Nursing care plan for episiotomy

Introduction

Episiotomy is a surgical incision that widens the opening of the vagina during childbirth to assist delivery of the baby by providing more room. It is usually done if the baby needs to be delivered quickly or if there is risk of feto-maternal injury or trauma.

Assessment

When conducting an assessment of episiotomy care, it is important to assess the patient’s:

• Pain – This can be assessed by asking questions about the severity of pain localization and type of pain.
• Bleeding – Assessing for any bleeding and determining the type (uterine, vaginal, etc).
• Vital Signs – Checking the patient’s temperature and pulse rate regularly post delivery will provide valuable information about the patient’s condition.
• Infection – Any signs of infection such as swelling, redness, tenderness, etc should be noted and reported.
• India ink stain – India ink stain should be assessed to determine if any un-dissolved ink remains after the procedure.
• Symptoms – Noting any reports of fever, chills, nausea and other symptoms.

Nursing Diagnosis

The nursing diagnosis for the care of episiotomy include:

• Acute Pain – Related to incision site and labor.
• Risk for Infection – Related to wounds from delivery, use of instruments and manual labor.
• Risk of Hemorrhage – Related to trauma to delicate tissue during delivery.
• Disturbed Body Image – Related to trauma to genital area and changes in body anatomy during labor and delivery.
• Ineffective Tissue Perfusion – Related to presence of stitches, bruising, swelling and inflammation.

Outcomes

The outcomes desired from the care plan for episiotomy are:

1. The patient will express minimal pain associated with episiotomy.
2. The patient will not have any signs of infection.
3. The patient will not experience any further hemorrhaging.
4. The patient will demonstrate positive self-image.
5. The patient will show improved tissue perfusion in the area.

Interventions

The interventions to be carried out in the care plan of episiotomy include:

• Pain Management – Pain medication or topical anesthetics may be applied to reduce discomfort.
• Infection Surveillance – Monitoring temperature and vital signs, inspecting the episiotomy stitches and incision site for signs of infection.
• Hemorrhage Prevention – Elevating the affected area, applying ice packs and manually checking for signs of excessive bleeding.
• Promote Self-Esteem – Emphasizing the regained strength and control with words of affirmation to boost the patient’s confidence.
• Tissue Perfusion – Applying warm compresses and instructing the patient on maintaining proper hygiene to ensure optimal recovery.

Rationales

It is important to understand the rationale behind each intervention when carrying out the care plan for episiotomy:

• Pain Management – This will help the patient to relax and promote healing.
• Infection Surveillance – An early diagnostic will limit the progression of any infectious agents into the bloodstream.
• Hemorrhage Prevention – Prevention of excessive bleeding will reduce the risk of anemia.
• Promote Self-Esteem – Positive reinforcement will help the patient overcome any fear or embarrassment regarding the appearance of their bodies.
• Tissue Perfusion – Ensuring free flow of blood and nutrients will speed up the healing process.

Evaluation

The evaluation of the nursing care plan for episiotomy can be done by gathering data and assessing outcomes. Results will help determine if the patient has achieved the desired outcomes or if any changes need to be made.

Conclusion

In conclusion, the nursing care plan for episiotomy is an effective tool in helping the patient to heal post delivery. Through frequent assessments, available pain management options and interventions geared towards promoting self-esteem, the patient can be provided with the best possible care.

FAQs

• What is an episiotomy?
  An episiotomy is a surgical incision that widens the opening of the vagina during childbirth to assist delivery.
• What are the common interventions for episiotomy?
  Interventions for episiotomy can include pain management, infection surveillance, hemorrhage prevention and promoting self-esteem.
• Is an episiotomy necessary?
  An episiotomy may be necessary if the baby needs to be delivered quickly or if there is risk of feto-maternal injury or trauma.
• What are the positive outcomes of having a care plan for episiotomy?
  Some positive outcomes of a care plan for episiotomy can include expressing minimal pain, not having any signs of infection, no further hemorrhaging, showing improved tissue perfusion in the area, and demonstrating positive self-image.
• What is the aim of a nursing care plan for episiotomy?
  The aim of a nursing care plan for episiotomy is to provide the best possible care for the patient post delivery in order to ensure a positive recovery.