lOMoARcPSD|12504245
Postpartum Affective Disorder
UNFOLDING Reasoning
Brittany Horton, 28-year-old female
Primary Concept
Mood and Affect
Interrelated Concepts (In order of emphasis)
• Stress
• Coping
• Clinical Judgment
• Patient Education
• Communication
• Collaboration
NCLEX Client Need Categories Percentage of Items from Each Covered in
Category/Subcategory Case Study
Safe and Effective Care Environment
• Management of Care 17-23% ✓
• Safety and Infection Control 9-15%
Health Promotion and Maintenance 6-12% ✓
Psychosocial Integrity 6-12% ✓
Physiological Integrity
• Basic Care and Comfort 6-12% ✓
• Pharmacological and Parenteral Therapies 12-18% ✓
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• Reduction of Risk Potential 9-15% ✓
• Physiological Adaptation 11-17% ✓
History of Present Problem:
Brittany Horton is a 28-year-old female, G1 P1, who delivered baby boy Mitchell 36 hours ago via primary cesarean
section due to breech presentation. Brittany was 39 3/7 weeks gestation and had an uneventful pregnancy. Brittany’s
blood type is B+ and she is GBS negative. Brittany weighs 190 pounds (86.1 kg) and has a pre-pregnancy BMI of 32.6.
Brittany gets out of bed independently but lets the nurses or her significant other do most of the care for Mitchell. Her
Foley catheter was removed 12 hours ago and she is voiding without difficulty. She is using hydrocodone bitartrate and
acetaminophen (Norco) 5/325 mg and Ibuprofen 600 mg as needed for pain and states her pain is well controlled. Her
significant other, Mark, is at the bedside and is helping care for Mitchell so Brittany can rest.
Personal/Social History:
Brittany and Mark have been together for four years and are planning to get married in six months. Mark is a loan officer
at a local bank. Brittany is attending college and not working outside the home. She is worried about the extra expense
of a new baby and is considering getting a job. Brittany’s family lives an hour away, and Mark’s family lives three hours
away. Brittany has a history of depression and quit taking Sertraline when she became pregnant.
What data from the histories are RELEVANT and must be interpreted as clinically significant by the nurse?
(Reduction of Risk Potential)
RELEVANT Data from Present Problem: Clinical Significance:
She is letting nurses and Mark care for the She is showing no interest in the baby, Might be the sign of baby-blues.
Mitchell
Mark is at the bedside and is helping care
for Mitchell so Brittany can rest
RELEVANT Data from Social History: Clinical Significance:
Brittany has a history of depression and is This could have increased the chances of PPD
not taking her medicines currently.
They have only one earning member and Only having one income can become stressful now with a baby
the expenditures are likely to rise in the
coming future.
Both families live over an hour away They don’t have a support system close by
Patient Care Begins:
Current VS: P-Q-R-S-T Pain Assessment:
T: 98.5 F/36.9 C (oral) Provoking/Palliative: Movement
P: 74 (regular) Quality: Burning
R: 16 (regular) Region/Radiation: Incisional
BP: 110/60 Severity: 5/10
O2 sat: 98% room air Timing: Worsens with getting out of bed
What VS data are RELEVANT and must be interpreted as clinically significant by the nurse? (Reduction
of Risk Potential/Health Promotion and Maintenance)
RELEVANT VS Data: Clinical Significance:
The patient has reported Pain after delivery increases the chance of postpartum depression.
the severity of pain as 5
on a scale of 10
incisional burning that
worsens with getting out
of bed
Copyright © 2018 Keith Rischer, d/b/a KeithRN.com. All Rights reserved.
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Postpartum Affective Disorder
UNFOLDING Reasoning
Brittany Horton, 28-year-old female
Primary Concept
Mood and Affect
Interrelated Concepts (In order of emphasis)
• Stress
• Coping
• Clinical Judgment
• Patient Education
• Communication
• Collaboration
NCLEX Client Need Categories Percentage of Items from Each Covered in
Category/Subcategory Case Study
Safe and Effective Care Environment
• Management of Care 17-23% ✓
• Safety and Infection Control 9-15%
Health Promotion and Maintenance 6-12% ✓
Psychosocial Integrity 6-12% ✓
Physiological Integrity
• Basic Care and Comfort 6-12% ✓
• Pharmacological and Parenteral Therapies 12-18% ✓
Copyright © 2018 Keith Rischer, d/b/a KeithRN.com. All Rights reserved.
Downloaded by Marcus Kenyatta
()
, lOMoARcPSD|12504245
• Reduction of Risk Potential 9-15% ✓
• Physiological Adaptation 11-17% ✓
History of Present Problem:
Brittany Horton is a 28-year-old female, G1 P1, who delivered baby boy Mitchell 36 hours ago via primary cesarean
section due to breech presentation. Brittany was 39 3/7 weeks gestation and had an uneventful pregnancy. Brittany’s
blood type is B+ and she is GBS negative. Brittany weighs 190 pounds (86.1 kg) and has a pre-pregnancy BMI of 32.6.
Brittany gets out of bed independently but lets the nurses or her significant other do most of the care for Mitchell. Her
Foley catheter was removed 12 hours ago and she is voiding without difficulty. She is using hydrocodone bitartrate and
acetaminophen (Norco) 5/325 mg and Ibuprofen 600 mg as needed for pain and states her pain is well controlled. Her
significant other, Mark, is at the bedside and is helping care for Mitchell so Brittany can rest.
Personal/Social History:
Brittany and Mark have been together for four years and are planning to get married in six months. Mark is a loan officer
at a local bank. Brittany is attending college and not working outside the home. She is worried about the extra expense
of a new baby and is considering getting a job. Brittany’s family lives an hour away, and Mark’s family lives three hours
away. Brittany has a history of depression and quit taking Sertraline when she became pregnant.
What data from the histories are RELEVANT and must be interpreted as clinically significant by the nurse?
(Reduction of Risk Potential)
RELEVANT Data from Present Problem: Clinical Significance:
She is letting nurses and Mark care for the She is showing no interest in the baby, Might be the sign of baby-blues.
Mitchell
Mark is at the bedside and is helping care
for Mitchell so Brittany can rest
RELEVANT Data from Social History: Clinical Significance:
Brittany has a history of depression and is This could have increased the chances of PPD
not taking her medicines currently.
They have only one earning member and Only having one income can become stressful now with a baby
the expenditures are likely to rise in the
coming future.
Both families live over an hour away They don’t have a support system close by
Patient Care Begins:
Current VS: P-Q-R-S-T Pain Assessment:
T: 98.5 F/36.9 C (oral) Provoking/Palliative: Movement
P: 74 (regular) Quality: Burning
R: 16 (regular) Region/Radiation: Incisional
BP: 110/60 Severity: 5/10
O2 sat: 98% room air Timing: Worsens with getting out of bed
What VS data are RELEVANT and must be interpreted as clinically significant by the nurse? (Reduction
of Risk Potential/Health Promotion and Maintenance)
RELEVANT VS Data: Clinical Significance:
The patient has reported Pain after delivery increases the chance of postpartum depression.
the severity of pain as 5
on a scale of 10
incisional burning that
worsens with getting out
of bed
Copyright © 2018 Keith Rischer, d/b/a KeithRN.com. All Rights reserved.
Downloaded by Marcus Kenyatta
()
