UNIT 4 POSTPARTUM CARE AND BREASTFEEDING CHAPTER 24 PG 589 PDF

Question 1

Promoting Self Care

Answer 1

Activity and Rest

Perineal Care
* Perineal Hygiene
* Topical Medications
* Ice Packs
* Sitz Baths

Nourishment
* Formula Feeding Mom
* Breastfeeding Mom

Elimination
* Voiding Patterns
* Bowel Patterns

Question 2

What is engorgement

Answer 2

Some women experience engorgement at this time due to an increase in blood and lymphatic fluid as milk production increases. Engorged breasts are hard and un- comfortable and mild temperature elevation can occur; the fullness of the nipple tissue can make it difficult for the infant to latch on and feed. With frequent breastfeeding and proper care, engorgement is a tempo- rary condition that typically lasts only 24 to 48 hours

Question 3

Is rest recommended for Mothers to rest?

Answer 3

The breastfeeding mother should rest as much as possible, especially in the first 1 or 2 weeks after birth. Fatigue, stress, and worry can nega- tively affect milk production and ejection (let-down). The nurse can encourage the mother to sleep when the baby sleeps. Breastfeeding in a side-lying position promotes rest for the mother. The father of the baby, the mother’s partner, grandparents, other relatives, and friends can help with household chores and caring for other children.

Question 4

Proper Perineal hygiene
Interventions for Perineal Lacerations, Episiotomy, and Hemorrhoids

Answer 4

• Perform hand hygiene before and after cleansing the perineum and changing pads.
• Wash the perineum with mild soap and warm water at least once daily.
• Cleanse from the symphysis pubis to the anal area.
• Apply the peripad from front to back, protecting the inner surface of the pad
  from contamination.
• Wrap the soiled pad, and place in a covered waste container.
• Change the pad with each void or defecation or at least four times per day.
• Assess the amount and character of the lochia with each pad change.

Question 5

Ice Compress for Perineal Area
Interventions for Perineal Lacerations, Episiotomy, and Hemorrhoids

Answer 5

Apply a covered ice pack or perineal pad with an enclosed ice pack to perineum from front to back:
* During the first 24 h following birth to decrease edema formation and
increase comfort
* After the first 24 h following birth as needed to provide an anesthetic
effect

Question 6

Sitz bath
Interventions for Perineal Lacerations, Episiotomy, and Hemorrhoids

Answer 6

• Prepare bath by thoroughly scrubbing with a cleaning agent and rinsing.
• Pad with a towel before filling.
• Fill one-third to one-half full with water of the correct temperature, 38°C–
  40.6°C (100.4°F–105.1°F). Some women prefer cool sitz baths instead. If this
  is the case, add ice to water to lower the temperature to a comfortable level. * Encourage the woman to use the sitz bath at least twice a day for 20 min.
• Place call bell within easy reach.
• Teach the woman to enter the bath by tightening gluteal muscles and keeping
  them tightened and then relaxing them after she is in the bath. * Placedrytowelswithinherreach.
• Ensureherprivacy.
• Checkthewomanin15min.

Question 7

Squeeze bottle method off Cleaning Perineum

Interventions for Perineal Lacerations, Episiotomy, and Hemorrhoids

Answer 7

Fill the bottle with tap water warmed to approximately 38°C (100.4°F) (comfortably warm on the wrist).
* Instruct the woman to position the nozzle between her legs so squirts of water reach the perineum as she sits on the toilet seat. Explain that it will take the entire bottle of water to cleanse the perineum.
* Remind her to blot dry with toilet paper or clean wipes.
* Remind her to avoid contamination from the anal area by wiping “front
to back.”
* Apply clean pad.

Question 8

Topical Medications for Perineal Pain and Hemmoroids

Interventions for Perineal Lacerations, Episiotomy, and Hemorrhoids

Answer 8

• Apply anesthetic cream or spray after cleansing the perineal area: use sparingly three or four times per day.
• Apply witch hazel pads after cleansing the perineum.
• Apply hemorrhoidal cream, as ordered, to the anal area after cleansing.

Question 9

Should Mom cleanse perineum back to front post partum?

A. Yes
B. No

Answer 9

B. No

• Remind her to avoid contamination from the anal area by wiping “front
  to back.”
• Apply clean pad.

Question 10

What is tubal ligation?

Answer 10

, the fallopian tubes are cut, tied or blocked to permanently prevent pregnancy. Is often done during cesarean deliveries

Question 11

Post Operative Care for Cesarean deliveries

Answer 11

*Epidural is used for Cesarean deliveries
-headache
-hypotension
-temporary nerve damage
Teachings
*SPLINT INCISION SITE WHEN COUGHING OR SNEEZING OR VOMITING TO DECREASE RISK OF DEHISCENSE

*DO NOT LIFT ANY HEAVY THINGS

*Mother is at fall risk due to numbness in her legs
*Monitor epidural sight for clear drainage
*Monitor for signs of infection on cesarean
-swelling
-green, yellow drainage
-pain at incision site
-dehiscence
-foul odor of incision site`

Question 12

Recovery from Anesthesia

Answer 12

• Monitor respirations
  -Monitor Blood pressure

Anesthesia can decrease respiration rate
and can decrease blood pressure (SLOW THE SYSTEM DOWN)

-Assess for bowel sounds
-Monitor if there’s paralytic ileas

Question 13

Benefits of Breastfeeding for Mom

Answer 13

-Reduce risk for breast cancer
-Reduce risk for ovarian cancer
-Reduce risk of hypertension
-Reduce risk for type 2 diabetes
-Increase secretion of oxytocin which increases involution rate
-Enhance mother and baby bonding

Question 14

Benefits of Breastfeeding for Baby

Answer 14

REDUCED RISK FOR

• Reduced infant and child mortality
• Reduced risk for Gastrointestinal infections
• Necrotizing enterocolitis in preterm infants
• Crohn’sdisease
• Ulcerative colitis
• Lower respiratory tract infections with hospitalizations
• Acute otitis media
• Obesity in childhood,adolescence,and adulthood
• Type 2 diabetes
• Acute lymphoblastic leukemia
• Sudden infant death syndrome
• Enhanced neurodevelopment outcomes,including higher intelligence

Question 15

Which of the following hormones is responsible for the milk ejection reflex(MER) or let down reflex?

A. Estrogen
B. Prolactin
C. Oxytocin
D. Progesterone

Answer 15

Oxytocin is essential to lactation. As the nipple is stimulated by the suckling infant, the posterior pituitary gland is prompted by the hypothalamus to produce oxytocin. This hormone is responsible for the milk ejection reflex (MER), or let-down reflex

Question 16

Physiology of Lactation

Answer 16

Prolactin levels are highest during the first 10 days after birth, gradually declining over time but remaining above baseline levels for the duration of lactation.

Prolactin is produced in response to infant suckling and emptying of the breasts (Fig. 24.3A). Milk production is a supply-meets-demand system (i.e., as milk is removed from the breast, more is produced). The incomplete removal of milk from the breasts can lead to decreased milk supply.

Oxytocin is essential to lactation. As the nipple is stimulated by the suckling infant, the posterior pituitary gland is prompted by the hypothalamus to produce oxytocin. This hormone is responsible for the milk ejection reflex (MER), or let-down reflex

Question 17

How is Prolactin released?

Answer 17

by the baby sucking and emptying breast

Question 18

What is a feeding or hunger cue for a baby?

Answer 18

feeding-readiness cues or early signs of hunger. Instead of waiting to feed until the infant is crying in a distraught manner or withdraw- ing into sleep, the mother should attempt to breastfeed when the baby exhibits feeding cues:
* Sucking or mouthing motions
* Hand-to-mouth or hand-to-hand movements
* Rooting reflex—infant moves toward whatever touches the area
around the mouth and attempts to suck

Question 19

Can a mom who’s breastfeeding feed on demand or whenever the baby presents feeding cues?

A. Yes
B. No

Answer 19

A. Yes

Question 20

How often should Breastfeeding moms feed baby?

Answer 20

2-3hrs or if baby presents feeding or hunger cues

Question 21

How often should bottle feeding moms feed baby?

Answer 21

Every 3-4hrs

Question 22

If your patient has decided not to breast feed what is one of the interventions you could recommend to prevent or relieve engorgement?

Answer 22

To reduce swelling of breast tissue surrounding the milk ducts, ice packs are often recommended in a 10- to 15-minutes-on, 45-minutes- off rotation between feedings. The ice packs should cover both breasts. Large bags of frozen peas make easy packs and can be refrozen between uses.

Fresh, raw cabbage leaves placed over the breasts between feedings can help relieve engorgement. The effect of the cabbage leaves may be related to the coolness of the leaves and phytoestrogens within them. They are washed, dried, chilled in the refrigerator or freezer, and then placed over the breasts for 15 to 20 minutes

Antiinflammatory medications such as ibuprofen can help reduce the pain and swelling associated with engorgement. Ibuprofen also helps reduce fever and aching in the breasts that are often associated with engorgement.

Question 23

What are the different positions for breast feeding?

Answer 23

-(A) Football or clutch (under the arm) hold.

-(B) Across the lap (modified cradle or cross-cradle).

• (C) Cradling.

-(D) Side-lying.

Question 24

Is cradling the most or (#1) effective positioning for breastfeeding?

A. True
B. False

Answer 24

B. False

The mother should be encouraged to use the position that most easily facilitates latch while allowing maximal comfort.

Question 25

Football clutch early feedings

Answer 25

The football or clutch hold is often recom- mended for early feedings because the mother can see the baby’s mouth easily as she guides the infant onto the nipple. Mothers who gave birth by cesarean often prefer the football or clutch hold. The modified cradle or across-the-lap hold works well for early feedings, especially with smaller babies. The side-lying position allows the mother to rest while breastfeeding. Women with perineal pain and swelling often prefer this position.

Question 26

What is the preferred hold for a mother who has had a c -section

Answer 26

Mothers who gave birth by cesarean often prefer the football or clutch hold.

Question 27

Which breastfeeding position allows the mother to rest while breast feeding?

This position also assists with comfort from perineal pain and swelling

Answer 27

The side-lying position allows the mother to rest while breastfeeding. Women with perineal pain and swelling often prefer this position.

Question 28

Which of the following positions are best when the bay who has learned to latch easily?

A. Cradle
B. Football
C. Side-lying
D. Crutch

Answer 28

A. Cradle

Cradling is the most common breastfeeding position for infants who have learned to latch easily and feed effectively. Before discharge from the birth institution, the nurse can help the mother try all the positions so she will be confident in trying these positions at home.

Question 29

What is LATCH

Answer 29

Latch, or latch-on, is defined as placement of the infant’s mouth over the nipple, areola, and breast, making a seal between the mouth and breast to create adequate suction for milk removal.

Question 30

What can entice the baby to open it’s mouth before initially breast feeding?

Answer 30

In preparation for latch during early feedings, the mother should manually express a few drops of colostrum or milk and spread it over the nipple. This action lubricates the nipple and entices the baby to open the mouth as the milk is tasted.

Question 31

What are the signs of effective breastfeeding? Mother

Answer 31

• If the mother feels pinching or pain after the initial sucks or does not feel a strong tugging sensation on the nipple, the latch and positioning are evaluated.
• Onset of copious milk production(milk is“in”) by day 3or 4
  *Firm tugging sensation on nipple as infant sucks but no pain
• Uterine contractions and increased vaginal bleeding while feeding (first
  week or less)
• Feels relaxed and drowsy while feeding
• Increased thirst
• Breasts soften or feel lighter while feeding
• With milk ejection (let-down), can feel warm rush or tingling in breasts, leaking of milk from opposite breast
  *Baby’s cheek are round not dimpled

Question 32

Signs of Ineffective latching

Answer 32

*Pinching or pain

*dimpling in baby

*No strong tugging feeling from breastfeeding

*

Question 33

How do you prevent nipple trauma when the baby is not effectively latched?

Answer 33

Any time the signs of adequate latch and sucking are not present, the baby should be taken off the breast, and latch should be attempted again.

To prevent nipple trauma as the baby is taken off the breast, the mother is instructed to break the suction by inserting a finger in the side of the baby’s mouth between the gums and leaving it there until the nipple is completely out of the mouth

Question 34

Signs of Effective Breastfeeding Infant?

Answer 34

• Latches without difficulty
• Has bursts of 15–20sucks/swallows at a time
• Audible swallowing is present
• Easily releases breast at end offering
• Infant appears content after feeding
• Has at least three substantive bowel movements and six to eight wet diapers every 24 h after day 4.

Question 35

Rubins Maternal Tasks

Answer 35

Phase one- taking in
-passive more dependent
- needs help
-concerned about own needs
-lets others care for baby

Phaser two- taking hold
-education timely

Phase 3 -LETTING GO
-BACK HOME
-making time for baby
-accepting role as mom’
-demand of motherhood can put into mild depression