Therapeutic Relationship With The Patient

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Therapeutic Relationship With The Patient

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Question:
Discuss about the Therapeutic Relationship With The Patient.

Answer:

1.The patient is to be observed for the vital signs and the overall body functioning. The observations would involve diarrhea, abdominal pain and bleeding. It would be important to establish a therapeutic relationship with the patient to provide her emotional support (London et al. 2016).
2.

Gestation- gestation is the process or period of intrauterine formation of the child from the time of conception through birth (London et al. 2014).
Gravida- It is the number of times a women has been pregnant regardless of whether the pregnancies were interrupted or resulted in a live birth.
Parity- It is the number of pregnancies >20 weeks.
Contractions- It is the shortening of the uterine muscles in women that occurs at intervals before and during childbirth.
placenta-it is the organ connecting the fetus to the uterine wall in women allowing thermo-regulation, nutrient uptake, gas exchange and waste elimination through the blood supply of the mother. It also helps in fighting against infections and producing hormones supporting pregnancy (Leifer 2015).
fetus-in case of human pregnancy, fetus is the prenatal human between the embryonic state and birth, mainly after eight weeks of conception.
preterm infant-A premature infant is a baby whose birth is before 37 completed weeks of gestation that is more than 3 weeks before the due date of delivery (London et al. 2016).
Estimation date of delivery-it is the date estimated on which the pregnant women would expectedly suffer spontaneous onset of labor
Rupture of membranes- Amnirrhexis or rupture of membrane is the rupture of the amniotic sac occurring spontaneously during or at the initial stage of labor (London et al. 2014).
Established labour- it is the period during which there is dilation of the cervix from four to ten cms and the pregnant women experiences painful and regular contraction.
Episiotomy- it is the surgical opening at the entry point of the vagina at the time of childbirth to support difficulty delivery through prevention of tissue rupture.
Fundus- it is the upper part of the uterus opposite to the cervix (Linnard-Palmer and Coats 2016).
Perineal tear- it is the laceration of the soft tissues such as skin which act as the separating point between the anus and the vagina, occurring due to childbirth straining the perneum.
Apgar score- it is the measurement of the physical condition of a newborn baby obtained by adding points for respiratory rate, heart rate, muscle tone skin coloration and response to stimulation, with the score of ten representing the best possible condition (Leifer 2015).
Fontanelles- it is an anatomical feature found in the infant human skull that contains the soft membranous gaps existing between cranial bones responsible for the calvaria of the individual.
Sutures- it is a row of medical stitches responsible for holding in place the edges of a surgical incision (London et al. 2015).
Meconium- It is the earliest form of mammalian infant stool formed from materials ingested when the fetus was in the uterus such as mucus, bile, amniotic fluid and epithelial cells (Linnard-Palmer and Coats 2016).
Konakion-it is the pharmacological drug delivered to women undergoing childbirth for preventing low level of blood clotting factors with the aim of preventing heavy bleeding after childbirth
Postdates-post dates pregnancy are the ones extending to 42 weeks of gestation and at time more than that, leading to fetal complications (Bindler et al. 2017).

3.The mother’s vital signs are to be monitored regularly and blood loss is to be checked appropriately. Early signs of infection are to be assessed for. Further, a nutritional diet is to be provided to her for addressing the demands of physical health. Lastly, emotional support is to be provided for avoiding post natal depression and anxiety (Leifer 2015).
4.The baby is to be regularly assessed for signs of fits, bleeding, breathing difficulty, diarrhea and discoloration of skin. Signs of infection are also to be monitored and the infant is to be placed in a safe and contamination free environment.
5.A new born has short legs and distended torsos. Further, they have big heads and no necks. Lastly, they have less hair on their heads (Bindler et al. 2017).
6.Kate is to be informed that the infant is to be placed on his back for a healthy sleep. It is to be made sure that the infant’s face or head does not get covered by anything (London et al. 2016).
7.Kate is to be informed that she can use contraceptive after six weeks of birth sine during this time the infant would take breast milk (London et al. 2014).
8.Certain cultures might be discouraging breast feeding and come up with certain beliefs regarding infant care. It is pivotal to address the local beliefs and provide counseling that is culturally appropriate (Leifer 2015).
9.

If the infant is feeding at least six to eight times a day, and he is alert and awake while feeding he is getting enough milk.
The infant needs to be breastfed for about 8 times a day for the first month. It can be reduced to 6 times a day after 1 month. Breastfeeding should be on demand which is almost after every 3 hours (Linnard-Palmer and Coats 2016).
The infant must be close to the body with the head free and in line with the mother’s body. The nose should be close to the nipple (Bindler et al. 2017).
Kate must have a diet consisting of oatmeal, spinach, fenugreek, apricots and garlic for maintaining her milk supply. In addition, the infant is to be encouraged to breastfeed longer for stimulation ((Linnard-Palmer and Coats 2016).
Glass containers with leak proof lids are to be used for storing breast milk. The containers are to be filled with smallest amount of milk the baby is likely to take. Storage time would depend on the temperature of the refrigerator and room temperature.
Kate is to be provided information about supporting breast feeding. She is to be reassured that she can nurse properly. Breast feeding can be augmented by providing frequent maternal-infant contact at the time of mother’s stay. Further help can be done by refraining from giving the baby other fluids (Linnard-Palmer and Coats 2016).

10.The immediate concern is that Kate does not have emotional support from her husband and she is suffering from postnatal depression. She is to be given psychological counseling to eliminate depression (Bindler et al. 2017).
11.

The bottle is to be disinfected before use using a proper disinfectant. Further, the bottle is to be open after cleaning hand with disinfectant.
Manual pumps are to be used for extracting the milk. Fresh milk is to be stored in a clean container. The container is to be thawed before use.
The bay is to be held straight while bottle feeding. The mouth of the baby should be aligned with the body in an upright position (Leifer 2015).

12.From the EDS score of 15, it is evident that Shuxim is experiencing signs of clinical depression. Physical, emotional and behavioural challenges are experienced by her describing postpartum depression (PPD). A postnatal physical examination is important ensuring well-being of mother and baby. An enrolled nurse should consider provide her high levels of support and comfort as caring for the new baby act as stressor affecting her self-esteem. PPD is more likely to be linked with social support and it is important to provide her emotional support. The nurse should have supportive interactions with the new mother that focuses on her mental health needs so that she shares her feelings and take a break from baby care. The nurse needs to encourage self-care activities so that it alleviates PPD symptoms and restoring her psychological health. The nurse should also provide education on PPD so that it improves awareness and strengthen the relationship between her and the baby. Breastfeeding problems can also occur due to PPD and the nurse should assist her in breastfeeding techniques so that she feels competent in taking care of her new baby (Glover 2014).

The main aspect of care in new mothers with PPD is healthy mother-infant relationship that might be affected by this clinical depression. Firstly, she need to be informed and made knowledgeable about PPD by educating her about the signs and symptoms. This would make her well informed and encourage her to discuss openly about her feelings. As she is having limited English ability, the nurse needs to understand her cultural values and beliefs for facilitating culturally sensitive care in PPD. The treatment should be based on her preferences that may include talk therapy with the help of an interpreter. Video demonstrations, pictures and pamphlets in Mandarin language can be helpful for her in understanding the planned care after delivery. Moreover, PCPNC by WHO also provides practical tasks that can be helpful in making her understand aspects of childcare making her feel assured and supported.
Breastfeeding attachment should start with well-supported and comforted pillows by leaning back instead of sitting upright. The baby should be placed on bare chest facing mother supporting behind his shoulders and under bottom. The baby needs to be supported by lap or thigh by placing the baby near to the nipple and start sucking. Frequent feeding stimulates milk production and mother should nurse 7 to 9 times in every one and a half to three hours (Rahim et al. 2014).
Swollen perineum can be healed through Sitz bath that soothes swelling, haemorrhoids and irritated stitches. Cold compression through perineal cool compresses can also provide great relief.
The nurse should be empathetic and provide her information on postnatal care that it is important to maintain good hygiene in order to prevent possible infections.
As bottles are not advisable for feeding baby and breast milk is best for her baby, Breast pump can be helpful and she need to get used to breastfeeding technique regularly to increase milk supply.
Body changes are common after birth and the nurse need to explain that hair, breast size, perspiration level, urination pattern and overall health changes after childbirth. Although, these changes are surprising for new mothers, it can be explained to her through videos and demonstrations about the physiology (Ouzounian and Elkayam 2012).
Referrals involve counsellors and psychotherapy that can be helpful in easing her present condition and alleviating feelings of PPD.

13.Postnatal depression is a type of depression that occurs in parents after childbirth that can occur in both mother and father being a type of mood disorder. Hormonal changes in progesterone, estrogen, thyroid hormone, cortisol, prenatal depression, lack of social support including life stress, family violence, relationship and financial difficulties and history of miscarriages or abuse.
14.Postnatal baby blues occur when women experience mood swings and feel like crying all the time becoming emotionally vulnerable where in PPD, mother feels depressed, anxious, uninterested in baby, irritated with feelings of hopelessness and incompetency to cope with fatigue and worry. Baby blues lasts for about two weeks post delivery with lack of concentration and feelings of dependency, whereas PPD may last for more than two weeks after birth being more severe than baby blues (Sharma and Sharma 2012).
15.Drop in breastfeeding clinics and services are important as it supports the new mothers and their family members in starting and continuing breastfeeding as it is not easy to start during the early days.
Early childhood nurse visits are well developed where nurses’ visits home from low-income to first-time mothers by working in partnership with them. The purpose is to improve health outcomes by encouraging new mothers to promote healthy behaviours, planning of mother’s life and effective parenting skills for improving child health, growth and development.
GP visits (Contraception and postnatal / baby check) include planning of postnatal appointments and visits after birth for a routine check-up between five to 10 days and again when the baby is six weeks old for ensuring the well-being of the new mother and her newborn. GP ensures proper growth and development of the baby while measuring head circumference, weight and length. Postnatal check ensures normal functioning of vaginal loss of blood, bowel and bladder function, mood and social supports like need for breastfeeding support and vaccination (Chamberlain, Chamberlain and Howlett 2016).

References
Bindler, R.M., Ball, J.W., London, M.L. and Davidson, M.R., 2017. Clinical Skills Manual for Maternity and Pediatric Nursing. Pearson.
Chamberlain, R., Chamberlain, G. and Howlett, B., 2016. The First Week of Life: A Survey Under the Joint Auspices of the National Birthday Trust Fund and the Royal College of Obstetricians and Gynaecologists. Elsevier.
Glover, V., 2014. Maternal depression, anxiety and stress during pregnancy and child outcome; what needs to be done. Best practice & research Clinical obstetrics & gynaecology, 28(1), pp.25-35.
Leifer, G., 2015. Introduction to Maternity and Pediatric Nursing-E-Book. Elsevier Health Sciences.
Linnard-Palmer, L. and Coats, G.H., 2016. Safe Maternity and Pediatric Nursing Care. FA Davis.
London, M.L., Ladewig, P.W., Ball, J.W., Bindler, R.M. and Cowen, K.J., 2014. Maternal & child nursing care. Pearson.
London, M.L., Ladewig, P.W., Davidson, M., Ball, J.W. and Bindler, R.C., 2016. Clinical Skills Manual for Maternity and Pediatric Nursing. Pearson.
Ouzounian, J.G. and Elkayam, U., 2012. Physiologic changes during normal pregnancy and delivery. Cardiology clinics, 30(3), pp.317-329.
Rahim, F., Muhammad, J., Ali, S. and Amir, S., 2014. Breastfeeding practices in neonatal units. Journal Of Medical Sciences, 22(4), pp.159-163.
Sharma, V. and Sharma, P., 2012. Postpartum depression: diagnostic and treatment issues. Journal of Obstetrics and Gynaecology Canada, 34(5), pp.436-442.

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