NURSING ASSESSMENT: - • Patient feels discomfort & verbally explains her pain level. • Pain level is also assessed by pain scale & verbal expressions. • Slightly increase in temperature (1000 F) • Patient feels itching on wound site & feels discomfort. • Patient feels weakness & decrease in appetite. • Patient & family members are confuse when I am asking questions. NURSING DIAGNOSIS: -  Acute pain related to surgical incision as manifested by verbally explaining or discomfortness.  Risk for infection related to hospitalisation as manifested by slightly increase in temperature.  Impaired skin integrity related to improper dressing & vaginal discharge as evidenced by poor hygienic condition.  Imbalanced nutritional status related to anorexia as manifested by fewer intakes.  Deficit knowledge related to postpartum care & newborn care as manifested by poor hygiene condition.

1. NURSING CARE PLAN
Topic: Intra uterine growth restriction
Subject: Obstetric and Gynecological nursing
Submitted To: Respected Madam Mrs. Gursangeet Kaur Sidhu
Submitted On: 3rd
March, 2016
Submitted By:-
Sukhpreet Kaur
M.Sc. (N) 2nd
Year
Roll No.6

2. HISTORY OF THE PATIENT
Name: Amandeep Kaur Husband’s name: Sahab singh
Age: 22 years Sex: female
Hospital: Civil Hospital, Ludhiana
Address: New Shakti Nagar,Ludhiana
Education: Matriculation Husband’s education: Matrix
Occupation: Housewife Husband’s occupation: Labourer
Religion: Sikh Date of Admission: 11-1-2016
Dr. Incharge: Dr. Ruchi
Diagnosis: PREGNANCY WITH INTRAUTERINE GROWTH RETARDATION
CHIEF COMPLAINTS: Patient admitted into civil hospital, Ludhiana with conscious & oriented state of mind for her safe confinement & for
IUGR management.
HISTORY OF PRESENT ILLNESS: Patient admitted into civil hospital, Ludhiana on dated 11-1-2016 for her safe confinement. Now, the
patient feels very tensed regarding less body weight of her baby & taking treatment under supervision of Dr.Ruchi.
OBSTETRICAL HISTORY:
Patient is primi gravida (G-1, P-0, A-0, L-0)
LMP: 24-5-2015
EDD: 2-3-2016
Duration of marriage – 2 years
Antenatal history: Her health status was good during antenatal period. No history of nausea or vomiting was present. She was immunised with
2 doses of injection TT. She was coming to civil hospital, ludhiana for her antenatal visit. NST was done & findings were normal.
Ultrasonography was done & showed low birth weight foetus (2 kg).
Contraceptive method used (if any): nil

3. MENSTRUAL HISTORY:
 Menarche at: 14 years of age.
 Cycle of: 24-25 days.
 Period: 3-4 days.
 Dysmenorrhoea: mild
 Amount of blood flow: moderate
 LMP: 24-5-2015
PERSONAL HISTORY:
 Dietary habits: vegetarian
 Any addiction: nil
 Immunisation status: not know about this.
 T.T. 1st dose: at 4th month 2nd dose: at 5th month
PAST MEDICAL HISTORY: There is no significant history of any medical disease e.g. diabetes, hypertension, etc.
PAST SURGICAL HISTORY: There is no any significant history of any surgery in her life.
FAMILY HISTORY: There is no significant family history of any medical disease e.g. diabetes, hypertension, tuberculosis, etc.
FAMILY TREE-
Patient Patient’s Husband
Amandeep Kaur (22years old) Sahab Singh (25 years old)
Diagnosis: IUGR
Name Relationship with
patient
Age Sex Education Occupation Health Status
Amandeep
Sahab
Patient
Husband
22 years
25 years
Female
Male
Matrix
Matrix
House wife
Labourer
IUGR
Healthy

4. VITAL SIGNS:-
Sr. No. Observation Patient’s value Normal value Remarks
1 Temperature 990F 98.6oF Normal
2 Pulse 78/min 72-80/ min Normal
3 Respiration 22/min 16-24/min Normal
4 Blood pressure 110/70mmhg 120/80mmhg Normal
LABORATORY INVESTIGATIONS:
Ultrasonography findings: - Single live intrauterine foetus with 34weeks4days of gestation without any abnormality.
S. No. Investigations Patient’s Value Normal Value Remarks
1. Hb 8.6 gm/dl 12-16 gm/dl Low
2. Blood group A+ A+, B+, ABO, O Normal
3. VDRL -ve - Normal
4. HIV -ve - Normal
5. HCV -ve - Normal
6. Blood sugar/albumin 80 mg/dl 70-150 mg/dl Normal
PHYSICAL EXAMINATION
Hair scalp: - no redness, lice’s and dandruff, brown black color hairs.
Eyes: - Both eyes are normal in size, shape and symmetry.
Mouth: - No coated and dry tongue.
Neck: - No tonsillitis
Breast: -

5.  Inspection - Both breasts are normal in size, shape and symmetry.
 Palpation - No any tenderness / engorgement is present
Abdomen: -
Inspection:
 Linea nigra and straie gravidarum are present during antenatal period.
 No any previous stretch mark present on abdomen.
Palpation: Fundal Height: 32 cm
Auscultation: FHR-158/min
Vaginal examination: - Doderlin’s bacillus (normal flora) with normal lochia
NURSING ASSESSMENT: -
• Patient feels discomfort & verbally explains her pain level.
• Pain level is also assessed by pain scale & verbal expressions.
• Slightly increase in temperature (1000 F)
• Patient feels itching on wound site & feels discomfort.
• Patient feels weakness & decrease in appetite.
• Patient & family members are confuse when I am asking questions.
NURSING DIAGNOSIS: -
 Acute pain related to surgical incision as manifested by verbally explaining or discomfortness.
 Risk for infection related to hospitalisation as manifested by slightly increase in temperature.

6.  Impaired skin integrity related to improper dressing & vaginal discharge as evidenced by poor hygienic condition.
 Imbalanced nutritional status related to anorexia as manifested by fewer intakes.
 Deficit knowledge related to postpartum care & newborn care as manifested by poor hygiene condition.
GOALS
 Short term goals
To provide comfortable environment.
To relieve the pain of patient.
To maintain the intake output chart.
To check the vital signs.
To prevent both mother & baby from the infection.
To provide well balanced diet.
To administer the medications as ordered.
To provide perineal hygienic care.
 Long term goals
To provide comprehensive care to baby & mother.
To provide the emotional & psychological support.
To encourage for proper follow-up visits.
To rehabilitate the patient.
To provide the thorough knowledge regarding
hygienic care.
To maintain the nutritional & hydration level.
To teach about the importance of exclusive breast
feeding to mother.
To teach about the newborn care.

7. NURSING CARE PLAN
Sr.
No.
Nursing
Assessment
Nursing
Diagnosis
Goal Planning Implementation Rationale Evaluation
1. Patient feels
discomfort &
verbally
explains her
pain level.
Pain level is
also assessed
by pain scale
& verbal
expressions.
Acute pain
related to
surgical incision
as manifested
by verbally
explaining or
discomfortness.
To reduce
& relieve
the pain of
patient.
o Monitor characteristics of
pain i.e. location,
intensity, duration,
frequency & rotation.
o Discuss reasons for pain
and discomfort and
measures to be carried
out for relief.
o Provide diversion therapy
(imagination therapy).
o Administer analgesic as
ordered.
o Provide that position in
which she feels comfort.
o Acute pain was present.
o Patient is asked about
the reason for pain and
discomfort.
o Imagination therapy
was given to patient.
o Tab. Diclofenac was
given.
o Comfortable position
was provided.
o It provides baseline
data to plan care on
basis of data
collected.
o It help to express the
patient’s ideas and
anxiety
o It can divert mind of
patient from pain.
o It reduces & relieves
the pain level.
o It provides comfort.
Intensity of
pain level is
reduced as
evidenced by
verbalisation
& by
checking
pain scale.
2. Slightly
increase in
temperature
(1000 F)
Risk for
infection related
to
hospitalisation
To reduce
risk of
infection
to both
o Follow universal
precautions.
o Universal precautions
was followed e.g. hand
washing, gloving,
gowning.
o It prevents
nosocomial infection.
Risk of
infection is
reduced as
evidenced by

8. as manifested
by slightly
increase in
temperature.
mother &
foetus.
o Restrict entry of visitors.
o Monitor incision site
daily for redness,
oedema, and any
drainage & do proper
dressing.
o Monitor vital signs.
o Monitor WBC count as
ordered and report
abnormal values.
o Monitor culture urine,
wound drainage and
lochia.
o Instruct patient to
o Visitors are allowed in
visiting time only.
o Daily dressing was
done & monitor
incision site.
o Temperature, pulse and
respiration was
checked every hour 4
hourly & recorded.
o WBC’s were
monitored.
o Urine and vaginal swab
was sent for culture.
o The patient maintained
o It prevents cross
infection.
o It helps to predict
signs of infection.
o Elevated vital signs
indicate infection.
Temp >1000 F on two
consecutive readings
after first 24 hr
indicates mastitis and
other infections.
o Increased production
of leucocytes shows
bacterial infection.
o Abnormal findings
show infection.
o It reduces the risk of
using aseptic
techniques.

9. maintain proper personal
hygiene.
o Teach patient how to
apply perineal pad.
o Administered antibiotics
as ordered.
perineal care, do hand
washing and breast
care.
o Patient was applying
the pad from front
back.
o Inj. Cefataxim was
given.
infection.
o It help to prevent
wound
contamination.
o It helps to prevent
chance of infection.
3. Patient feels
itching on
wound site &
feels
discomfort.
Impaired skin
integrity related
to improper
dressing &
vaginal
discharge as
evidenced by
poor hygienic
condition.
To
improve
skin
condition
of patient.
o Inspect the incision daily
by REEDA scale.
o Instruct and assist the
patient with hygienic
practices such as hand
washing and toileting
practices.
o Carry out prescribed
treatment such as
cleaning and applying
medication and dressing
change.
o Incision was inspected
daily & does dressing
& recorded.
o Patient was doing hand
washing while toileting
clean the area from
perineum to back.
o Surgical wound was
cleaned and dressing
was changed daily.
o It helps to detect
signs of possible
infection.
o It helps to prevent
infection.
o It helps to decrease
bacterial
contamination.
Skin
condition is
improved as
manifested
by doing
dressing with
aseptic
techniques &
she maintain
her hygienic
condition.

10. o Instruct and assist the
patient in performing
perineal wash/ care 3-4
times a day.
o Maintain infection
control standards.
o Patient was applying
perineal pad from front
to back and remove it
from back to front.
o Sterile techniques were
used while caring the
patient.
o It helps to maintain
cleanliness and
promote healing.
o It helps to prevent
nosocomial
infections.
4. Patient feels
weakness &
decrease in
appetite.
Imbalanced
nutritional
status related to
anorexia as
manifested by
fewer intakes.
To
improve
nutritional
status.
o Check weight of patient
daily at same time with
same clothes.
o Check dietary patterns –
vegetarian / non –
vegetarian, likes /
dislikes.
o Maintain intake – output
chart.
o Provide well balanced
diet (protein diet- milk,
milk products) with
frequent meals.
o Plenty of fluids should be
o Weight of patient was
checked daily.
o Dietary pattern was
monitored by noting
liking & disliking
related to food.
o Intake-output chart was
recorded.
o Proper diet was taken
by patient.
o She drink a glass of hot
o It provides baseline
data.
o It provides variety to
food.
o It provides baseline
data.
o It provides nutrients
to patient.
o It promotes stool
Nutritional
status is
improved as
evidenced by
increase in
weight.

11. given in diet. water 30 min before
breakfast which may
stimulate bowel
evacuation.
consistency.
5. Patient &
family
members are
confuse when I
am asking
questions.
Deficit
knowledge
related to
postpartum care
& newborn care
as manifested
by poor hygiene
condition.
To
improve
understan
ding level
of patient
& family.
o Assess patient level of
understanding of
postpartum care self care
activities.
o Teach skills like perineal
care, breast care, care of
newborn and removal
and application of pads.
o Teach the patient about
importance of adequate
nutrition and hydration.
o Discuss the importance
of adequate rest.
o Patient understands
level was assessed by
asking fewer questions.
o Patient was taught
about perineal care,
breast care, newborn
care and removal and
application pads.
o Patient was taking
green leafy vegetables,
black grams and
fibrous food and avoids
spicy and fatty food.
o Patient was taking
proper rest.
o It will help to
establish a baseline
for learning.
o This will help to
prevent postpartum
infection and provide
a sense of well being.
o It helps to meet
nutritional needs of
mother body.
o It will develop
confidence and
enhance breast
Patient gives
answer with
confident.

12. o Explain the patient about
the breast feeding.
o Discuss with the patient
about importance of
contraceptive measures.
o The patient was giving
proper breast feeding &
does burping.
o Patient was advised to
prevent intercourse for
6 weeks and use
contraceptives for
family planning. Cu T
is contraceptive of
choice after delivery.
feeding and prevent
breast engorgement.
o It will help the patient
to get motivated
towards small family
norms.
o It will promote
emotional and
physical stability.
LYDIA E HALL THEORY OF NURSING
Lydia Eloise Hall, RN, M.A. (1906-1969): - Born in New York City on September 21, 1906, Hall grew up in York, Pennsylvania. She was an
innovator, motivator, and mentor to nurses in all phases of their careers, and advocate for the chronically ill patient. She promoted involvement
of the community in health-care issues. Hall stated that “from Psychology, I learned people can do three things with their feelings: express them
verbally, repress verbal expression leading to sickness and dis-ease, or become psychotic.”
• Lydia E Hall presents her theory of nursing visually by drawing three interlocking circles, each circle presenting a particular aspect of
nursing .The circles represent care, core and cure

13. According to the Care, Core, and Cure" model, nurses work in three areas: care (hands on bodily care), core (using the self in relationship to the
patient), and cure (applying medical knowledge). Hall was another nurse to the delineate the practice of nursing from the practice of medicine.
CORE
Nursing Assessment: -
Patient feels discomfort & verbally explains her
pain level.
Pain level is also assessed by pain scale &
verbal expressions.
CARE
Nursing Diagnosis: - Acute pain related to surgical incision as
manifested by verbally explaining or discomfortness.
Goal: - To reduce & relieve the pain of patient.
Planning: -
 To monitor characteristics of pain i.e. location,
intensity, duration, frequency & rotation.
 To discuss reasons for pain and discomfort and
measures to be carried out for relief.
 To provide diversion therapy (imagination therapy).
 To administer analgesic as ordered.
 To provide that position in which she feels comfort.
CURE
Implementation: -
 Acute pain was present.
 Patient is asked about the reason for pain and discomfort.
 Imagination therapy was given to patient.
 Tab. Diclofenac was given.
 Comfortable position was provided.
Evaluation: - Intensity of pain level is reduced as evidenced by
verbalisation & by checking pain scale.

14. HEALTH EDUCATION: -
1. Patient is instructed to maintain her personal hygiene especially of perineal care.
2. Instruct to patient regarding importance of follow up.
3. Take medications as ordered.
4. Explain about importance of postnatal exercises by giving demonstrations.
5. Give exclusive breastfeed to baby.
6. Instruct patient about importance of family planning. Take birth space between children is of at least 2 years.
7. Take well balanced diet. Take 2 glass of milk in a day.
8. Get baby immunised at proper time.
9. Bath the baby with warm water & massage with coconut oil.
10. Antimalarial chemoprophylaxis in selected groups.
11. Balanced protein and energy supplements especially in adolescent pregnancy and low socio economic status.
12. Avoid contact with individual with viral infection.
13. Testing for immunity of rubella in non pregnant population and immunization in non immunized mothers
14. Maternal oxygen therapy; it has shows conclusion benefits in management of IUGR.
15. Preventive measures for maternal disease causing IUGR: correction of maternal anaemia, treatment of hypertension can have
positive effects on birth weight.
16. Do her daily lightly routine work. Take proper rest & work period.

15. BIBLIOGRAPHY: -
1. DuttaD.C.text book of obstetrics.16thed.calcutta:central publisher;Pp-588-98.
2. Gupta sadhana. A comprehensive textbook of obstetrics & gynaecology. Ed.3rd .New Delhi; jaypeebrothers medical publishers; Pp-565-
67.
3. Dawn C.S. text book of obstetrics and neonatology. 15th ed. Calcutta:dawn books;Pp-362-367.
4. Jacob Annamma.A comprehensive textbook of midwifery & gynaecological Nursing.3rded.New Delhi: jaypee brothers;Pp-396-99.