Case Study 1

Running head: MATERNAL AND NEWBORN CASE STUDY

Maternal and Newborn Case Study

Erin Border & Mariah Maul

Kent State University College of Nursing Spring 2010

Case Study 2
 Case Study 3

Patient Profile

C.R. is a confident, 5 feet and 9 inches tall, ABO B+, 24-year-old Caucasian female patient:

gravida 1(any pregnancy, regardless of duration), para 1(any birth after 20 weeks, dead or alive),

LMP (last menstrual period) is June 28, 2009, EDB (estimated date of birth) is April 2, 2010 and

gestation of 396/7 weeks confirmed by an ultrasound per chart. Pre-pregnancy weight was 244 lbs

and pregnancy weight is 256 lbs for a total gain of 12pounds. C.R. BMI was 36% and she was

considered obese before her pregnancy started so her recommended weight gain is 15-25lbs,

which she did not meet. She was also diagnosed with pregnancy induced

hypertension/preeclampsia (high blood pressure). She also socially drinks alcohol, but she had no

alcohol while pregnant, and she has never smoked cigarettes or took recreational drugs. She was

considered GBS + and was treated three times with Penicillin. C.R. was admitted to Aultman

after she started to go into labor on April 6, 2010. C.R plans on breastfeeding her son for at least

1 year. She is allergic to Pertussis. Significant medical history includes kidney surgery in 1989,

and L knee surgery in 1999.Significant family medical history hypertension, heart disease, and

the father’s brother was born with a hole in his heart. C.R. has a supportive, caring, and

protective boyfriend (who has a three year old boy, as well as this new baby) was at bedside

throughout the labor and delivery.

IV Lactated Ringers 1000 mL at 50 mL/hr and external fetal monitoring was initiated shortly

after admission. Throughout the labor phases, there were several accelerations, but no late

decelerations of the FHR per chart. C.R. was placed on continuous epidural of Fentanyl, 0.2%

and 0.25% Marcaine at 14 mL/hr for pain at 4 cm dilation. Her first stage of labor lasted 10hours

and 24minutes.An AROM [(Artificial Rupture of the Membranes /Amniotomy where the

physician inserts an instrument like a crochet hook through the cervix, and snags and breaks the
 Case Study 4

amniotic sac (Davidson, London, Ladewig 2008).]AROM was performed at 1645hrs resulting in

clear amniotic fluid and negative meconium stain. A 2° laceration occurred before a spontaneous

vaginal delivery. A healthy male neonate was delivered at 1810hrs on April 6, 2010: birth weight

7lbs.2oz (3231.9g) and the neonate had the cord wrapped around his neck and body. Her second

stage of labor lasted 1hour and 25minutes. They then took the neonate’s APGAR score (The

APGAR is a score based on five vital areas of newborn health, heart rate, respiration, muscle,

tone, response to stimulation, and color receiving a score from 0-2 in each category. This is used

to quickly assess the health of an infant one minute and five minutes after birth. These score

measures how well the newborn tolerated the birthing process, and how well the newborn is

adapting to the environment. A score of seven to 10 is normal and indicates your newborn is in

good condition. (Davidson, London, Ladewig 2008)His APGAR scores where 7 at 1 minute after

birth and 9 minutes after birth. The umbilical cord had 2 arteries and 1 vein. Not all of the

placental tissue was expelled, and if tissue is left behind, excess bleeding can result, perhaps

even life-threatening hemorrhaging. PPH, postpartum hemorrhage “can be caused from uterine

atony, lower genital tract lacerations, uterine rupture, or inversion, retained products of

conception and underlying coagulopathy are some common causes PPH”, (Lee, Kim, et al).

Ultrasound, CT scan, or MRI can diagnose PPH. In this case, the doctor ordered to remove any

remaining tissue with a D&C through ultrasound imaging. A D&C (dilation and curettage)

involves expanding or enlarging the entrance of a woman's uterus so that a thin, sharp instrument

can scrape or suction away the lining of the uterus (Taber’s Cyclopedic Medical

Dictionary).After the D&C was complete that ended her third stage of labor which was a total of

1hour and 45minutes.

 Case Study 5

The mother and newborn bonded very well after birth per chart. C.R.’s IV in her left hand

was discontinued per orders. The parents refused the PKU testing “it test for congenital,

autosomal recessive disease marked by the failure to metabolize the amino acid phenylalanine to

tyrosine, and results in severe neurological deficits in infancy if it is unrecognized or

untreated(Taber’s Cyclopedic Medical Dictionary ), erythromycin eye ointment which is a

prophylactic eye treatment for the bacteria N. gonorrhea in the newborn(Davidson, London,

Ladewig 2008),the Vitamin K injection which is a prophylactic injection given the day of birth to

combat potential clinical bleeding problems due to the absence of the normal gut bacterial

flora(Davidson, London, Ladewig 2008). , and the hearing test to be conducted, and they signed

the all the refusal forms. According to the night RN, a few of their family members came in,

and the mother-in-law came to visit in the afternoon to bring in the boyfriend’s other son.

Patient’s Birthing Plan per C.R

 No Vitamin K Hep B vaccine. TDap vaccine, no eye drops of any kind, no newborn

screening tests, and no invasive procedures.

 Mag-Sulfate IV only if Blood pressure continues to rise.

 Baby is to be place on mom’s chest right after delivery.

 The cord is not to be clamped or cut until the placenta shuts down.

 No episiotomy, Dad can use warm compresses and olive oil to stretch perineum.

 Baby is to stay in mom’s room at all times.

Prenatal care record

Date of exam Gestational Fetal heart Fetal Blood Weight Fundal

age rate movement pressure height
 Case Study 6

09-28-09 12.1 162 Little 128/66 244

10-23-09 16.5 140 Flutters 162/82 243 17cm
11-20-09 20.4 142 Yes 156/80 246 20cm
12-04-09 22.4 136 Yes 160/86 244 18cm
12-18-09 24.6 136 Yes 160/88 240 26cm
01-08-10 27.5 136 Yes 158/80 243 28cm
01-15-10 28.6 133 Yes 118/68 244 29cm
02-05-10 32 138 Yes 132/70 242 33cm
02-19-10 33.6 140 Yes 130/70 248 33cm
02-26-10 34.6 142 Yes 134/72 249 34cm
03-05-10 35.5 140 Yes 128/72 251 36cm
03-19-10 37.6 140 Yes 182/90 253 37cm
03-25-10 38.5 138 Yes 140/78 254
03-29-10 39.2 134 Yes 160/90

Prenatal Medications

Medication Indications for use Dose, route Nursing Side Effects

Responsibilities
(Generic /
Trade)
Treatment of various allergic PO–(12.5-25mg Assess blood Confusion,
conditions and motion q4hr as needed) pressure, pulse disorientation,
Promethazine sickness, preoperative respirations. Assess dizziness,
(Phenergan) sedation, level of sedation & neuroleptic
treatment/prevention of respiratory malignant
nausea and vomiting. depression. monitor syndrome
for extrapyramidal
side effects

Aldomet Management of moderate to PO-(250-500mg Monitor blood Sedation,

severe hypotension 2-3 times daily) pressure, pulse, myocarditis,
not to exceed I&O, edema, bradycardia,
500mg day if depression, depression,
used with other alterations in mental nasal stuffiness,
agents status. Temperature fever
 Case Study 7

Prenatal A daily Multivitamin PO-( one tab Labs need to be discoloration of

vitamins formulated to decrease daily) monitored to make the urine, GI
nutritional deficiencies in the sure there is not upset, nausea &
mother’s diet. Prenatal toxicity or vomiting
vitamins have an increased overdose. Also
dose of folic acid to decrease encourage pt to take
the incidence of spina bifida. daily and explain the
importance of
compliance and the
effects on the fetus
without good
prenatal care.

Labetalol Management of hypertension PO-(100mg Monitor blood Fatigue,

twice a day) pressure, pulse, weakness,
orthostatic arrhythmias,
hypotension, bradycardia,
Monitor I&O, CHF,
fatigue, Lung sounds Orthostatic
hypotension

(*Medication information from: Davis’s Drug Guide for Nurses)

Diagnostic Laboratory - Admission

Test Normal Pregnant Values On Admission

Type & Rh B+

*Hematocrit 32% - 42% 36.4%

*Hemoglobin 10-14 g/dL 12.8 g/dL

VDRL/RPR Negative Refused

Chlamydia/Gonorrhea Negative Refused

*1 Hour Glucose Tolerance <140 mg/dL 110 mg/dL

 Case Study 8

PAP test Normal Refused

Hepatitis B Negative Negative

HIV Screen Negative Negative

Group B Strep Negative Positive and was treated

Rubella Immune Immune

Triple Screen Normal Refused

24-hour diet recall

Breakfast when she eats in the morning would be coffee, maybe some orange juice, eggs,

bacon and toast. Lunch is normally on the run and she would have a hamburger, french fries, and

a diet coke from Wendy’s. Dinner would be chili, a salad, and dinner rolls with a diet coke.

Snacks could consist of anything from crackers, cookies, chips, ice cream chocolate, and a diet

coke. Her poor diet and lack of exercise probably contribute to her being obese.

Postpartum assessment of the mother

Prior to my 0800 assessment, the mother was gazing, smiling, and talking softly to her

newborn and seemed slightly reluctant to give the newborn to the father in order for me to

perform an assessment. The father looked tired as he held the newborn closely and fondly. The

father smiled at his son when he opened his eyes and excitedly informed his wife. The patient’s

vital signs were WNL: oral temperature 36.5°C apical pulse 70, respirations 20, and blood

pressure 120/52, pain 4/10, but she refused any pain medications. Lung sounds were clear
 Case Study 9

bilaterally. The trachea was midline, respirations regular, and there was no use of accessory

muscles. Heart sounds were regular and there were no murmurs heard. Pedal pulses were 2+

bilaterally and cap refill <3 seconds. Skin was slightly pale, warm, and dry. +1 Edema in the

lower extremities bilaterally. The patient has refused her TDap vaccination.

BUBBLE-HEB: Is an acronym used to assess postpartum women. (Breast, Uterus, Bladder,

Bowel, Lochia, Episiotomy (laceration), Holman’s, Emotions, Bonding)

 Breasts are semi-soft, non-tender without any erythema (redness) or areas of increased

warmth. Nipples are not cracked and nontender. C.R. stated that she was having

difficulties breast feeding, and she was unsure if he son was receiving enough nutrition.

“I don’t think that he is latching on properly and he spits up afterwards.”

 The Fundus (uterus) of the uterus is firm, midline, and located 1 finger breadths below

the umbilicus. Facial grimacing and furrowed brows occur upon brief, gentle palpation of

fundus.

 Bladder non-distended, voiding adequately without concerns.

 Abdomen is soft, non-tender, rounded and bowel sounds active in all four quadrants. C.R.

last Bowel movement was April 1, 2010 per patient.

 Lochia, the puerperal discharge of blood, mucus, and tissue from the uterus (Taber’s

Cyclopedic Medical Dictionary), was rubra (red) and scant, without clots or odor.

 2° Laceration was intact without erythema (redness) or edema. The laceration site should

remain free from drainage, edema, pain, and heat as well as remain well approximated

throughout the healing process. The laceration is assessed using an evaluation tool

REEDA. Which stands for R-Redness; E-Edema (swelling); E-(bruising); D-Discharge;

A-Approximation (Calvert, S., Fleming, V. 2000) There were no visible hemorrhoids.

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 Homan’s (the physical finding suggestive of venous thrombosis of the veins of the calf,

(Taber’s Cyclopedic Medical Dictionary) sign was negative bilaterally.

 C.R’s Emotional issues are her deep desire to control her environment and the

importance of adhering to her well-researched birthing plan.

 The patient was Bonding very well to her newborn and enjoys watching her husband

bond with their newborn too.

Achievement of Erikson’s Developmental Tasks

Intimacy vs. Isolation [18-40 yrs]: C.R. was glowing in the wonder of her first newborn and
handled her son with such care, concern, protection, and love. She held him close and softly
talked to him as she caressed his back and rocked him slowly. The newborn reacted and made
eye contact with his mother. C.R. and the father admired their newborn together as a couple. The
patient stated that she was going to call her mother to come to the hospital this afternoon in order
for her husband to finally go and get his other child. (Craven & Hirnle, 2009).

Postpartum medications

Medication Indications for Dose, route Nursing Side Effects

use Responsibilities
(Generic / Trade)
SCHEDULED MEDICATIONS
Folic acid Vitamin PO-( Assess for fatigue, Rashes, fever,
( Folvite) 0.4mg/day) weakness, dyspnea. irritability,
Monitor Hct, Hgb, sleeping, confusion
folic acids
Ferrous Sulfate Antianemics / PO-(2- Assess diet, Bowel Nausea,
Iron supplement 3mg/kg/day) function. Monitor Hct, constipation, dark
Hgb. Take tablet with stools, epigastric
a full glass of water pain
Avoid use of antacids,
coffee, tea, dairy
products, eggs or
whole grain breads
within 1 hr of
administration because
these decrease iron
 Case Study 11

absorption

Antidote:
DEFEROXAMINE
Ascorbic Acid Treatment/ PO- Assess for vitamin C Drowsiness,
prevention of (500mg/day) deficiency( faulty fatigue, headache,
vitamin C bone /tooth insomnia, flushing,
deficiency, development, cramps, nausea,
Supplement gingivitis, bleeding diarrhea
therapy , and gums, loosened teeth)
states of
increased
requirements
Mefoxin Treatment of IVPB-( 2g 30- Monitor VS Diarrhea, rashes,
(cefoxitin) infections and 60min before Appearance of wound, nausea, vomiting,
perioperative the procedure sputum, urine, WBC phlebitis at IV site,
prophylaxis then 2g every Monitor for seizures
6hr for up anaphylaxis
24hr)
Bisacodyl Laxative/treatme RS- (10mg Watch for Abd Abd cramps,
nt of single dose) distention, BS, Bowel nausea, diarrhea,
Constipation function. Assess color, rectal burning,
consistency, amount, hypokalemia,
stool muscle weakness
PRN MEDICATIONS
Propoxyphene Decrease PO-(100mg Assess type, location, Abd pain,
Napsylate mild/moderate q4h PRN not intensity of pain constipation,
(Darvocet -N100) pain to exceed before and after, physical
600mg/day) assess HR, B RR, dependence, rash,
bowel sounds blurred vision ,
sedation, headache,
nausea, weakness,
dizziness, rash
Relieves mild PO (325- Asses type, location, Hepatic failure,
Acetaminophen pain and fever 650mg q4-6hr intensity of pain Hepatotoxicity,
PRN) up to 4g) before and after, fever, renal failure,
Admin w/ full glass of neutropenia,
water leukopenia, rash
Ibuprofen Decrease PO-(400- Asses type, location, Headaches,
(Motrin 650mg) mild/moderate 800mg 3-4 intensity of pain dizziness,
pain, times daily) before and after, fever, drowsiness, psychic
Dysmenorrhea, (up to Admin w/ full glass of disturbances,
inflammatory 3600mg/day) water and remain edema,
disorders, upright for 15-30 min constipation,
decreasing fever after. dyspepsia, nausea,
 Case Study 12

Co-administration vomiting, Abd

with opoid analgesics discomfort,
may have additive amblyopia, renal
analgesic effects and failure
may permit lower
opioid doses.
Benzocaine topical Relief of pruritus Topical used as Asses type, location, Burning, edema,
(Americaine) or pain needed intensity of pain irritation, stinging,
associated with before and a few tenderness,
minor skin minutes after. Assess urticaria.
disorders integrity of involved
including burns, skin
abrasions,
bruises, insect
stings/bites,
dermatitis,
hemorrhoids, or
other forms of
skin irritation.
Glycerin-witch Witch hazel has Topical Pad Advise to take as Contact your doctor
hazel topical been used to directed and to notify if you experience
(Tucks 50%) relieve swelling, their doctor if they are any unpleasant
bleeding, itching, experiencing any side effects while using
minor pain, and effects. this product. A very
discomfort serious allergic
caused by minor reaction to this
skin irritations product is rare
and
hemorrhoids.
Hydrocortisone Management of Rectal Assess skin before and Burning, edema,
topical (Anusol- inflammation suppository( 1- after. Notify DR of irritation, stinging,
HC 25mg) and pruritis 4 times a day) symptoms of infection tenderness, dryness,
associated with hypersensitivity
various reactions, irritation
allergic/immunol
ogic skin
problems
Hydrocortisone- Management of Rectal foam( Advise to clean area Burning, edema,
pramoxine inflammation 1-4 times a before use and wash irritation, stinging,
(Epiform) and pruritis, day) hands immediately tenderness, dryness,
hemorrhoids, or after hypersensitivity
other forms of reactions, irritation
skin irritation
(*Medication information from: Davis’s Drug Guide for Nurses)
 Case Study 13

Postpartum Lab Results

Lab Test Result 1 Normal Interpretation

Range
5,000-10,000 ↑ d/t infection, inflammation response,
WBC ↑13.91 pre- emotional stress.
pregnancy;
25,000-
30,000
during
pregnancy

RBC 2.39

d/t blood loss during labor.

Hgb 7.8 Female- 4.2-
5.4 mil/mm³
d/t blood loss during labor.
Hct 22% F- 38-47%

Glucose 118 70-120 ↑ d/t illness, stress, pregnancy.

Lymphocytes 10.8 14-16 ↓ d/t blood loss during delivery.

Neutrophile 11.8 5-19 ↑

Absolute

Neutrophile 79.8 5-19 ↑

Protein 4.4 80-213 ↓
Albumin 2.7 80-213 ↓
mg/dL
(* Laboratory values are from Clinical Handbook for Maternal-newborn nursing & women’s

health care (8th ed.) p. 389.)

Lab Results: Neutrophilia observed during labor and early postpartum is caused by the

physiologic response to the stress of labor and delivery (Davidson,London, Ladewig 2008).

Lymphopenia - Low hemoglobin and hematocrit (H&H) can reflect the condition of physiologic

or relative anemia due to blood loss during delivery (Davidson,London, Ladewig 2008).
 Case Study 14

Hyperglycemia can result from being pregnant (slight elevation) (Davidson, London, Ladewig

2008).

Physiological Nursing Care Plan – Maternal

Nursing Impaired comfort related to laceration of the perineum and trauma during labor and
Diagnosis: delivery. AEB…
Supporting D&C (dilation and curettage) - 4/10 pain - +1 Edema in the lower extremities
Data bilaterally - 2° laceration
Short-term The patient will report an increase in comfort by the end of my clinical day
Goal:
Long-term The patient will experience no discomfort by her 6 week check-up.
Goal
Interventions 1. Intervention: Assess pain location and intensity using a pain scale from
and Rationales 1(mild)-10(severe). And monitor for nonverbal signs of pain (facial
grimacing and agitation) every two hours.

Rationale: Assessing the need for pain management and evaluates the
interventions already implemented (Davidson, London, & Ladewig, 2008 p.
1170).

2. Intervention: Teach patient proper technique of using the “Peri-bottle”(

squirt bottle filled with warm water, squirted over perineum following
elimination) and encourage her to use it daily after elimination and when
there is mild perineum irritation.

Rationale: Cleaning the perineum will help decrease the risk of infection
and will help promote comfort (Davidson, London, & Ladewig, 2008,
p.1078).

3. Intervention: Instruct patient to request pain medication before the pain is

severe, as needed.

Rationale: It is easier to control the pain at a lower intensity. A more

intense pain will equal a higher dose of medicine and a longer reaction time
(Davidson, London, & Ladewig, 2008, p.1170).

4. Intervention: Reposition client, reduce stimuli, and offer comfort measures,

e.g., back rubs, massages. Encourage use of breathing and relaxation
techniques and distraction as needed.

Rationale: Relaxes muscles, and redirects attention away from painful

sensations. Promotes comfort, and reduces unpleasant distractions,
 Case Study 15

enhancing sense of well-being (Davidson, London, & Ladewig, 2008,

p.1170).

5. Intervention: I-Encourage early ambulation, use of rocking chair or left

side-lying position as appropriate

Rationale:-Decreases gas formation and promotes peristalsis to relieve

discomfort of gas accumulation. (Davidson, London, & Ladewig, 2008,
p.1170).

Evaluation of By the end of my shift the patient reported a pain level of 2 on the 1-10 pain scale.
Goal: Patient will continue using squirt bottle, and relaxation techniques, at home. Patient
was up in the room and reported a decrease in her discomfort. Her long term goal
will be evaluated at her 6 weeks check up.

Neonatal Assessment

When I did my assessment of the neonate he was only 13hours and 50minutes old. The

patient’s vital signs were WNL: oral temperature 36.9°C apical pulse 146/regular, respirations

were 38/ irregular and there was no use of accessory muscles. He had a normal cry. Skin was

pink and dry. His head was round and symmetrical. He had small centimeter long lacerations on

his head from where the doctor hit him with the instrument to AROM. Fontanels were both soft

and level. Rooting reflex was present. Symmetrical movement of all facial features noted. Ears

were at same level and had good recoil. Nostrils were patent and equal in size. Cheeks were full.

Lips were equal on both sides of midline. Chin recedes when compared to other bones of

face and makes facial grimaces. Eyes were bright and clear, and evenly placed. The mouth was

moist and pink. Suck reflex was present and poor. Clavicles were straight and intact on both

sides. Moro reflex was present. Chest expansion and retraction was equal bilaterally, and
 Case Study 16

unlabored. Lung sounds were clear to auscultation anterior and posterior. Bowel sounds were

active in all quadrants. Abdomen was soft and not distended. Umbilical Cord was drying and

cord care was done and demonstrated to the parents. Penis was slender with urethral meatus at

tip of penis, and testes were descended. He moved all exterminates, and had one wet diaper and

one diaper containing dark brown, soft stool.

Diagnostic & Laboratory: Newborn

Laboratory Test Date Norms Findings

* Glucose Test 04-06-2010 45-96 mg/dL 51 mg/dL

* Hematocrit 04-06-2010 43-63% 48%

* Hemoglobin 04-06-2010 14-20 g/dL 19 g/dL

Bilirubin 04-06-2010 < 15 mg/dL 6 mg/dL

*Laboratory Values from Clinical Handbook for Maternal-newborn nursing & women’s health
care (8th ed.) p. 390.

Nutritional Nursing Care Plan – Newborn

Nursing Risk for Altered Nutrition, less than body requirements related to inability to
Diagnosis: correctly latch on and transfer milk and regurgitation.

Supporting Uncoordinated suck and swallow reflex. - Regurgitation, -C.R. stated “that she
Data was having difficulties breast feeding, and she was unsure if he son was receiving
enough nutrition. I don’t think that he is latching on properly and he spits up
afterwards”
Short-term The newborn will ingest 90ml by the end of my clinical day.
Goal:
Long-term Goal The newborn will gain approximately 5 ounces by his first week check-up.

Interventions 1. Intervention: Arrange for the mother to meet with a lactation consultant
and Rationales about breastfeeding concerns and complications as needed.

Rationale: A lactation consultant has greater understanding of what to

expect when breastfeeding and problems that may arise can help increase
 Case Study 17

the likelihood of continued success. (Davidson, London, & Ladewig, 2008

p. 1124).

2. Intervention: Monitor weight and document daily, and provide education

to the parents on how to do these themselves. As needed

Rationale: Monitoring identifies abnormalities in weight gain/ weight loss

and allows for early intervention (Davidson, London, & Ladewig, 2008,
p.971). The nurse can recommend to the parents to track the progress of
weight gain or loss to ensure adequate nutrition is received by the
newborn. (Davidson, London, & Ladewig, 2008, p. 1122).

3. Intervention: Position infant on right side after all feedings. As needed

Rationale: Positioning the newborn on the right side prevents

regurgitation, and promotes gastric emptying (Davidson, London, &
Ladewig, 2008, p. 971).

4. Intervention: Have mom pump breast milk and supplement with formula
to ensure an adequate feeding as needed.

Rationale: Supplementation will assist in ensuring that the infant is

receiving adequate nutrition (Alahuhta, S.; Valanne, J.; Volmanen,
P.2004)

5. Intervention: Offer pacifier between feeding three times per shift.

Rationale: Nonnutritive sucking allows for sucking practice (Davidson,

London, & Ladewig, 2008, p.971).

.
Evaluation of By the end of my clinical day the newborn was having more success with latching
Goal: and sucking. His intake was a total of 60ml, but the goal was not met. The
interventions where working and we can try to met the goal next shift. The intake
will need to be increased daily as the newborn grows and requires more. The
mother and father stated that they understood that breastfeeding occurs on demand
and that as long as the baby is receiving adequate nutrition the breast feeding will
come. The parents will continue to monitor the infant’s weight upon discharge
and notify the physician if they have any further problems.
 Case Study 18

References

Alahuhta, S.; Valanne, J.; Volmanen, P.(2004), Breast-feeding problems after epidural
analgesia for labour: a retrospective cohort study of pain, obstetrical procedures and
breast-feeding practices International Journal of Obstetric Anesthesia, 13(1), p. 25-29

Calvert, S.;Fleming, V.(2000). Minimizing postpartum pain: a review of research

pertaining to perineal care in childbearing women. Journal of Advanced Nursing, 32(2),
p407-415.

Chuwa E.W.L., Hong, G.S., Tan Y.Y., & Wong C.M.Y.,(2009) MRSA Breast Abscesses
in Postpartum Women Asian Journal of Surgery 32(1) p 55-58.

Craven, R. F., & Hirnle, C. J. (2009). Fundamentals of Nursing. Philadelphia: Lippincott

Williams & Wilkins

Davidson, M. R., London, M. L. & Ladewig, W. P. (2008). Clinical handbook for Old’s
Maternal-newborn nursing and women’s health across the lifespan (8th ed.). Upper
Saddle River, NJ: Prentice-Hall.

Davidson, M. R., London, M. L. & Ladewig, W. P. (2008). Old’s Maternal-newborn

nursing and women’s health across the lifespan (8th ed.). Upper Saddle River, NJ:
Prentice-Hall.

Davis’s Drug Guide for Nurses (Version 10.0.4) (2007). [PDA software]. F.A. Davis
Company.

LWWmobile Handbook of Nursing Diagnosis (Version 11.0.5/2008.4.25) [PDA

software].

Lee, N.K, Kim, S, Lee J.W, Sol, Y.L, & Kim C.W (2009). Postpartum hemorrhage:
Clinical and radiologic aspects. European Journal of Radiology. 74 p.50-59.

Stuart S, Couser G, Schilder K, O’Hara MW, & Gorman L (1998) Postpartum anxiety
and depression: onset and comorbidity community sample Department of Psychiatry U of
I PMID: 9680043 [PubMed - indexed for MEDLINE]

Taber’s Cyclopedic Medical Dictionary 20th Edition (Version 2.0) (2005)[PDA software].
Developed by Medical Wizards based on the book by F.A. Davis Company.
Case Study 19