CUES NURSING DIAGNOSIS GOALS/OBJECTIVES NURSING INTERVENTION EVALUATION

Subjective: Fatigue may be related to Short- term goal: Identify presence of physical and/ or physiological Patient’s sense of energy was improved
“ sobra akong napagal, di postpartum stress and anxiety To improve patient’s sense conditions. as manifested by increase in the
ko aram kung paunon ko as manifested by physical of energy by providing Assess client’s belief of what causes the fatigue. tolerability of activities.
kading akos ko. Ga di ko exhaustion and verbalization sufficient rest and health Assess the vital signs to evaluate fluid status and After the nursing intervention the
pa kayang magparaiwag. of overwhelming lack of teaching regarding cardiopulmonary response to activity. patient understood strategies regarding
Sobrang kapagalan talaga energy. postpartum care and Determine presence/ degree of sleep disturbance. postpartum care and newborn care
kan namati ko.” newborn care. Fatigue can be a consequence of, and /or that would not require much of her
Objective: exacerbated by sleep deprivation. energy.
Lack of energy Note recent developmental issues such as that of
Decreased performance new parenthood. Patient’s level of activity was increased
Long –term goal: Evaluate aspect of ‘learned helplessness’ that may without experiencing exhaustion.
To increase patient’s level be manifested by giving up. Can perpetuate a
of activity and be able to cycle of fatigue, impaired functioning and
participate in desired increased anxiety and fatigue.
activities at level of ability. Note daily energy patterns for this is helpful in
determining pattern/ timing of activity.
Establish realistic activity goals with client and
encourage forward movement.
Enhances commitment to promoting optimal
outcomes.
Plan interventions to allow individually adequate
rest period.
Instruct in methods to conserve energy such as
scheduling with the significant other the time for
sleep, time for breastfeeding and etc.
Assist client with identifying appropriate coping
techniques.
Teach client of the strategies regarding
postpartum and newborn care that would
facilitate minimum consumption of energy.
 BICOL UNIVERSITY POLANGUI CAMPUS
POLANGUI ALBAY

NURSING CARE PLAN OF POSTPARTUM MOOD DISORDERS

SUBMITTED BY:

SHERRYLYN B. SIONICIO
BSN-IV- GROUP 5B

SUBMITTED TO:

EDGAR D. SALARZON RN
CLINICAL INSTRUCTOR
 CUES NURSING DIAGNOSIS GOALS/OBJECTIVES NURSING INTERVENTIONS EVALUATION
“ Di ko maray naasikaso kading Impaired parenting may be To demonstrate appropriate Observe attachment behaviours Client develop sense of
akos ko. Pirmi n asana nagibi, di related to postpartum attachment/ parenting between parental figure and understanding regarding
ko na ngani maraman kung unu depression as manifested by behaviours. child. appropriate action to situation
kan gigibon ko idi.” statements of inability to meet To help client in the acceptance Note presence of factors in the meeting child’s needs therefore
child’s needs, verbalization of of individual situation. child (e.g birth defects, or improving behaviours regarding
Objectives: inability to control child, hyperactivity) that may affect parenting.
Child’s long nails inadequate childcare attachment and caretaking
Dirty clothings maintenance. needs.
Identify physical challenges/
limitations of the parents
(depression) that may affect
ability to care for child and
suggests individual needs for
assistance/ support.
Create an environment in which
relationship can be developed
and neads of each individuals
met.
Emphasize positive aspect of the
situation, maintaining a hopeful
attitude toward the parent’s
capabilities and potential for
improving the situation.
Acknowledge difficulty of
situations and normalcy of of
feelings to enhance the feeling of
acceptance.
Provide information appropriate
to the situation including time
management, limit setting, and
stress reduction techniques. To
facilitate satisfactory
implementation of plan/ new
behaviours.
 Postpartum Mood Disorders

THE "BABY BLUES"

 
 Occurs in 75-80% of new mothers.
 The "Baby Blues" is described as mild depression interspersed with happier feelings, or as some women state, it is "an emotional roller-coaster".
 Onset is usually 2-3 days postpartum, with a peak around 7-10 days. 
 Symptoms may include: 
o Fatigue/ Exhaustion
o Feelings of sadness
o Crying spells
o Anxiety
o Mood swings/ Irritability
o Confusion
o Feeling overwhelmed
o Inability to cope
o Oversensitivity
o Inability to sleep
o Feelings of loneliness
 Causes of the "Baby Blues":  include biological factors (drop in hormone levels), social/environmental factors (marital stress, lack of support system, low SES), stress, and
sleep deprivation, in addition to the physical aftermath of labor and delivery.
 First-time moms are at a higher risk of experiencing the "Baby Blues".
 The "Baby Blues" typically does not require professional treatment and should subside within two weeks after delivery.
 Treatments include:  validation of the existence of the phenomenon, labeling it as real but a normal adjustment reaction, assistance with self/infant care, and family
support.
 
POSTPARTUM DEPRESSION
 
 If the "Baby Blues" persist for two weeks or longer and/or if symptoms of the blues intensify, it is then considered to be a "Postpartum Depression" (PPD).
 10-20% of postpartum women will experience PPD.
 Onset of PPD can be anytime during the first year after delivery, with the highest incidence of onset between 4 and 8 weeks postpartum.
 PPD may last from 3 to 14 months or longer, if left untreated.
 Though most women recover within a year, the condition may become chronic if it goes untreated.  Chronic depression may have significant effects on mother-baby
attachment and bonding.
 Symptoms of PPD include:
 o Sadness
o Frequent crying
o Insomnia
o Appetite changes
o Difficulty concentrating/making decisions
o Feelings of worthlessness
o Racing thoughts
o Agitation and/or persistent anxiety
o Anger, fear, and/or feelings of guilt
o Obsessive thoughts of inadequacy as a person/parent
o Lack of interest in usual activities
o Lack of concern about personal appearance
o Feeling a loss of control
o Feeling disconnected from the baby
o Possible suicidal thoughts
 Although most symptoms of PPD are similar to those in a Major Depressive Disorder, many symptoms are unique to PPD, including feelings of anger, fear, or extreme
feelings of guilt, obsessive thoughts of inadequacy as a parent, extreme exhaustion yet difficulty sleeping, agitation, feelings of disconnection from the baby, and feeling
a loss of control over one's life.
 Risk factors for PPD include:  1) First-time motherhood,
2) ambivalence about keeping the pregnancy, 3) history of PPD, bipolar, or another mood disorder, 4) lack of social support, 5) lack of stable relationship with partner
and/or with parents, 6) woman's dissatisfaction with herself, 7) history of infertility, 8) unrealistic expectations of parenthood, 9) recent stressful event, 10) previous
aversive reaction to oral contraceptives or severe PMS.
 Causes of PPD include:  1) biological/ physiological factors (genetic predisposition, hormone-related, severity of physical damage from labor and delivery), 2)
environmental factors (stress, feeling alone, lack of support),
3) psychological factors (things that affect a woman's self-esteem and the way she copes with stress), or 4) infant-related factors (infants with difficult temperament or
colic, infants born with problems).  **Most likely it is a combination of all of these**.
 Treatments include:  1) individual and/or couple's therapy, 2) group therapy or support groups, 3) psychotropic medications,
4) practical assistance with child care/ other demands of daily life.
 If a woman experiences PPD, her chances of PPD with subsequent children are 10-50%.
 
POSTPARTUM ANXIETY DISORDERS
 
 Postpartum Anxiety Disorders are common, yet are diagnosed far less than the others because of the belief that new mothers are just naturally anxious.
 There are two forms of Postpartum Anxiety Disorders.
  
Postpartum Panic Disorder
 Occurs in up to 10% of postpartum women.
 Symptoms include:  feelings of extreme anxiety and recurring panic attacks, including shortness of breath, chest pain, heart palpitations, agitation, and excessive worry
or fears.
 Three common fears experienced by women with a Postpartum Panic Disorder are:  1) fear of dying, 2) fear of losing control, and/or 3) fear that one is going crazy.
 2 significant risk factors:  1) a previous history of anxiety or panic disorder, and 2) thyroid dysfunction.
 
Postpartum Obsessive-Compulsive Disorder
 Occurs in approximately 3-5% of childbearing women.
 Symptoms include:  presence of both repetitive obsessions (intrusive and persistent thoughts or mental images) and compulsions (repetitive behaviors performed with
the intention of reducing the obsessions), as well as a sense of horror about these thoughts.
 The most common obsession is thoughts or mental images of harming or even killing one's own baby.  The most frequent compulsion is bathing the baby often or
changing the child's clothes.
 Postpartum Obsessive-Compulsive Disorder is the most under-reported and under-treated disorder of childbirth, since these symptoms are horrifying or embarrassing to
the mother and she may fear that others will think she is a risk to her child.
 It is important to note  that, unlike Postpartum Psychosis, these mothers know their thoughts are bizarre and are highly unlikely to ever indulge in the imagined
behaviors.
 Risk factors include:  history of Obsessive-Compulsive Disorder and/ or negative feelings about motherhood resulting from unrealistic expectations.
 Treatments for both Postpartum Panic and Obsessive-Compulsive Disorders include:   1) individual therapy (cognitive-behavioral is recommended) with, 2) psychotropic
medications, also 3) couple's therapy, 4) group therapy/ support group, and 5) practical assistance with child care and/or demands of life.
 
POSTPARTUM PSYCHOSIS
 
 Occurs in 1-2 of every 1,000 births
 Onset is usually within the first two weeks- three months
 Symptoms include: 
o Acute onset of psychotic symptoms including
o Delusions and/or hallucinations
o Extreme agitation
o Hyperactivity
o Insomnia
o Mood lability
o Confusion/ Poor judgment
 o Irrationality
o Difficulty remembering/concentrating
 Risk Factors include:  1) previous postpartum psychosis, 2) manic-depressive (bipolar) history, 3) prenatal stressors (lack of supportive partner, social support, low
socioeconomic status), 4) obsessive personality traits, 5) family history of mood disorder.
 Treatments include:  1) hospitalization with 2) antipsychotic medication (lithium, when indicated) and 3) temporary removal of infant from mother's care, also     4)
sedatives, 5) electroconvulsive therapy, 6) psychotherapy, and 7) social support.
 There is a 10% rate of suicide/infanticide associated with this disorder.  Thus, immediate treatment is imperative.
 Women are 20-30 times more likely to be hospitalized for a psychotic episode in the first 30 days after delivery than at any other time in their life.
 Women with a history of bipolar illness have a 40% chance of developing Postpartum Psychosis after their first child is born.
 Almost all women with previous episodes of Postpartum Psychosis will experience repeat episodes in subsequent pregnancies.  Preparing for this ahead of time is key.