pain level from 4/10 to 1/10 within 8 hours through non-pharmacological and pharmacological interventions.

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Ella Dayanghirang
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1K views4 pages

Intrapartum Nursing Care Plan

The nursing care plan addresses a patient experiencing acute pain related to labor contractions. The plan includes assessing the patient's contractions, acknowledging their pain experience, encouraging rest, teaching breathing exercises, administering pain medications, notifying the physician if pain is not controlled, advising against strenuous tasks, and allowing the patient to find a comfortable position. The overall goal is to decrease the patient's pain level from 4/10 to 1/10 within 8 hours through non-pharmacological and pharmacological interventions.

Uploaded by

Ella Dayanghirang
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
  • Nursing Care Plan (Intra-Partum)

NURSING CARE PLAN (INTRA-PARTUM)

ASSESSMENT NURSING NEED PLANNING INTERVENTION EVALUATION


DIAGNOSIS
Subjective: “Sakit Acute pain C Within 8 hours of  Assess Patient’s Uterus for

akong puson inig related to labor O nursing intervention: contractility

mugahi” contractions R: Contractions can be


G Patient will verbalize
assessed for severity.
Objective: R: Unpleasant a decrease in the pain
N
 Acknowledge the pain
sensory and scale from 4/10 to
 Vital Signs: I GOAL MET
experience and convey
emotional 1/10.
Temp. = 35.9 C
T acceptance of client’s
experience
PR = 83 bpm response to pain.
arising from I

RR = 18 breaths/min R: Reduces defensive


actual or V
responses, promotes
BP =110/90 potential tissue
E
trust, and enhances
damage or
 Pain scale: -
cooperation with regimen.
prescribed in
4/10
terms of such
P  Encourage patient to have

adequate rest periods.


 (+) Uterine damage E R: Prevent fatigue that can

Contractions (International R impair ability to manage or

 Grimaced Association for cope with pain.


C
Face the Study of  Teach Patient proper
E
 Guarding of Pain); sudden breathing exercises to relax
P
lower mid or slow onset abdomen.

abdomen of any intensity T R: Breathing exercises aid in

(hypogastrium) from U relaxation of the abdomen to

 Pain felt upon reduce pain felt on pt.’s


Reference: A
occurrence of uterus.
Doenges, M., L
uterine  Administer prescribed
Moorhouse,
contractions. medications for pain.
M., & Murr, A.
 Patient in P R: For maintaining
(2016).
labor A “acceptable” level of pain.
Nurse’s
 6 cm cervical Notify physician
Pocket Guide: T
dilatation
Diagnoses, T
Prioritized E if regimen is inadequate to

Interventions, R meet pain control goal.

and Rationales Combinations of medications


N
(14th ed.). may be used on prescribed

Philadelphia: intervals.

F.A. Davis  Advice the mother to refrain

Company. from strenuous tasks.

R: Preventing doing

strenuous task would allow

less work needed by

abdominal muscles to reduce

contractions.

 Inform Patient that labor-pain

of is normal and it is usually

painful.
R: Patient needs to

understand that labor-pain is

normal during pregnancy.

 Allow patient to find a

comfortable position where in

pain is less than usual.

R: Proper positioning during

labor is recommended in

order to reduce pain felt and

increase comfort during labor

while preparing for delivery.

NURSING CARE PLAN (INTRA-PARTUM) ASSESSMENT NURSING DIAGNOSIS NEED PLANNING INTERVENTION EVALUATION Subjective: “Saki
 (+) Uterine Contractions  Grimaced Face  Guarding of lower mid abdomen (hypogastrium)  Pain felt upon occurrenc
Prioritized Interventions, and Rationales (14th ed.). Philadelphia: F.A. Davis Company. E R N if regimen is i
R: Patient needs to understand that labor-pain is normal during pregnancy.  Allow patient to find a comfortable position

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