Question

I. Read Chapters 22, 23, 24 and 25 from your textbook.

II. NCLEX Review Questions Chapters 22, 23, 24, 25 from Evolve Resources.

III. Case Study: Nursing Care of the Breastfeeding Mother/Newborn Couplet

Charlotte is a 27-year-old G1P1 who just gave birth to a healthy girl at 39 weeks of gestation. The baby is now 20 minutes old and has transitioned well. Charlotte wants to breastfeed her infant because she has read about the benefits of breastfeeding. Her mother and sisters who are present have not breastfed and are not convinced of any benefit because their children were also healthy. The father of the baby is not involved.

What can the nurse do now to help Charlotte succeed in breastfeeding?

Charlotte’s mother comments that she does not think the baby got enough breast milk from the first breastfeeding attempt. Charlotte agrees and feels that she does not have any milk yet. The baby latched on to both nipples well and effectively sucked for 15 minutes on each side. The infant now is crying, and Charlotte’s mother requests a bottle of formula. How can the nurse address this situation?

It is now day 2 after birth, and Charlotte is complaining of sore nipples. How should the nurse evaluate this complaint ?

What nursing interventions can assist Charlotte with sore nipples?.

What additional nursing interventions may be helpful for Charlotte before hospital discharge?

Answer 1

A) The nurse should educate the things which help Charlotte in breast feeding. She should educate her how to hold the baby while nursing , how to check the breastfeeding attachment , how to break attachment and burping and also about basic feeding routines and times.

B) The best thing for the nurse to do is provide teaching. The nurse should tell Charlotte and her mother that there is a small amount of milk in the breast at the beginning of feeding. Most of the milk is made during infant suckling. Therefore, Charlotte should continue breast feeding to enhance the milk production.

Rationale :- After birth, prolactin stimulates milk production. Suckling and removal of colostrum or milk cause continued increases levels of prolactin. The amount of milk produces depends primarily on adequate stimulation of the breast and removal of the milk.

C) The first thing that the nurse should do is to evaluate the nipple for any trauma. The signs of nipple trauma are red nipples, cracked nipples, blisters on the nipple and bleeding. Minor nipple trauma can easily be treated with antibiotics.

If no trauma or minor trauma is noted, patient teaching is needed to explain that nipple pains occurs at the beginning of breastfeeding ( 3 to 6 days after birth) and resolves soon after. The nipple pain is caused by the infants stretching the tissue during suckling.

Serious nipple trauma should be evaluated by the doctor who will prescribe treatment.

D) The nurse advice Charlotte to massage the breast before the feeding to help milk flow more quickly and to apply warm water or warm washcloth to the breast between feedings to soothe nipples.

E) It is important for the nurse to teach Charlotte how to deal with a sleepy baby during feeding time. This situation occurs when an infant in sleeping / sleepy during feeding time or falls asleep shortly after starting to feed. To prevent this from happening, unwrapping the baby is the most effective way. If the baby is still sleeping, the mother should look for signs such as eye movements or leg movement which indicate that the baby is not all the way sleeping yet. Gently play with the baby by rubbing its back or hair to keep it awake. Changing a diaper or changing clothes at this time also help the baby staying awake.