Teaching Experience Paper

Episiotomy Self-Care Comprehensive Nursing Essay Example

Comprehensive Assessment

Patient DC is a 26-year-old G1P1 mother admitted to the postpartum room following delivery 24 hours ago. DC delivered through spontaneous vaginal delivery with midline episiotomy. DC appears relaxed and comfortable and plans to go home today. She does not have a significant medical history and has had a normal pregnancy. She attended prenatal clinics for vital signs, which were documented as within defined limits (WDL). However, she has been diagnosed with an overactive bladder (OAB), which can be exacerbated by childbirth that weakens the pelvic floor muscles. Episiotomy also causes OAB and can lead to urinary inconsistency after delivery. The OAB presents a concern for DC, and she is looking forward to information on how to control the associated urine inconsistency and unintentional loss of urine. Besides, she is looking forward to caring for the incision and when to call a doctor.(Episiotomy Self-Care Comprehensive Nursing Essay Example)

Patient Learning Needs Assessment

Nursing Diagnosis: Inadequate knowledge on post-vaginal delivery care and unfamiliarity with midline episiotomy care. DC has had one pregnancy, and this is her first delivery. Equally, the patient has no previous episiotomy or OAB diagnosis. In this regard, she has no prior experience with managing her present condition.(Episiotomy Self-Care Comprehensive Nursing Essay Example)

An episiotomy is a slight incision made during delivery to enlarge the vaginal opening to hasten delivery or to avoid or decrease potential tearing (Barjon & Mahdy, 2019). Stitches are required to repair and achieve the appropriate healing of perineal lacerations and episiotomy. The procedure is more s less risky than a Cesarean section delivery, which is major surgery. The resultant wound and OAB cause discomfort during healing, embarrassment, social isolation, limited work, and social life. The good news is, proper evaluation and consistent management can hasten recovery and return to a normal lifestyle.  (Episiotomy Self-Care Comprehensive Nursing Essay Example)

Before providing the patient with discharge instruction, it is prudent to assess the patient’s knowledge of her present condition, i.e., midline episiotomy, OAM, and their perception about it. The patient’s perception will help determine their anxiety level and factors limiting her understanding of discharge instruction and postpartum care activities. While disseminating patient education, priority is given to the immediate needs, considering her perception. The provided information includes patient symptoms and measurable signs, i.e., observing the healing rate of her wounds and the frequency of urination or unintentional urine loss. Equally, patient education is carried using a language the patient understands, avoiding complex clinical terminologies and ambiguous sentences.(Episiotomy Self-Care Comprehensive Nursing Essay Example)

DC’s strengths include her composure and quick understanding of post vaginal delivery care. In addition, she demonstrates a clear understanding of everyday sanitary activities around the vulvar area. However, DC presents particular fear, such as embarrassment associated with unintentional loss of urine. In this sense, there is a need to inform her that simple dietary changes, timed voiding, and bladder-holding techniques can help minimize instances of unintentional urine loss. Besides, assuring DC of the availability of medical personnel through 24/7 phone calls is a vital resource whenever she is convinced her condition is not normal.(Episiotomy Self-Care Comprehensive Nursing Essay Example)

Organization/Evidence-based Information

The patient is provided with postpartum healthcare education as follows. “How are you today, DC? My name is Dr. YZ, and I am here to present your discharge instructions to you and explain the necessary health guidelines for your home recuperation and ultimate healing.  With these guidelines, you can be sure you will recover in under one month. However, before the guidelines, I present to you the objectives of this education session:(Episiotomy Self-Care Comprehensive Nursing Essay Example)

1. Objective 1:  To develop an understanding of postpartum care, i.e., management of OAB and episiotomy wound.

Appropriate postpartum care is crucial for the mother and newborn’s social, psychological, and physical health. Finlayson, Crossland, Bonet, and Downe (2020) posit that achieving joyous motherhood, i.e., competency, autonomy, and positive self-esteem, adaptation to altered intimacy with a family relationship, regaining health and well-being is crucial for the mother. In this regard, the educational priorities are DC’s individual needs, preferences, and supportive environment. As such, establishing optimal postpartum care would result in joy, good health, and self-confidence. The following are postpartum measures for effective episiotomy wound healing and management of OAB. These guidelines are appropriate for living normally and performing appropriate routine activities. They include:(Episiotomy Self-Care Comprehensive Nursing Essay Example)

1. Do not remove your stitches
2. Wait for six months before having sex, using tampons, or heaving activity that might rupture your stitches.
3. Take ibuprofen 400g every 6 hours as needed to relieve pain.
4. Change your pads frequently. It is recommended that pads are changes between 2 and 4 hours.
5. Spray warm water over the vulvar/ incision area following urination or bowel movement. Use a dry clean towel/baby wipe to dry the area. Toilet paper is contraindicated.(Episiotomy Self-Care Comprehensive Nursing Essay Example)
6. Have warm baths
7. Clean and disinfect the bathtub before bathing.
8. Use sitz baths at least twice a day.
9. Use a clean towel to pat dry the vulvar/ stitched area after taking a shower. It is advisable to keep the area clean and dry.  
10. Perform routine Kegel exercises, i.e., squeezing muscles to hold urine for about five minutes. Do the Kegel exercise about ten times daily. The Kegel exercise is as outlined below:
11.  Relax your thigh, buttocks, and abdominal muscles.
12.  Squeeze your pelvic floor muscles.
13.  Tighten the muscles for about ten seconds.
14.   Relax the muscles for about ten seconds.(Episiotomy Self-Care Comprehensive Nursing Essay Example)
15. Practice time timed voiding and bladder training. These will help to treat urinary incontinence. Record the times you urinate and when urine leaks to determine leakage patterns when practicing timed voiding. In bladder training, you increase the interval with which you visit the bathroom.  You can also delay going to the bathroom for 15 minutes after the initial urge, increasing the time gap to 30 minutes, and so on in subsequent weeks.
16. Drink lots of water and stool softeners to prevent constipation.
17. Eat lots of fiber to prevent constipation.(Episiotomy Self-Care Comprehensive Nursing Essay Example)
18. Objective 2: To develop an understanding of warning signs associated with OAB and episiotomy wounds.

Educational and supportive needs assessments form the basic strategy for effective postpartum care. According to Milani et al. (2017), appropriate medical care allows medical personnel to identify potential issues affecting a new mother’s recovery. On the other hand, risk factors can lead to wound breakdown and an imperfect healing process (O’kelly & Moore, 2017). This is because new mothers are predisposed to risks of complication, but postpartum care can help protect them. In this context, DC’s understanding of the warning signs will enable her to report health concerns before they become life-threatening. As a result, she will heal faster and gain the joy of motherhood despite the physical and psychological demands. (Episiotomy Self-Care Comprehensive Nursing Essay Example)

The following signs necessitate professional response:

1. Exacerbating pain.
2. Reduced bowel movement frequency, i.e., more than four days.
3. Opening episiotomy stitches.
4. Bad odor.
5. Larger blood clots.

Body Language/Voice

The patient demonstrated an eagerness to learn more about her condition and the associated management measures by maintaining calmness and composure. Similarly, the patient’s willingness to learn was shown by maintaining appropriate eye contact and asking questions about their conditions.  The medical personnel should maintain proper eye contact with the patient to ensure that she follows the teaching.  Appropriate eye contact is shown by staring at the medical personnel’s explanation of health guidelines to show interest and confidence. Equally, the medical personnel displayed confidence and ask questions regarding the education given to evaluate understanding. These questions were open-ended and probing.  The patient showed composure and a relaxed state of mind, was attentive, motivated, and following the practitioner’s body movement. Lastly, the medical personnel used a clear speech, simple grammar, and exciting aspects of motherhood to capture the patient’s attention.(Episiotomy Self-Care Comprehensive Nursing Essay Example)

Learning Evaluation

Evaluation of the patient’s understanding is crucial for effective postpartum care education. According to O’kelly and Moore (2017), it is critical to assess whether or not a patient understands the provided postpartum care education as it positively affects healing and enhances well-being. A learning evaluation also empowers women to incorporate best practices and the associated evidence-based self-care measures in the immediate postpartum period.(Episiotomy Self-Care Comprehensive Nursing Essay Example)

The patient demonstrated understanding of warning signs associated with OAB and episiotomy wound by verbalizing typical signs, symptoms, and feelings related to spontaneous vaginal delivery with midline episiotomy. Accordingly, the patient was requested to recall and verbalize the main health measures for managing episiotomy stitches and OAB. This would allow the medical personnel to evaluate understanding and possible reinforcement of points that the patient does not clearly understand. In addition, the patient identified crucial management strategies and requested a further explanation on the different exercises associated with OAB management, i.e., Kegel exercise and timed voiding and bladder training, which the practitioner did.(Episiotomy Self-Care Comprehensive Nursing Essay Example)

 The teaching methodologies involved the use of questioning and face value patient education. The method encouraged attentiveness, composure, and effective delivery of the necessary postpartum health management for the patient. However, the teaching lacks a practical explanation of the postpartum care measures. Nevertheless, the patient was given additional information in the handout form for their referral. (Episiotomy Self-Care Comprehensive Nursing Essay Example)

References

Barjon, K., & Mahdy, H. (2019). Episiotomy.(Episiotomy Self-Care Comprehensive Nursing Essay Example) https://www.ncbi.nlm.nih.gov/books/NBK546675/

Finlayson, K., Crossland, N., Bonet, M., & Downe, S. (2020). What matters to women in the postnatal period: a meta-synthesis of qualitative studies. PLoS One, 15(4), e0231415.(Episiotomy Self-Care Comprehensive Nursing Essay Example) 10.1371/journal.pone.0231415

Milani, H. S., Amiri, P., Mohseny, M., Abadi, A., Vaziri, S. M., & Vejdani, M. (2017). Postpartum home care and its effects on mothers’ health: A clinical trial. Journal of research in medical sciences: the official journal of Isfahan University of Medical Sciences, 22.(Episiotomy Self-Care Comprehensive Nursing Essay Example) 10.4103/jrms.JRMS_319_17

O’kelly, S. M., & Moore, Z. E. (2017). Antenatal maternal education for improving postnatal perineal healing for women who have been birthed in a hospital setting. Cochrane Database of Systematic Reviews, (12)(Episiotomy Self-Care Comprehensive Nursing Essay Example). 10.1002/14651858.CD012258.pub2