Discharge planning and teaching 16 Flashcards
choice between breastfeeding and bottle feeding
influenced by past infant feeding experiences, cultural beliefs, friends and family, health of the woman and baby, support of the partner, perceived health effects, and discussion during pregnancy with a health care provider.
Breastfeeding
Human milk is the preferred source of infant nutrition and provides all the nutritional needs an infant requires. It changes as the infant grows to meet individualized growth and development needs
Short term benefits breastfeeding
●Gastroenteritis.
● Hospitalization due to respiratory syncytial virus.
● Otitis media.
● Necrotizing enterocolitis.
● Sudden infant death syndrome (SIDS).
● Urinary tract infections
Long term breastfeeding decrease:
● Asthma.
● Atopic dermatitis.
● Cardiovascular disease.
● Celiac disease.
● Childhood inflammatory bowel disease.
● Obesity.
● Sleep disorders.
Benefits mom breastfeeding
Long-term maternal benefits include decreased risk for diabetes, metabolic syndrome, osteoporosis, autoimmune disease, and ovarian and breast cancer.
Bonding
decreased blood loss and decreased risk of infection.
ten steps to successful breastfeeding:
- Have a written breastfeeding policy that is routinely communicated to all health care staff.
- Train all health care staff in the skills necessary to implement this policy.
- Inform all pregnant women about the benefits and management of breastfeeding.
- Help mothers initiate breastfeeding within 1 hour of birth.
- Show mothers how to breastfeed and how to maintain lactation, even if they are separated from their infants.
- Give infants no food or drink other than breast milk unless medically indicated.
- Practice rooming-in: Allow mothers and infants to remain together 24 hours a day.
- Encourage breastfeeding on demand.
- Do not give pacifiers or artificial nipples to breastfeeding infants.
- Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or birth center.
Contradictions to breastfeeding
● Women with active and untreated tuberculosis
● Women who are receiving diagnostic or therapeutic radioactive isotopes
● Women who are receiving antimetabolites or chemotherapeutic agents
● Women who have herpes simplex lesions on a breast
● Women who are HIV positive
● In the developing world, the risks of artificial feedings outweigh the risks of acquiring HIV through breast milk; therefore, women are encouraged to breastfeed.
● Women who use street drugs such as cocaine
● Infants with galactosemia
Breastfeeding and Infants With Phenylketonuria (PKU)`
Women whose infants have PKU are encouraged to breastfeed. Human milk has lower levels of phenylalanine than cow’s milk. Phenylalanine levels need to be monitored, and the amount of breast milk may need to be decreased and breastfeeding be supplemented with low-protein formula.
Human milk nutrition
● Proteins account for approximately 6% of the calories in human milk and are easier to digest than protein in prepared formula.
● Carbohydrates account for approximately 42% of the calories in human milk with lactose as the main carbohydrate.
● Fats account for approximately 52% of the calories in human milk.
● Cholesterol, which is essential for brain development, is higher in human milk.
● Vitamins and minerals are transferred to the human milk from the maternal plasma.
Stage 1:
Colostrum, which is present in the breast starting in the second trimester, is a thick yellowish breast fluid.
Stage 2:
Transitional milk consists of colostrum and milk. This stage lasts from 6 to 13 days. During this stage, the milk will gradually change, with decreasing levels of protein and increasing levels of fats, carbohydrates, and calories.
Stage 3:
Mature milk is composed of 20% solids and 80% water. It contains approximately 22 to 23 calories per ounce. Human milk will change to meet the needs of the infant. Milk produced for preterm infants contains twice the amount of protein than milk produced to mothers of full-term infants
Foremilk
is the milk that is produced and stored between feedings and released at the beginning of the feeding session. It has higher water content.
Hind milk
the milk produced during the feeding session and released at the end of the session. It has a higher fat content.
Prolactin
the primary hormone responsible for lactation, is produced during pregnancy
Suckling
increases prolactin levels and volume of milk production. Milk production can be viewed as a supply–demand effect. The more milk the infant takes in, the more milk is produced.
Lactogenesis I
I begins during the second trimester and ends around the second day postpartum.
Colostrum
Lactogenesis II
begins around the third postpartum day. Prolactin levels increase as progesterone levels decrease. These changes and infant suckling stimulate the breast to begin producing large amounts of milk.
Lactogenesis III
The woman enters this phase when the milk supply is established and the amount of milk is controlled by the suckling and emptying of the breast
let down reflex
results in milk being ejected into and through the lactiferous duct system. Oxytocin causes the myoepithelial cells of the alveoli to contract, forcing the milk into the duct system.
Signs of Successful Breastfeeding
● Latch-on should not be painful after the first few moments of suckling.
● The newborn’s tongue is between the lower gum and breast.
● The woman feels a tugging sensation when the newborn begins to suckle.
● Swallowing can be heard.
● Satiation cues include but are not limited to relaxed body, decreased suckling, and sleep.
The nurse and hospital policies can promote optimal breastfeeding by:
- Encouraging early and frequent breastfeeding.
- Providing 24-hour rooming-in for healthy moms and infants.
- Keeping baby warm and close by promoting skin-to-skin contact during feedings.
- Teaching mother about infant hunger cues and to feed on demand versus on schedule or timed feedings.
- Explaining to mother that cluster feeds are normal and they usually occur in the evening, sometimes leading to longer sleep for the infant.
- Keeping the mother comfortable and pain-free.
Cues that indicate feedings are effective include the following:
● The woman feels physically and emotionally comfortable when feeding her newborn.
● The newborn properly latches on, as indicated by no nipple pain or trauma.
● The newborn suckles and the woman can hear and/or see swallowing, which indicates the transfer of milk.
● The newborn spontaneously releases his or her grip on the breast when satiated.
● The newborn is drowsy and arms and legs are relaxed at the end of the feeding session.
● There are at least eight wet diapers and several stools per day once breast milk has come in and breastfeeding is established.
● The newborn recovers his or her birth weight by 2 weeks of age.
Bristol Breastfeeding Assessment Tool (BBAT)
The infant and mother are given a score between 0 and 2 on each of the following:
- Positioning: Infant well supported, tucked into mother on his or her side, nose opposite nipple, and mother is confident in handling infant.
- Attachment: Infant roots, wide-open mouth, quick latch encompassing a large amount of breast tissue, able to maintain a good latch throughout feeding.
- Suckling: Establishes effective pattern on both breasts (rapid sucks, then slow with occasional pauses). Infant demonstrates sign of satisfaction and ends feeding.
- Swallowing: Audible and regular swallowing; no clicks.
pain assessment separate
Preventing nipple tissue breakdown
● Use proper technique for latching on and releasing suction.
● Apply warm compresses to the breasts/nipples before feeding to enhance the let-down reflex
● Express colostrum or milk and rub it on the nipple and areola at the end of the feeding session.
● Change positions when feeding
● Begin the feeding session on the less sore breast because suckling is more vigorous at the beginning of the feeding session.
● Wash breasts with water only.
● Contact her health care provider if she is experiencing cracked and/or bleeding nipples.
nutrition notes
Additional 500cal/day plus minimum of 2 liters of fluid/day
NOTE: Do not eat shark, swordfish, king mackerel, or tilefish when you are pregnant or breastfeeding. They contain high levels of mercury.
Comfort and Relaxation
High levels of anxiety and discomfort interfere with successful breastfeeding by preventing or delaying the let-down reflex, which can cause a decrease in milk transfer and a decrease in milk supply.
manual expression of milk, instruct the woman to:
● Wash her hands before touching her breasts.
● Massage each quadrant of her breast.
● Place her thumb and forefinger so they form the letter C, with the thumb at the 12 o’clock position and the forefinger at the 6 o’clock position.
● Push the thumb and finger toward the chest wall.
● Lean over and direct the spray of milk into a clean container.
● Repeat this several times.
● Occasionally massage the distal area of the breast.
● Reposition the thumb and forefinger to the 3 and 9 o’clock positions and repeat the above sequence.
