Nursing Care Plan (NCP) for Maternal-Fetal Dyad using GTPAL

Lesson Objective for Nursing Care Plan (NCP) for Maternal-Fetal Dyad using GTPAL

By the end of this nursing care plan lesson for Maternal-Fetal Dyad, students should be able to:

• Effectively manage and support the maternal/fetal dyad through delivery and postpartum period, focusing on understanding the concepts of bonding and implementing appropriate interventions for mother and baby.

 

Pathophysiology for Maternal-Fetal Dyad

Pathophysiology for Maternal-Fetal Dyad

• Dyad: consisting of two elements or parts
• Maternal-Fetal Dyad: 2-patient model that has a unique relationship with medical, ethical, and legal implications
• Gravidity (G)**: Refers to the total number of pregnancies a woman has had, regardless of the outcome.
• Parity (P)**: Refers to the number of pregnancies carried to a viable gestational age.
• The **GTPAL** system further breaks down parity into:
  • **T (Term births)**: Deliveries after 37 weeks.
  • **P (Preterm births)**: Deliveries between 20 and 37 weeks.
  • **A (Abortions or miscarriages)**: Pregnancies ending before 20 weeks.
  • **L (Living children)**: Number of living children.

Analogy for Maternal-Fetal Dyad

• Imagine the mother’s body as a factory that has just completed a major project (pregnancy and childbirth). This factory now needs to shift back to its regular operations (pre-pregnancy state), but the transition isn’t instant.
• Hormonal Changes: It’s like the factory suddenly changes its main product line. This sudden shift (drop in pregnancy hormones) can cause some confusion and adjustments within the factory (the mother’s body), leading to emotional changes and physical symptoms.
• Physical Recovery: Think of the factory undergoing repairs after the heavy workload of the big project. This repair process (recovery from childbirth) might mean the factory isn’t operating at full capacity for a while. The workers (various body systems) are tired and need time to get back to normal.
• Breastfeeding Adjustments: Now, the factory has a new task: producing milk. This is like setting up a new production line. It might take some time to get it running smoothly, and there could be some initial glitches, like discomfort or supply issues.
• Emotional and Mental Adjustments: The factory workers (the mother’s emotions and mental state) are adapting to a new routine and dealing with the aftermath of the big project. They might feel overwhelmed or exhausted until they find their new rhythm.
• In this analogy, the postpartum period is a time of transition and adjustment for the factory (the mother’s body and mind). Just like a factory needs time to adapt to new changes and recover from a big project, the mother needs time to heal physically, adjust to hormonal changes, start breastfeeding, and adapt emotionally to her new role.

 

Etiology for Maternal-Fetal Dyad

• Hormonal Changes: After childbirth, the mother’s body undergoes significant hormonal adjustments. The sudden drop in hormones like estrogen and progesterone can affect her physically and emotionally.
• Physical Recovery from Childbirth: The process of childbirth, whether vaginal or cesarean, can lead to various physical challenges like soreness, fatigue, and recovery from any childbirth-related injuries.
• Breastfeeding Adjustments: The initiation of breastfeeding leads to hormonal and physical changes, such as the production of milk and potential for breast engorgement or soreness.
• Emotional and Mental Adjustments: The transition to parenthood, along with sleep deprivation and physical changes, can impact the mother’s emotional and mental well-being.

 

Desired Outcomes for Maternal-Fetal Dyad

• Provision of appropriate intra-natal care based on the patient’s obstetric history.
• Identification and management of potential risks associated with multiple pregnancies or history of preterm/term births.
• Patient understanding of her obstetric history and its implications for current and future pregnancies.
• Promotion of mother-child bonding.

Subjective Data for Maternal-Fetal Dyad

• Concerns or questions about current pregnancy based on past experiences.
• Reports of feeling bonded or disconnected during pregnancy.

Objective Data for Maternal-Fetal Dyad

• Willingness to hold or look at baby.
• Willingness to perform interventions on/for baby.
• GTPAL history

Assessment for Maternal-Fetal Dyad

• Assess the mother’s willingness to interact with the baby.
• Assess mother’s history by using GTPAL tool.
• Assess extent of interventions mom performs on/for baby.

Nursing Diagnosis for Maternal-Fetal Dyad

• Risk for disturbed maternal-fetal dyad.
• Risk for impaired parenting

Nursing Interventions and Rationales for Maternal-Fetal Dyad

• Provide education and encouragement to promote bonding.
  • Touch baby
  • Respond to crying
  • Look at baby while performing interventions
  • Talk/sing to baby
• Monitoring Physical Recovery
  • Intervention: Regularly check the mother’s vital signs, assess for bleeding, and monitor the uterus’s return to its normal size.
    • Rationale: After childbirth, it’s important to make sure the mother’s body is recovering properly. Checking these things helps to catch and treat any problems early.
• Pain Management
  • Intervention: Manage pain with medication if needed and provide comfort measures like warm compresses.
    • Rationale: The mother may experience pain after childbirth. Proper pain management helps her to be more comfortable and take care of her baby.
• Supporting Breastfeeding
  • Intervention: Offer guidance and support for breastfeeding, including how to latch the baby and how to recognize if the baby is getting enough milk.
    • Rationale: Breastfeeding can be challenging. Helping the mother with breastfeeding ensures that the baby is well-nourished and promotes bonding.
• Educating on Newborn Care
  • Intervention: Teach the mother how to care for the newborn, including bathing, diapering, and recognizing signs of illness.
    • Rationale: New mothers often need guidance on how to care for their babies. This education helps the mother feel more confident and ensures the baby is well taken care of.
• Emotional Support and Assessment
  • Intervention: Provide emotional support and assess for signs of postpartum depression or mood disorders.
    • Rationale: The postpartum period can be emotionally challenging. Providing support and catching any signs of depression early are important for the mother’s mental health.
• Promoting Rest and Recovery
  • Intervention: Encourage the mother to rest as much as possible and accept help with baby care and household tasks.
    • Rationale: Rest is crucial for recovery after childbirth. Getting enough rest helps the mother heal and take care of her baby.
• Nutritional Support
  • Intervention: Advise on a nutritious diet, especially if breastfeeding, and ensure adequate hydration.
    • Rationale: Good nutrition helps the mother recover and provides the necessary nutrients for breastfeeding.
• Family Planning and Contraception Education
  • Intervention: Discuss family planning and contraception options with the mother.
    • Rationale: It’s important for mothers to understand their options for family planning after childbirth. This helps them make informed decisions about their health and future pregnancies.
• Postpartum Follow-Up
  • Intervention: Arrange for postpartum follow-up visits to monitor the mother’s and baby’s health.
    • Rationale: Regular check-ups after childbirth help ensure that both mother and baby are healthy and any issues are addressed promptly.
• In summary, postpartum nursing care for the maternal-fetal dyad focuses on monitoring physical recovery, managing pain, supporting breastfeeding, educating on newborn care, providing emotional support, promoting rest, ensuring good nutrition, discussing family planning, and arranging follow-up care. Each of these interventions is aimed at supporting the mother and baby during this critical period of adjustment and recovery.

Evaluation for Maternal-Fetal Dyad

• Identify if mom is following through with personal care
• Ask mom to verbalize ways to bond with baby
• Ask mom to demonstrate successful bonding techniques
• Ask mom their feelings related to the bonding process.

References:

• [NURSING.com – Gravidity and Parity](https://www.nursing.com)
• [ACOG – Prenatal Care](https://www.acog.org/womens-health/faqs/prenatal-care)
• [March of Dimes – Pregnancy Complications](https://www.marchofdimes.org/complications/pregnancy-complications.aspx)
• [UC Davis Health – The Importance of Infant Bonding] (https://health.ucdavis.edu/medicalcenter/healthtips/20100114_infant-bonding.html)