Anemia is a medical condition in which there is not enough healthy red blood cells to carry oxygen to the tissues

in the body. When the tissues do

not receive an adequate amount of oxygen, many organs and functions are affected. Anemia during pregnancy is especially a concern because it is
associated with low birth weight, premature birth and maternal mortality

Causes of Anemia during Pregnancy

The cause of anemia truly comes down to how many red blood cells are being produced in the body and how healthy they are. A fall in
hemoglobin levels during pregnancy is caused by a greater expansion of plasma volume compared with the increase in red cell
volume. This disproportion between the rates of increase for, plasma and erythrocytes has the most distinction during the second
trimester

A lack of iron in the diet as a result of not eating enough iron-rich foods or the bodys inability to absorb the iron being
consumed. Learn more about how to get iron naturally.

Pregnancy itself because the iron being produced is needed for the womans body to increase her own blood volume. Without
an iron supplement, there is not enough iron to feed the blood supply of the growing fetus.

Heavy bleeding due to menstruation, an ulcer or polyp, or blood donation causes red blood cells to be destroyed faster than
they can be replenished

Examples of iron-rich foods are:

Lean, red meats and poultry

Eggs
 Dark, leafy green vegetables (such as broccoli, kale, and spinach)

Nuts and seeds

Beans, lentils, and tofu

NURSING CARE PLAN

ASSESSMENT

Patient is week and looking pale and lethargic

Patient is having pain at frequent intervals
Patient is asking for water
Client says feeling powerlessness
Client feels very difficulty in breathing
Client says she need support persons and is unable to control situvations

NURSING DIAGNOSIS

1. Risk for ineffective tissue perfusion related to maternal anemia during pregnancy as evidenced by fatigue and lethargy
2. Labour pain related to contractions and pressure on pelvic structures during labour as evidenced by facial expression.
3. Risk for fluid volume deficit related to prolonged lack of oral intake and diaphoresis from effort of the labour as evidenced by
dry mucosa and decreased skin turgour.
4. Risk for maternal fatigue related to physical exertion during labour as evidenced by drooping eyes and pallor.
5. Risk for ineffective breathing pattern related to anxiety and pain as evidenced by increased respiratory rate and appearance.
6. Anxiety related to the stress of labour as evidenced by feelings of concern and nervouseness.
S.N. Nursing Nursing Nursing Implementation Rationale Evaluation
Assessment Diagnosis Goal/EOC (client outcome)

SUBJECTIV Risk for To Assess the previous lab To obtain baseline Mother
E ineffective tissue increasethe investigations data understood the
Pt is feeling perfusion related hemoglobin management
very weak to maternal level of the Assess the dietary chart/ modalities.
and lethargic. anemia during mother pattern of the mother To know the iron
pregnancy as content in food
OBJECTIV evidenced by Prescribe vitamin consumed
E fatigue and supplements and iron
Pt is less lethargy To reduce supplements with New RBC s begin to
active the elemental iron 60 mg. increase or
Pale weakness reticulocyte cout
conjuctiva faced. begins to rise from a
and Hb 9.8 normal range(0.5% to
gm Advice a diet high in iron 1.5%) to (3% to 4%)
and vitamins by 2 weeks time

Advice to take iron withvit Increases the RBC

c which supplies ascorbic count
acid

Increase roughage in diet Iron best absorbed

from acidic medium
 Caution on black stools Constipation or
gastric irritation
If necessary go for occurs while iron
intravenous intake
supplementation Ferrous sulphate
Or blood transfutions turns stool black
To prevent further
Subjective Labour pain To reduce complications. Client reports
data: related toincreased the pain and signs of minimal
Patient is uterinecontraction facilitate a tolerable pain
complaining s andpressure normal 1.Monitor vitalsigns every and reports that
of pain at onpelvic structures vaginal 15minutes for 2 hours environment is
regular as evidenced by delivery. and 30 minutes until comfortable and
intervals facial expressions stable To obtain baseline she feels secure.
Objective To monitor data.
data: the progress 2.Assess contraction
Uterus hard in labour patterns, bloody show
and and the degree of pain
contracted and its characteristics This is to monitor
during ,location, severity the progress of
contractions ,duration, and frequency labor and the
and then condition of both
relaxed 3.Provide comfort the mother and
measures:Encourage the baby.
Rated pain as comfortable positioning.
9 in ascale of
Position the
1 to 10;
client in aleft Left lateral
10being most side lying position increases
painfulwhile position venous return and
1 being least Encourage client to enhances
assume different placental
positions and change circulation.
them regularly.
4.Teach proper breathing
technique Position changes
promote comfort ,
reduce muscle
tension, relieve
pressure .

5.Inspect the clients suprapubic Proper breathing

area and palpate for bladder
distention. Encourage the client
to void.
technique can prevent
exhaustion, therefore
preventing prolonged
delivery of the fetus and
prolonged pain.

6. Provide information and A full bladder

update client on labor progress contributes to
discomfort and impedes
fetal descent.

Helps alleviate any

 anxiety and fears that
may exacerbate pain.

Subjective Fluid volume To maintain 1.Assess patients hydration To obtain baseline data. Thirst of the
data: deficit related to adequate status: Determine alterations in patient
Patient is prolonged lack of fluid volume Monitor vital signs fluid volume and decreased to
experiencing oral intake and status in (skin turgor, mucous electrolyte imbalance. some extent
thirst. diaphoresis from body. membranes, and capillary refill) .Exibits normal
Objective the effort of Observe urinary output, color, intake or output
data: labour as Expected measure amount, and specific and maintain
Patient is evidenced by dry outcome: gravity. adequate fluid
having dry mucosa and Increased Review lab data (Hb/hct, volume status.
lips decreased skin hydration of serum electrolytes).
turgour. body.
2. Provide frequent oral and skin To maintain skin
Decreased care integrity, prevent
thirst. dehydration and
preserve kidney
function.

3. Discuss importance of To prevent aspiration

withholding food and water which can lead to
during the entire labor course. respiratory distress.

4. Identify means to prevent To prevent dehydration

dehydration such as providing and preserve kidney
 ice chips or saturate OS with function.
water to be sipped by the pt.

5. Assist in IV infusion as To prevent dehydration

ordered. and preserve kidney
function

Subjective Maternal fatigue To monitor Assess the psychological Client expresses

data: related to the progress situation of the patient by proper To obtain the baseline preferences for
Client says physical exertion and duration communication data position and
feeling during labour as of labour techniques to
uncomfortabl evidenced by and reduce Explain well about the labour Increases the control pain..
e and drooping eyes fatigue contractions which progress confidence of the
powerlessnes and pallor from moderate to severe mother
s due to long
duration. Explain to concentrate on
Objective controlled breathing exercises Helps in relieving pain
data; during labour
Looks weak Give frequent progress reports
and during labour Avoid the fear of lack of
powerless progress

Promote change in positions

Provides comfort
Promote voiding and bladder
care Relieve the exess
 pressure and tension
Encourage rest in between the
contractions

.
SUBJECTIV Risk for To maintain 1.Assess for concomitant pain/ Pain can limit Respiratory rate
E DATA: ineffective effective discomfort, URI,allergies. respiratory effort is within normal
Client breathing pattern breathing limits 22
reported related to anxiety pattern. 2. Encourage deep breathing Facilitates alveolar lung b/mt.Skin is in
difficulty in and pain as exercise expansion thus normal colour,
breathing and evidenced by improving gas exchange and hydration.
cried for help increased
respiratory rate 3. Maintain calm attitude while To limit level of anxiety
. and appearance dealing with client Various positions
OBJECTIV facilitates lung
E DATA: expansion and easy
Hyperventilat expulsion of the fetus.
ion noted 4. Encourage pt. to assume
RR= 31cpm various position during active
Appears labor (ex. Squatting position)
restless
Profuse 5.Encourage rest period between To limit fatigue
sweating bearing down.
noted
6.Urge women to keep a paper To rebreathe the co2 she
bag nearby when doing has exhaled.
breathing exercises
SUBJECTIV Anxiety related To reduce 1. Assess level of anxiety Identify areas of
E DATA to the stress of the anxiety through verbal and nonverbal concern that might
Client says labour as due to cues. interfere with the
she is unable evidenced by labour. normal progress of
to control the feelings of labor.
situvation and concern and 2. Employ a calm, caring, Enhances nurse client
support nervouseness. confident, and non-judgmental relationship.
person too approach.
looks very
stressed. 3. Allow client to express fears Provides a healthy
and feelings of anxiety outlet of emotions and
OBJECTIVE appropriately. relieves anxiety.
Both look Adequate explanation
very confused 4. Acknowledge normalcy of helps reduce anxiety,
and stressed. fear and provide opportunity for soothe fears, and
questions and answer honestly provides assurance.
within clients level of
understanding
 5. Assist pt. in proper This position aids in the
positioning Lithotomy easy expulsion of the
position fetus, thus reducing
stress and anxiety from
6.Promote effective second- prolonged labor.
stage pushing by instructing
client to push with each
contractions and rest between
them

CONCLUSION

After my care samreeen delivered a female babby on 18 th of november 2016. It was a normal full term vaginal delivery. Their was
no complications associated.bleeding is within normal limits.Baby is taking feed and is active.By this care plan I came to know more
about intranatal care and its management.