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OB > 9.1d Care Management > Flashcards

9.1d Care Management Flashcards

1
Q

Breastfeeding Support

A
  • Key is education and guidance as early as possible (before pregnancy)
  • Support groups to connect expectant mothers with similar backgrounds
  • Most common cause of concern for mothers is insufficient milk supply, painful nipples, problems getting baby to feed,
  • Lactation consultants at hospitals can help breastfeeding mothers
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2
Q

Nursing Interventions for Breastfeeding

A
  • Knowledge/Skills
  • Promote and support breastfeeding
  • Assist in early initiation of breastfeeding
  • Assess lactating breasts
  • Preform infant feeding observations
  • Recognize normal/abnormal infant feeding patterns
  • Develop/communicate appropriate breastfeeding care plan
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3
Q

Baby-Friendly Initiative 10 Steps to Breastfeeding

A

1 - Have written feeding policies routinely communicated to staff and policies
2 - Establish ongoing monitoring and data management systems
3 - Discuss importance of breastfeeding with parents
4 - Facilitate immediate skin to skin after birth
5 - Support breastfeeding and manage complications
6 - Only provide newborns with breastmilk unless otherwise indicated
7 - Enable others to remain with their baby and practice rooming in for 24 hours a day
8 - Teach mother to recognize cues of feeding
9 - Counsel mothers on risks of feeding bottles and pacifiers
10 - Coordinate discharge so parents have ongoing care

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4
Q

Feeding-Readiness Cues

A

Signs of Hunger

  • Sucking/Mouthing motions
  • Hand to mouth and Hand to Hand motions
  • Rooting Reflex (infant moves towards whatever touches their mouth and tries to suck)
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5
Q

Education for Mothers

A
  • Latch and Position
  • Signs of adequate feeding
  • Self-care measures such as engorgement prevention
  • Resources they can contact from birthing facility
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6
Q

Breastfeeding Positions

A
  • Football (Clutch) Hold - Under the arm
  • Cross-Cradle (Modified Cradle) - Across the lap
  • Cradle
  • Side lying
  • Mother should empty bladder, be in privacy, have their support partner before breastfeeding
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7
Q

Latch

A
  • Mother should first express a few drops of colostrum over nipple to entice baby to open their mouth
  • Babies with rooting reflex will latch on easier
  • Tickle babies lips with nipple to stimulate baby opening mouth
  • Once babies mouth is open and tongue down, hug baby to breast bringing it to the nipple
  • Painful breastfeeding could mean baby has not taken in enough breast into the mouth and the tongue is pinching the nipple
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8
Q

Asymmetric Latch Technique

A
  • Once babies mouth is open, pull baby in towards breast where chine and lower mandible make contact first, and then top lip
  • Once latched babies chin should be pressed into underside of breast and nose tilted slightly away
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9
Q

Signs feeding is going well

A
  • Mother reports firm tugging on nipple but no pinching/pain
  • Baby sucks with rounded cheeks (not dimpled)
  • Babies jaw glides smoothly
  • Swallowing is audible
  • Baby has bursts of 15-20 sucks/swallows at a time
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10
Q

Potential Problem 1

A
  • Lack of knowledge about breastfeeding

OUTCOME
- Mother verbalizes understanding and demonstrates proper technique
INTERVENTION
- Assess knowledge of breastfeeding
- Observe feeding session once every shift

OUTCOME
- Mother reports no nipple pain with infant suckling
INTERVENTION
- Instruct mother with positive feeding signs

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11
Q

Potential Problem 2

A
  • Difficulty with latch and milk transfer due to sleepy baby evidenced by lack of output

OUTCOME
- Latch and effective suckling
INTERVENTION
- Observe for cues of readiness of feeding

OUTCOME
- Infant wakes up and breastfeeds every 2-3 hours for 15-20 minutes
INTERVENTION
- Assist with awakening techniques such as skin to skin, massage, diaper change

OUTCOME
- Infant voids at least 2-3 times and 1 bowel movement in the next 24 hours
Intervention
- Closely monitor and document infants I&O

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12
Q

Potential Problem 3-

A
  • Anxiety about producing adequate milk supply

OUTCOME
- Mother states signs that infant is receiving enough breastmilk
INTERVENTION
- Teach mother signs of positive breastfeeding (urine/stool output, weight gain, behavior, breast softening after feeding)

OUTCOME
- Mother verbalizes factors that influence milk production
INTERVENTION
- Teach supply-meet-demand, importance of regular feedings, teach to hand-express milk

OUTCOME
- Identify resources to help with concerns related to milk supply post-discharge
INTERVENTIONS
- Refer to lactation consultant and provide resources available on internet and community

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13
Q

Milk Ejection (Let-down)

A

SIGNS OF IT OCCURING

  • Tingling in nipple and breast
  • Baby suck changes from quick and shallow to slow
  • Audible swallowing is heard
  • Uterine cramping and lochia can be seen
  • Mother feels relaxed and drowsy during feedings
  • Opposite breast may leak
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14
Q

Feeding Frequency

A
  • 8-12 times a day
  • Some babies feed every 2-3 hours
  • Some babies cluster feed where they feed every hour for 3-5 feedings then sleep for 3-4 hours
  • ## First 24-48 hours, parents must wakeup baby every 3 hours during the day and every 4 hours at night to feed
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15
Q

Demand Feeding

A
  • Once infants gain weight properly demand feeding is appropriate where baby determines frequency of eating.
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16
Q

Cue-based feeding

A
  • Infants are fed whenever they display cues

- Keep baby close to best observe cues

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17
Q

Duration of Feedings

A
  • Average is 30-40 minutes total (15-20 minutes per breast)
  • Length of feeding decreases as babies become more efficient at feeding
  • Time spent breastfeeding is not reliable indicator of how much milk baby has gotten
  • If baby is feeding effectively, I&O is normal, but weight gain is not enough, mom may be switching breasts too soon.
  • Feed first breast until soft to ensure baby receives higher-fat hindmilk (weight gain milk)
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18
Q

Indicators of Effective Breastfeeding

A
  • Food diary is helpful
  • Output is good indicator of adequacy
  • As volume of breastmilk increases, baby urine will become more dilute and lighter yellow. Dark yellow urine can indicate inadequate intake and dehydration
  • 6-8 urine a day after day 4
19
Q

Stool

A
  • First 1-2 days will be meconium stool (green/black, thick and sticky)
  • Day 2-3 stool is more green, thinner, and less sticky
  • If meconium is still being passed by day 3-4 breastfeeding should be assessed
  • Day 7 for breastfeeding stool will be yellow/soft and seedy
  • 3 stools a day for the first month
  • Breastfed babies may have more than 1 stool a day or 1 stool every 2-3 days
  • As long as baby gains weight and appears healthy, decreased bowel movement is normal
20
Q

Breastfeeding Assessment

A
  • Breastfeeding should be assessed at least once every 8-12 hours for effectiveness
  • There should be at least 1 assessment during the 8 hours prior to discharge
    (Position, Latch, Milk Transfer)
  • Jaundice and daily weights should also be assessed
  • Output should be assessed (voiding and stools, color, transition, uric acid crystals)
21
Q

Supplement/Bottles/Pacifiers

A
  • No supplements should be given with breastfeeding (unless indicated)
  • When supplements are needed, expressed breastmilk is the best. If milk is not providable than pasteurized donor milk is the next best option
  • Best to avoid bottle feeding until breastfeeding is well established (3-4 weeks) to avoid confusing the infant (they require different motor skills)
  • Pacifier can be used at 3-4 weeks of age after breastfeeding is well established
  • Pacifiers at naps or sleep has shown to decrease risk of SIDS
22
Q

When Supplementary Feeding may be Needed

A

INFANT

  • Hypoglycemia/Dehydration/Hyperbilirubinemia
  • Weight loss more than 8% by day 5 (exceeding 75th percentile)
  • Delayed passage of stool or still meconium by day 5

MOTHER

  • Delayed lactogenesis
  • Intolerable pain during feedings
  • Temporary cessation due to medications
  • Insufficient glandular tissue
  • Previous breast surgery such as breast enlargement or reduction
23
Q

Slow Weight Gain

A
  • Babies lose 5-10% of weight after birth prior to gaining weight
  • Weight loss more than 7% during first 3 days should be investigated
  • Once baby is on mature milk, 110-200g should be gained per week (20-28g a day) for the first 3 months
  • Solution to slow weight gain is increased feedings and improved feeding technique
24
Q

Jaundice

A
  • Newborns should be fed frequently 8-12 times a day to prevent breastfeeding-associated jaundice
  • Treat early-onset jaundice by evaluating breastfeeding technique
  • Late on-set jaundice or breast milk jaundice develops between 5-10 days of age
  • Baby should be evaluated for weight loss greater than 7%, less than 3 stools a day, and less than 4-6 wet diapers a day
25
Q

Preterm Infants

A
  • Human milk is ideal
  • Breastmilk enhances retinal maturation in preterm infants
  • Improves neurocognitive outcomes
  • Decreases risk of sepsis and necrotizing enterocolitis (GI issue)
  • Mothers of pre-term babies who cannot breastfeed yet should begin pumping their breasts as soon as possible after birth
26
Q

Early Term Infants

A
  • 34 weeks - 36 6/7 weeks Late Preterm Infants
  • 37 weeks - 38 6/7 weeks Early Term Infants

Both at risk for breastfeeding difficulties due to low energy stores and high energy demand

RISKS

  • Hypothermia/Hypoglycemia/Hyperbilirubinemia
  • Respiratory issues
  • Sleepiness/Minimal Wakeful Periods/Tired After Feedings
  • Weak suck and low tone
27
Q

Steps to Expressing Milk

A
  • Wash hands with soap before starting
  • Containers for storing milk should be washed with hot soapy water or dishwasher. Specific plastic bags for storage of breastmilk lasts less than 72 hours
  • Write date of expression on container before storing milk
  • Store milk in 2-4 ounce servings
  • Milk can be stored at room temperature for 4 hours and refrigerator for 4 days
  • Milk can be stored in freezer from 6 months to a year
  • Storing in fridge and freezer is the best (can be placed with other foods)
  • You can combine milk from pumping on the same day but do not add warm milk to cold milk
  • Place milk in the back of the fridge, not on the door
  • Only fill storage to 3/4 if they will be frozen to allow expansion
  • Thaw milk in refrigerator or under warm water (never microwave)
  • Milk thawed in fridge is good for 24 hours
  • Milk should never be refrozen
  • Shake milk container before feeding and test temperature on inner wrist
  • Discard un-used milk within 1-2 hours
28
Q

Weaning

A
  • Transferring dependence on breastmilk to other sources of nutrition
  • Should be done gradually over weeks/months
  • Abrupt stopping of breastfeeding can cause engorgement/mastitis and baby stress
29
Q

Milk Banking

A
  • Donor milk is important for babies who cannot survive without human milk, but mother is incapable of breastfeeding
30
Q

Milk Sharing

A
  • Another woman who is not the mother breastfeeds the baby because mother is either contraindicated for breastfeeding (HIV), or maternal death occurred.
31
Q

Nutrition for Mother

A
  • Breastfeeding women need 450-500 extra calories a day
32
Q

Breast Care

A
  • Bathing is all that is necessary to keep breast clean
  • Avoid washing nipple with soap as it may dry them out
  • Breast cream can cause blockage of oils from Montgomery glands (use them sparingly)
33
Q

Breastfeeding and Contraception

A
  • Not effective contraceptive
  • Oral contraceptives with progesterone/estrogen not recommended due to potential to reduce breast milk
  • Progestin only contraceptives are better options but not recommended during first 6 weeks postpartum
34
Q

Breastfeeding

A
  • Can continue even if mother becomes pregnant again
  • Any breast surgery can affect milk production, it is possible for breast cancer patients to breastfeed though they may have lower milk supply
  • Nipple piercings do not affect breast feeding
  • Obese mothers may have delayed lactogenesis stages and insufficient milk production. Those with bariatric surgery must monitor for nutrient deficiency
35
Q

Medications and Breastfeeding

A
  • Benefits of breastfeeding outweigh the risks of medications.
    ADVERSE EFFECT MEDICATIONS
  • Antimetabolite and Cytotoxic medications
  • Cocaine
  • Heroin
  • Amphetamines
  • Phencyclidine
  • Methadone and Buprenorphine are safe
  • Antidepressants such as nortriptyline, sertraline, paroxetine are safe
  • Alcohol and Cigarettes are contraindicated
  • Moderate caffeine pose no risk
36
Q

Engorgement

A
  • Common due to significant increase in milk volume during lactogenesis stage 2
  • Occurs during day 3-5 during milk transition
  • Breast take increased glucose and oxygen consumption
  • Alveoli may become distended causing capillary blood flow impairment. As the vessels become more congested, fluid leaks to surrounding tissue causing edema.
  • Breasts may be firm, tender, hot and appear shiny/taut
  • Nipples can flatten making latching difficult
  • Engorgement usually resolves in 24 hours
  • Feed 8-12 times a day
37
Q

Engorgement Treatment

A
  • Icepacks
  • Warm packs/showers
  • Cabbage
  • Anti-inflammatory medications
  • Breast massage
  • Hand/Pump expression
  • Ultrasound
  • Acupressure/Acupuncture
  • Reverse Pressure Softening (manually displace areolar fluid inward which softens the areola and makes latching easier for baby)
38
Q

Sore Nipples

A
  • Best way is to use proper breastfeeding techniques

- Limiting infant time on feedings does not prevent sore nipples

39
Q

Ankyloglossia

A
  • Tongue tie that restricts tongue range of motion for baby.
  • Can be surgically treated
40
Q

Insufficient Milk Interventions

A
  • Skin to skin contact
  • Increase feeding frequency
  • Express milk using electric pump
  • Rest as much as possible, proper nutrition, reduce stress
41
Q

Galactagogues

A
  • Medications that can increase milk supply
42
Q

Plugged Milk Ducts

A
  • Breast can become swollen and tender
  • Caused by inadequate removal of milk from breast caused by tight clothing, poor fitting bra, or always feeding in same position.
  • Warm compress before feedings can help

REQUINTO FEEDING
- Baby begins to feed on affected side to foster more complete emptying

INTERVENTIONS

  • Massage breasts while pumping
  • Use proper fitting clothes
  • Change positions while feeding
  • These blocks should be resolved as soon as possible due to risk of infection
43
Q

Mastitis

A
  • Infection of breasts
  • Influenza like symptoms (fever, chills, malaise, body aches, headache, nausea, vomiting)
  • Localized breast pain and tenderness with hot red area
  • Most cases occur 2-4 weeks postpartum
  • Antibiotics such as cephalexin and dicloxacillin for 10-14 days is used as treatment
  • Can still breastfeed

OB (96 decks)

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