Chapter 16 Flashcards
5 rights of teaching
- time
- context
- goal
- content
- method
discharge planning includes
- standards written instructions
- tailored discharge plans
- may also include follow-up appointments
when should you discuss follow-up appointments?
during discharge teaching
what are the benefits to breastfeeding for baby?
decreased risk of
- gastroenteritis
- otitis media
- SIDS
- necrotizing enterocolitis
- UTI
reduced hospitalization
what are the long-term benefits to breastfeeding?
decreased risk of
- asthma
- atopic dermatitis (eczema)
- cardiovascular disease
- celiac disease
- childhood IBS
- obesity
- sleep disorders
contraindications for breastfeeding
- disease: TB, HIV, infants with galactosemia
- treatments: radioactive isotopes, chemotherapy
- street drugs
3 stages of milk development
- colostrum
- transitional milk
- mature milk
mature milk is broken up into
- foremilk
- hindmilk
foremilk
- comes out first
- very watery
- purpose: to hydrate baby
hindmilk
- end of feeding
- rich in fat
- keeps baby satiated longer
colostrum
- thick, clear
- high in protein
- good carbohydrates
transitional milk
- colostrum going towards milk
- increased levels of fat and protein
breastfeeding cues
- hunger
- satiation
what is included in the breastfeeding process
- latching on
- positioning
what should you do during and after breastfeeding?
burp the baby
what is a proper latch?
- mouth around the areola
- nipple in the back of the mouth
- lips with firm seal around the areola
storage guidelines of breastmilk: freshly pumped/expressed
- countertop/room temp: up to 4 hours
- fridge: up to 4 days
- freezer: up to 6 months best, up to 12 months ok
storage guidelines of breastmilk: thawed/previously frozen
- countertop/room temp: 1-2 hours
- fridge: up to 1 day
- freezer: never refreeze human milk after it has been thawed
storage guidelines of breastmilk: leftover from a feeding (baby didn’t finish the bottle)
use within 2 hours after the baby is finished feeding
*storage condition does not matter
formula feedings: pros and cons
- nutritious alternative
- special formulas
- proper intake
teaching topics for formula/bottle feeding
- BPA free bottles
- clean bottles and nipples with warm soapy water
normal activities of newborn care
- bathing
- clothing
- diapering
- more awake at night
- more tired during the day
- let normal noises happen so baby gets used to it
newborn care: cord care
- leave it alone and let it fall off on its own
- don’t want diaper covering the cord
- want to keep it dry
- should fall off within a few days
newborn care: bulb syringe
- don’t use too much, can cause swelling and trauma in mouth and nose
- only use when necessary
follow-up care appointments: timing of 1st appointment
2-4 days after discharge
- first time parents: 48 hours
follow-up care appointments: timing of well-baby visit appointments
done at 1, 2, 4, 6, 9, and 12 months of age
preventative actions: P A H T
Pediatric Abusive Head Trauma
- aka shaken baby syndrome
- counsel patient to reach out to support system when feeling overwhelmed
5 S’s to soothe the baby
- swaddle
- side position (not to sleep, just to soothe)
- shushing
- swinging (rocking)
- sucking (pacifier- wait 2 weeks for good breastfeeding initiation, bottle)
safe sleep: do’s
- on back
- swaddle
- ASTM certified crib
- firm crib mattress
- mattress encasement
- fitted mattress pad and sheets
safety teaching
- infant car seats
- fall prevention
- accident prevention, safety at home
- poison prevention
- take baby out in public, but not an overly crowded/invasive place
- vaccines
when to call MD
- rectal temp above 100.4 or axillary above 99
- loss of appetite
- not interested in eating q3h
- lethargic
- sleepy or not active per norm
- doesn’t cry or has weak cry
- skin rash
- sunken or bulging fontanels
- bleeding from circumcision or cord site
- foul odor from circumcision or cord site
how long does the WHO recommended women breastfeed?
breastfeed exclusively for 6 months
why do most moms stop breastfeeding?
- painful
- lack of support from providers, nurses
- have to go back to work (only 6-8 weeks of maternity leave)
what are the benefits to breastfeeding for mom?
- decreased risk of breast and ovarian cancer
what happens to the hormones: progesterone, estrogen, prolactin after delivery?
- progesterone estrogen fall after
- prolactin increases- allows for production secretion of milk
how does the milk let down response work?
oxytocin is secreted when baby stimulates the nipple
- causes the myoepithelial cells of alveoli in breast to contract, which pushes milk into the duct system
- milk travels into ducts, baby does let down suck, which allows milk to come down and eject into further ducts
what can trigger a milk let down response?
- baby cries
- if she’s too full (of milk)
hunger cues of newborn
- licking lips
- smacking lips
- sticking tongue out
- hand in mouth
- suck on fingers
- turn head towards mom’s voice
- rooting reflex
- quiet alert stage
is crying an early or late sign of hunger?
late sign
rule of 3s for breastmilk
- 3 hr on counter
- 3 days in fridge
- 3 month in freezer
s/sx of umbilical cord infection
- swelling
- tenderness
- bleeding
safe sleep: don’ts
- crib bumpers
- toys
- pillows
- blankets
- overheating house
- hat
- overdress
- cords near crib
- sleep positioners or wedges
how can parent reduce risk of SIDS
- sleep on back
- breastfeeding
how often should the newborn be bathed?
sponge bath 2-3x/week
how should the newborn be clothed? (layers)
what you are comfortable in +1 layer
how often should the diaper be changed?
change every 2-4 hrs, use diaper cream
is the baby more awake during the day or at night?
- more awake at night
is the baby quieter/sleepier during the day or at night?
- sleepier during the day
why shouldn’t the type of formula be changed?
will upset baby’s GI system
