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Flashcards in Discharge planning and teaching 16 Deck (72)
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1
Q

choice between breastfeeding and bottle feeding

A

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.

2
Q

Breastfeeding

A

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

3
Q

Short term benefits breastfeeding

A

●Gastroenteritis.

● Hospitalization due to respiratory syncytial virus.

● Otitis media.
● Necrotizing enterocolitis.

● Sudden infant death syndrome (SIDS).

● Urinary tract infections

4
Q

Long term breastfeeding decrease:

A

● Asthma.

● Atopic dermatitis.

● Cardiovascular disease.

● Celiac disease.

● Childhood inflammatory bowel disease.

● Obesity.

● Sleep disorders.

5
Q

Benefits mom breastfeeding

A

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.

6
Q

ten steps to successful breastfeeding:

A
  • 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.
7
Q

Contradictions to breastfeeding

A

● 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

8
Q

Breastfeeding and Infants With Phenylketonuria (PKU)`

A

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.

9
Q

Human milk nutrition

A

● 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.

10
Q

Stage 1:

A

Colostrum, which is present in the breast starting in the second trimester, is a thick yellowish breast fluid.

11
Q

Stage 2:

A

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.

12
Q

Stage 3:

A

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

13
Q

Foremilk

A

is the milk that is produced and stored between feedings and released at the beginning of the feeding session. It has higher water content.

14
Q

Hind milk

A

the milk produced during the feeding session and released at the end of the session. It has a higher fat content.

15
Q

Prolactin

A

the primary hormone responsible for lactation, is produced during pregnancy

16
Q

Suckling

A

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.

17
Q

Lactogenesis I

A

I begins during the second trimester and ends around the second day postpartum.

Colostrum

18
Q

Lactogenesis II

A

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.

19
Q

Lactogenesis III

A

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

20
Q

let down reflex

A

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.

21
Q

Signs of Successful Breastfeeding

A

● 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.

22
Q

The nurse and hospital policies can promote optimal breastfeeding by:

A
  • 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.
23
Q

Cues that indicate feedings are effective include the following:

A

● 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.

24
Q

Bristol Breastfeeding Assessment Tool (BBAT)

The infant and mother are given a score between 0 and 2 on each of the following:

A
  1. Positioning: Infant well supported, tucked into mother on his or her side, nose opposite nipple, and mother is confident in handling infant.
  2. Attachment: Infant roots, wide-open mouth, quick latch encompassing a large amount of breast tissue, able to maintain a good latch throughout feeding.
  3. Suckling: Establishes effective pattern on both breasts (rapid sucks, then slow with occasional pauses). Infant demonstrates sign of satisfaction and ends feeding.
  4. Swallowing: Audible and regular swallowing; no clicks.

pain assessment separate

25
Q

Preventing nipple tissue breakdown

A

● 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.

26
Q

nutrition notes

A

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.

27
Q

Comfort and Relaxation

A

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.

28
Q

manual expression of milk, instruct the woman to:

A

● 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.

29
Q

Breast milk can safely be stored:

A

● At room temperature (77°F) for up to 6 to 8 hours.

● In the refrigerator for up to 5 days.

● In the freezer that is attached to a refrigerator for 3 to 6 months.

● In a deep freezer for 6 to 12 months

30
Q

Breast milk is safely thawed by:

A

● Placing the bottle or bag in the refrigerator overnight.

● Placing it under warm running water.

● Setting it in a container of warm water.

31
Q

advantages of formula

A

● Provides a pleasurable infant caring experience for the partner, as either parent can feed the infant.

● Provides the opportunity for the woman to leave the infant with other people while she goes out or returns to work without the need to pump breast milk or plan activities around the infant’s feeding schedule.

● Decreases the frequency of feedings because digestion of formula is slower than that of human milk.

32
Q

Disadvantages formula

A

● Need for increased time to prepare formula

● Increased cost compared to breastfeeding

● Increased risk of infection due to lack of antibodies that are naturally present in human milk

● Increased risk of childhood obesity and insulin-dependent diabetes

33
Q

formula info:

A

● Prolonged overdilution of formulas can cause water intoxication; prolonged underdilution can cause dehydration.

● Once bottles of formula have been prepared, they need to be kept refrigerated and used within 24 hours to decrease risk of bacterial contamination.

● Opened cans or bottles of ready-to-use formula need to be kept refrigerated and used within 24 hours to decrease risk of bacterial contamination.

● Clean bottles, nipples, and can openers in a dishwasher or with hot soapy water.

● Discard unused formula that remains in the bottle at the end of feeding to decrease risk of bacterial contamination.

34
Q

Feeding amount:

A

0.5 to 1 ounce (15 to 30 mL) per feeding during the first few days of life. This increases to 2.5 to 3 ounces (75 to 90 mL) per feeding by day 4 and gradually increases to 32 ounces (950 mL) per day.

● Rule of thumb: 2.5 ounces of formula/1 pound of baby weight/day.

● Newborns/infants can be fed on demand or at least every 3 to 4 hours.

35
Q

Critical component

Bottle Feeding

A
  • Mix the formula as directed by the manufacturer.
  • Hold the infant close to the body as with breastfeeding.
  • Tilt the bottle so that the nipple is full of milk to decrease the amount of air swallowed by the infant.
  • Do not prop bottles, as this places infants at higher risk for choking, otitis media, and tooth decay.
  • Check the size of the nipple hole.
  • The hole may be too big if the infant has a sudden mouthful of formula and almost chokes, or when you turn the bottle upside down and the milk flows out of the nipple instead of dripping.
  • The hole may be too small if the infant seems to be working hard when sucking or when the bottle is upside down and it takes longer than a second per drip of formula.
  • Discard unused formula from the bottle at the end of the feeding.
36
Q

Birth-4m

A

The nutritional requirements for infants are ideally met by breast milk. Iron-fortified infant formula is substituted when the woman is not breastfeeding.

breastfeeding on demand
formula every 3-4hr

37
Q

4-6m

A

Feeding breast milk or formula is continued. Introduction of semisolid foods is determined by the physician or nurse practitioner in collaboration with parents.

38
Q

bathing

A

best done before a feeding to decrease the risk of emesis

● Support the infant’s head and neck with the parent’s forearm.

● Do not leave the infant unattended in bathwater.

● Start from the cleanest area (eyes) and end with the dirtiest area (buttock).

● An alternative method is trunk-to-head.

● Cleanse eyes from the inner to outer aspects using a clean corner of the washcloth per eye to reduce the risk of transfer of infection from one eye to the other.

● Wash hair and massage the scalp.

● Lift the chin to clean neck folds, where milk often collects.

● Cleanse the upper body.

● Cleanse the lower body.

● Clean female genitals by washing from front to back to decrease the risk of cystitis.

● Elevate the scrotum and cleanse the area.

● Dry the infant and put on a clean diaper and clothes.

39
Q

Bulb syringes

A

are used to assist the infant in clearing mucus from the nasopharynx.

40
Q

bulb syringe procedure

A

● Compress the syringe and insert it into either the nose or the mouth.
● Release pressure from the syringe and allow it to slowly expand.

● Remove the syringe from the area.

● Remove the drainage from the syringe by compressing the syringe and forcing the contents into a tissue.

● Repeat until newborn is clear of mucus.

41
Q

Circumcision

Parents should also notify the health care provider if:

A

● The newborn has not voided within 24 hours.

● There is bleeding from the circumcised area.

● The entire penis is red, warm, and swollen and/or there is drainage from the surgical site (signs of infection).

Gomco or Mogen clamp:

● Apply a protective lubricant over the circumcision site after each diaper change for the first week. The protective lubricant helps keep the area clean and keeps the wound from adhering to the diaper.

● The circumcised area heals within 2 weeks.

Plastibell method:

● Do not apply lubricants on the penis when a Plastibell has been used. Lubricants can increase the risk of displacement of the plastic ring.

● The plastic ring falls off in 7 to 10 days. Parents should not pull it off.

42
Q

Signs of overheating are:

A

Sweating.

● Damp hair.

● Heat rash.

● Rapid breathing.

● Restlessness.

43
Q

Colic

A

uncontrollable crying in healthy infants younger than the age of 5 months and occurs in 20% of infants between 2 and 4 weeks of age

44
Q

Symptoms of colic include:

A

● Infant flexes/curls legs when crying.

● Infant has difficulty/discomfort with bowel movements.

● Infant is more irritable after a feeding.

● Infant is more irritable when placed in crib.

● Infant appears in pain.

● Infant requires frequent cuddling.

● Infant suddenly changes from happy to crying.

45
Q

Methods for soothing colicky infants include the following

A

● Hold the infant and sway from side to side or walk around with the infant.

● Give the infant a pacifier.

● Swaddle the infant.

● Place the infant (abdomen facing down) over the knees and gently rub or pat the back.

● Place the infant in a baby bouncer.

● Place the infant in a car seat and take him or her for a ride in the car.

● Place the infant in a car seat and put on top of a running clothes dryer. Do not leave the infant unattended on the dryer.

● Place the infant in a stroller and go for a walk.

46
Q

Umbilical cord

A

The umbilical cord begins to dry once the cord is clamped and cut. The cord clamp is removed 24 hours after birth. Over the next few days, the cord becomes dry, hard, and black. The cord falls off and the site subsequently heals within 2 weeks.

47
Q

care of the cord

A

● The diaper is placed below the cord to facilitate drying of the cord

● If the cord becomes dirty, clean it with plain water and dry it with a clean, absorbent cloth.

● Parents should contact the health care provider if there is bleeding from the cord site, foul-smelling drainage, redness in the surrounding skin, or fever.

48
Q

diaper guidelines

A

Diapers need to be changed when they become wet or soiled to prevent skin irritation. Parents should check diapers every few hours to see if they need changing. It is recommended to change the diapers every 1 to 3 hours during the day and at least once at night

49
Q

elimination guidelines

A

● Instruct parents on the stages of newborn stools

● Explain that newborns pass several stools per day

● Inform parents that newborns should have at least six wet diapers per day once breastfeeding or bottle feeding has been established

● Inform parents that a newborn’s diapers may have a pink stain related to urates, which is a normal occurrence.
● Inform parents that blood may occur on the diaper of female newborns related to a withdrawal of maternal hormones.
● Instruct parents to notify the health care provider if stools are runny and green and/or if infant has fewer than six wet diapers per day.

● Instruct parents to notify the health care provider if the infant becomes constipated.

50
Q

follow up

A

newborn follow-up visit within 48 to 72 hours of discharge.

51
Q

well-child checkups provide an opportunity to:

A

● Assess the infant’s growth.

● Growth spurts occur at 14 days, 3 weeks, 6 weeks, 3 months, and 6 months. During these growth spurts, infants can be fussy and need to be fed more frequently.

● Assess feeding pattern.

● Assess the developmental level.

● Assess for jaundice.

● Provide the appropriate immunizations

● Do follow-up metabolic screening.

● Continue teaching parents about the care of their child and what to expect at each developmental milestone.

52
Q

● Subsequent visits

follow up

A

1, 2, 4, 6, 9, and 12 months of age.

53
Q

● First visit follow up

A

within 2 to 4 days after hospital discharge

54
Q

Kangaroo care

A

referred to as skin-to-skin care, is when a parent holds his or her bare-chested infant to their bare chest.

55
Q

baby benefits kangaroo care

A

● Stabilization of temperature, heart rate, and breathing.

● Increased weight gain.

● Increased time in deep sleep.

● Decreased crying.

● Longer quiet alert states that facilitate successful breastfeeding sessions.

56
Q

pacifiers

A

● Pacifier should not be used with breastfed infants until 1 month of age. This provides the time needed for infants to establish breastfeeding.

● Pacifiers have been linked to shorter breastfeeding duration.

57
Q

Pediatric abusive head trauma (PAHT) or abusive head trauma (AHT), also referred to as shaken baby syndrome

A

an injury to the skull or intracranial contents of an infant or child younger than age 5 caused by inflicted blunt impact and/or violent shaking.

58
Q

PAHT risks

A

can cause death or permanent and severe brain damage such as:

● Subdural hematomas

● Hypoxic ischemic encephalopathy (HEI) resulting in:

● Cerebral palsy

● Seizures

● Mental retardation

● Learning disabilities

● Retinal hemorrhage occurs in 85% of cases

59
Q

Outcomes of Pediatric Abusive Head Trauma

A
  • Ongoing rehabilitation needs—83%.
  • Attention deficits—79%.
  • Behavioral disorders—53%.
  • Language abnormalities—49%.
  • Motor deficits—45%.
  • Visual deficits—45%.
  • Severe neurological impairment—40%.
  • Epilepsy—38%.
  • The need for special education—30%.
  • Sleep disorders—17%.
60
Q

Symptoms of injury related to PAHT include:

A

● Extreme irritability.

● Lethargy.

● Poor feeding.

● Breathing problems.

● Convulsions.

● Vomiting.

● Decreased smile or vocalization.

● Increased head circumference.

● Grip-like bruising on arms and chest

61
Q

Period of PURPLE Crying

A

the name given to the National Center on Shaken Baby Syndrome’s evidence-based prevention program.

62
Q

PURPLE Crying

A

P: Peak of crying—your baby may cry more each week, the most at 2 months, the least in 3 to 5 months.

U: Unexpected—crying can come and go and you do not know why.

R: Resists soothing—your baby may not stop crying no matter what you do.

P: Pain-like face—a crying baby may look to be in pain, even when he or she is not.

L: Long lasting—crying can last as much as 5 hours a day or more.

E: Evening—your baby may cry more in the late afternoon and evening.

63
Q

“baby bottle tooth decay,”

A

a condition that occurs when sweetened liquids are given in bottles to infants and allowed to remain in the mouth for a period of time.

64
Q

Decreasing the Risk of Baby Bottle Tooth Decay

A
  • Do not put infants to bed with a bottle of milk, juice, or sugar water.
  • Do not give infants bottles with sugar water or soda.
  • Clean the infant’s gums with clean gauze after each feeding.
  • Brush teeth once the first tooth erupts.
  • Consult a dentist regarding fluoride treatments if the water supply does not contain it.
  • Begin regular dental appointments by the first birthday.
65
Q

Safe sleep to reduce SIDS

A

● Always place infants on their backs to sleep, for nap and at night.
● Use a firm sleep surface covered by a fitted sheet.
● Keep soft objects, toys, and loose bedding out of infant’s sleep area.

● Infants should sleep in a crib in their parents’ room for at least the first 6 months of life.
● Women should get regular health care during pregnancy and should not smoke, drink alcohol, or use illegal drugs during pregnancy.

● Parents should not smoke or allow smoking around their baby.

● Infants should be breastfed to reduce risk for SIDS.

● Give infants dry pacifiers that are not attached to a string for naps and at night.

● Do not allow infants to overheat during sleep.

● Follow health care provider’s guidance on infant vaccines and regular health checkups.

● Avoid products that claim to reduce the risk of SIDS and other sleep-related cause of infant death.

● Give infants plenty of tummy time when they are awake and supervised.

66
Q

Diaper dermatitis

A

It can occur when diapers are not changed frequently or when the area is not cleaned thoroughly at each diaper change.

change diapers frequenty

cleans with water or wipes

petroleum based or zinc oxide ointments

avoid powders
avoid antibiotic ointments

67
Q

general skin care

A

● Avoid daily bathing with soap.

● Use cleansers that have neutral pH.

● Avoid use of adhesives.
● Apply petroleum-based ointments sparingly to dry skin and avoid the head and face.

● Avoid use of skin ointments with perfume, dyes, and preservatives.

68
Q

soothing babies

A

● Feed if crying is related to hunger.

● Reposition the infant to a more comfortable position.

● Talk or sing to the infant.

● Swaddle the infant.

● Hold the infant close to the body so he or she can feel the warmth of the parent’s body and hear the parent’s heartbeat.

● Hold the infant and rock back and forth or walk around the house or dance with the infant.

● Offer the infant a pacifier.

● Place the infant in a stroller and go for a walk.

69
Q

Five S’s for Soothing Babies

A
  1. Swaddling
  2. Side positioning or stomach position (supervised by adult)
  3. Shushing
  4. Swinging
  5. Sucking
70
Q

Hip Dysplasia

A

“It’s especially important to allow the hips to spread apart and bend up. In the womb, the legs are in a fetal position with the legs bent up across each other. Sudden straightening of the legs to a standing position can loosen the joints and damage the soft cartilage of the socket.”

71
Q

Uncircumcised Male

A

● Do not force the foreskin over the penis.

● Gently cleanse the penis when bathing the infant and when changing the diaper.

● Once the foreskin naturally retracts (around age 3), gently clean between the foreskin and glans of the penis when bathing the child.

72
Q

When to call doctor

A

● Has a rectal temperature above 100.4°F (38°C) or axillary temperature below 99°F (37.2°C)

● Has loss of appetite.

● Is not interested in eating every 3 hours.

● Refuses to eat.

● Is lethargic.

● Is sleepy and not as active as usual.

● Does not wake on own for feedings or is not interested in feeding.

● Does not cry or has weak cry.

● Has watery green stools.

● Is vomiting.

● Has a decrease in the number of wet diapers.

● Has a skin rash.

● Has sunken or bulging fontanels.

● Is bleeding from circumcision site and/or cord site.

● Has afoul odor from the circumcision site and/or cord site.