PRIORITIZED NURSING PROBLEM FOR ACUTE LABOR PAIN(LABOR STAGE III: PLACENTAL EXPULSION)
Nursing Diagnosis                 Nursing Intervention                                            Rationale
Acute pain related to Independent
physiological               Change wet clothing and bedding.            Promotes warmth, comfort, and cleanliness.
response after trauma.
                            Apply ice bags to perineum after            Constricts blood vessels, reduces edema and provides local
                             delivery.                                    comfort and anesthesia.
                            Provide a heated blanket.                   Post-delivery tremors/chills may be caused by sudden release of
                                                                          pressure on pelvic nerves or may be possibly be related to a
                                                                          fetus-to-mother transfusion occurring with placental separation.
                                                                          Warmth promotes muscle relaxation and enhances tissue
                                                                          perfusion, reducing fatigue and enhancing sense of well-being.
                            Assist with the use of breathing            Breathing helps direct attention away from the discomfort,
                             techniques during surgical repair, as        promotes relaxation.
                             appropriate.
                                                                     REFERENCE:
                                                                     https://nurseslabs.com/labor-stages-labor-induced-nursing-care-plan/5/ -
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