Transition to parenthood ch13

Question 1

TRANSITION TO PARENTHOOD

Answer 1

The transition to parenthood is a dynamic developmental process that begins with the knowledge of pregnancy and continues throughout the postpartum period as the couple takes on their new or expanded roles of mother and father. Whether this is the first child or tenth child, this transition is a major life event that is both exciting and stressful, producing developmental challenges for the individual, the couple’s relationship, and family members. It is common for new parents to experience
● Increased stress related to learning the role of mother or father, childcare tasks, financial concerns, work-family conflict, and chronic fatigue.

● Decreased satisfaction within their couple relationship.

● Decrease in sexual and intimate activities.

Question 2

Factors affecting transition to parenthood

Answer 2

Each individual deals with the growth, realization, and preparation of becoming a parent in different ways. Personal values, societal expectations, and cultural beliefs influence how an individual takes on the role of parent. Transition to parenthood is fostered or hampered by many factors, some of which include:
● Previous life experiences: Previous experiences caring for infants and children can foster a smoother transition to parenthood.

● How they were parented: A positive feeling of how they were parented can enhance the transition to parenthood.

● Length and strength of the relationship between partners: A strong relationship between the couple can foster a smoother transition to parenthood.

● Financial considerations: Financial concerns can cause stress and hamper the transition to parenting.

● Educational levels: Decreased ability to read and comprehend information regarding child care may hamper the couple’s ability to gain knowledge in the care of the infant.

● Support systems: A lack of positive support in the care of the woman and infant can increase stress and hamper the transition to parenting.

● Desire to be a parent: A lack of desire to be a parent can hamper the transition to parenting.

● Age of parents: Adolescent parents may have a more difficult transition to parenthood.
The transition to parenthood involves taking on the role of mother or father, viewing the child as an individual with his or her own personality, and incorporating the new child into the family system.

Question 3

Evidence-Based Practice: Maternal and Paternal Fatigue

Answer 3

The sample consisted of 108 cohabitating mother–father couples expecting their first child. Data were collected during the third trimester and at 1, 3, and 6 months postbirth.

Results:

● High levels of prenatal fatigue were associated with higher levels of postpartum fatigue for both the mother and father.

● Maternal and paternal fatigue increased following the birth and remained consistent over 6 months.

● Mothers were more fatigued than fathers.

● Poor sleep quality was associated with fatigue for both mothers and fathers.

● Poor sleep quality in mothers was associated with higher levels of stress and depressive symptoms.

● Poor quality of sleep for fathers was associated with shorter duration of infant sleep.

● Age was not associated with postpartum fatigue for either mother or father.

● Younger mothers reported high levels of stress and depressive symptoms than older mother

● Neither family income nor length of couple relationship was associated with fatigue.

Nursing actions:

● Assess levels of fatigue for both the mother and father during the postpartum period.

● Promote rest by providing uninterrupted time during the postpartum hospitalization.

● Promote resting during postpartum hospitalization by clustering nursing care to allow for periods of uninterrupted times for resting.

● Provide information on strategies to decrease fatigue during the prenatal period and postnatal periods.

● Assist mothers in managing stress and depressive symptoms. This is more beneficial to improving their sleep quality than focusing on infant sleep patterns.

Question 4

Parental roles

Answer 4

The role of mother or father evolves and changes over time as the child grows and additional children are added to the family. Each new role has expectations and responsibilities that the individual must learn in order to be successful in the role.

Couples are given the title of mother and father with the birth of their child but must learn the expectations and responsibilities of these roles.

● Examples of parental role expectations are that others will acknowledge the person as being a parent or that the child will obey the parents.

● Examples of responsibilities are that the parents will love and protect their child.

Question 5

Knowledge of parental roles

Answer 5

Knowledge of these expectations and responsibilities is acquired through intentional learning (formal instructions) and incidental learning (observing others in the role). Most individuals have little intentional/instructional learning regarding the role of mother or father and must rely on incidental learning of these expectations and responsibilities. Examples of incidental learning of the parental role are:

● Observing other individuals who are mothers and fathers.

● Recalling how they were parented.

● Watching movies or television programs that have mothers and/or fathers as characters.

The process of learning and developing parental roles should start during the pregnancy. Partners who learn together during the pregnancy have better outcomes when they take on the role of parents. Providing couples with written information regarding different styles of parenting roles allows the expectant couple to learn about parenting behaviors. The expectant couple can then discuss parenting issues and mutually agree on expectations and responsibilities for their new roles.

Question 6

Expected Findings in parental roles

Answer 6

● Parents identify changing roles and are willing to make lifestyle changes to accommodate the changes.

● Parents identify with the parental roles.

● Parents discuss what the roles mean to them.

● Couples incorporate a third person, the infant, into their relationship.

● Couples support each other in mutual caregiving tasks.

Question 7

Nursing actions

Answer 7

Nursing actions are directed at supporting the couple as they take on their role of mother or father. Nursing actions include:

● Providing an environment that is conducive to rest, such as uninterrupted periods of time so that parents can sleep.

● Adequate rest can increase the couple’s ability to take in new information and develop new skills.

● Providing culturally sensitive care.

● Mother and father role expectations and responsibilities vary based on cultural backgrounds.

● Active listening; encourage the parents to talk about their expectations of each other in their respective role of mother or father.

● Having realistic and mutually agreed upon expectations decreases the level of stress within the relationship.

● Providing parental education on infant care with a variety of educational strategies such as handouts, videos, and demonstrations of procedures (burping, swaddling, entertaining, and stimulating the infant).

● Information needs to be appropriate and relevant for the couple.

● Providing positive feedback for parents’ infant care behaviors.

● New parents are insecure regarding infant care and need to know they are correctly interacting with and caring for their infant.

● Providing information on community parenting classes and support groups.

● This will provide parents opportunities for both intentional and incidental learning.

Question 8

Motherhood & mercer’s 4 stages in “becoming a mother”

Answer 8

Mercer describes four stages through which women progress in “becoming a mother”:

● Commitment, attachment, and preparation for an infant during pregnancy

● Acquaintance with and increasing attachment to the infant, learning how to care for the infant, and physical restoration during the early weeks after birth

● Moving toward a new normal during the first 4 months

● Achievement of a maternal identity around 4 months
The process of becoming a mother begins during pregnancy but can occur before pregnancy. Some women begin preparing for this role as children when they fantasize about being mothers and role-play motherhood with dolls. Others actively improve their health in preparation for the pregnancy before conceiving

Question 9

The process of “becoming a mother” is influenced by:

Answer 9

● How the woman was parented.

● Her life experiences.

● Her unique characteristics.

● Her cultural beliefs.

● The pregnancy experience.

● The birth experience.

● Support from partner, family, and friends.

● The woman’s willingness to assume the role of mother.

● The infant’s characteristics such as appearance and temperament

Question 10

Nursing actions

Answer 10

● Review prenatal and labor records for risk factors such as complications during pregnancy and labor and birth.

● Pregnancy and birth experiences can either enhance or impede the process of becoming a mother.

● Assess the stages of “becoming a mother.”

● Assessment data assists in developing individualized nursing actions.

● Expected assessment findings:

● Positive feelings toward being pregnant

● Positive health behaviors

● Nurturing behaviors toward the infant

● Protective feelings toward the infant

● Increasing confidence in knowing and caring for the infant

● Establishment of new family routines (Mercer, 2006)

● Provide rooming-in or couplet care to facilitate bonding and attachment.

● Provide private time for the parents to interact with their infant.

● Provide comfort measures for the woman to promote rest and healing.

● Listen to the woman’s concerns in order for her to process the incorporation of the infant into her life.

● Provide information on the care of infants.

● Praise the woman for the care she provides her infant.

Question 11

Evidence-Based Practice: Maternal Adaptation During the Early Postpartum Period

Answer 11

In the 1960s, Reba Rubin conducted qualitative research studies focusing on maternal adaptation during the early postpartum weeks. Her research is the foundation of our understanding of the psychosocial experience of women during the postpartum period.
Two concepts identified through her research are “maternal phases” and “maternal touch.” Rubin (1984) refined and modified the process as more evidence was linked to maternal adjustments and behaviors and identified areas of development that women progress through to “becoming a mother.”
Mercer (1995) developed the theory of “maternal role attainment,” which describes and explains the process women progress through as they become a mother. Based on her previous research and the research of others, Mercer (2004) supports replacing the term maternal role attainment with becoming a mother. The term becoming a mother reflects that the process is not stagnant but continually evolving as the woman and her child are changing and growing.

The theories generated by Rubin’s and Mercer’s research agendas are the cornerstone of evidence-based knowledge used in establishing nursing guidelines for the care of postpartum women and families.

Question 12

Maternal phases-factors afffecting transition thru the maternal phases

Answer 12

As defined by Rubin (1963b, 1967), a three-phase maternal process occurs during the first few weeks of the postpartum period (Table 13–1). A delay in transitioning through the phases may indicate that the woman is experiencing difficulty in becoming a mother. Factors that can affect the woman’s transition through the maternal phases are:
● Medications (e.g., magnesium sulfate or analgesics) that depress the central nervous system (CNS), leading to tiredness and a slow response to stimuli.

● Complications during pregnancy, labor and birth, and/or postpartum (e.g., preterm labor, chronic illness, difficult birth, or cesarean birth) can cause the woman’s focus to shift to her health and well-being, and/or to resolving feelings of disappointment.

● Cesarean births can cause increased discomfort that interferes with the woman’s ability to care for her infant.

● Pain causes a shift of maternal attention from focusing on caring for baby to seeking pain relief for self.

● Preterm infants or infants who experience complications can cause additional stress on the woman and delay her transition through the phases.

● Mood disorders such as depression cause the woman’s focus to be more on self and less on the infant.

● Lack of support from the partner and/or support system may lead to maternal exhaustion.

● Adolescent mothers, who are more focused inwardly and on peer relationships than on care of the infant.

● Lack of financial resources, which forces the woman to focus on obtaining basic needs rather than on her infant.

● Cultural beliefs, which can influence the woman’s behavior and the amount of time she spends in each phase. In some cultures, for example, women are expected to rest rather than be actively involved in care or decision making during the first few months of the infant’s life.

Question 13

Nursing Actions- maternal phases

Answer 13

● Review prenatal and labor records for factors that might delay progression through the maternal phases.

● Assess for maternal phases.

● Assessment data assists in developing individualized nursing actions.

● Expected assessment findings:

● Taking-in behaviors during the first 24 to 48 hours

● Taking-hold behaviors from 24 to 48 hours through the first few weeks after birth

● Nursing care during the taking-in phase is directed by the nurse because the woman is more dependent during this phase and has difficulty making decisions.

● Nursing care during the taking-hold phase is directed more by the woman, as she is becoming more independent and has an increased ability to make decisions.

● Provide comfort measures such as backrubs, uninterrupted periods of rest, and analgesics.

● Adapt teaching to reflect the maternal phase.

● During the taking-in phase, teaching is directed to immediate learning needs and is provided in short sessions, as the woman’s focus is on self versus learning about the care of the infant.

● During the taking-hold phase, praise the woman for her learning, as she is eager to learn but can become frustrated with not being able to master a new task quickly.

Question 14

Taking in phase

Answer 14

The taking-in phase, a period of dependent behaviors, occurs during the first 24 to 48 hours after birth and includes the following maternal behaviors:

• The woman is focused on her personal comfort and physical changes.
• The woman relives and speaks of the birth experience.
• The woman adjusts to psychological changes.
• The woman is dependent on others for her and her infant’s immediate needs.
• The woman has a decreased ability to make decisions.
• The woman concentrates on personal physical healing (Rubin, 1963b, 1967).

Question 15

Taking-hold phase

Answer 15

The taking-hold phase, the movement between dependent and independent behaviors, follows the taking-in phase. It can last weeks and includes the following maternal behaviors:

• The focus moves from self to the infant.
• The woman begins to be independent.
• The woman has an increased ability to make decisions.
• The woman is interested in the infant’s cues and needs.
• The woman gives up the pregnancy role and initiates taking on the maternal role.
• The woman is eager to learn; it is an excellent time to initiate postpartum teaching.
• The woman begins to like the role of “mother.”
• The woman may have feelings of inadequacy and being overwhelmed.
• The woman needs verbal reassurance that she is meeting her infant’s needs.
• The woman may show signs and symptoms of baby blues and fatigue.
• The woman begins to let more of the outside world in (Rubin, 1963b, 1967)

Question 16

Letting-go phase

Answer 16

In the letting-go phase, the movement from independence to the new role of mother is fluid and interchangeable with the taking-hold phase. Maternal characteristics during this phase are:

• Grieving and letting go of old relationship behaviors in favor of new ones.
• Incorporating the infant into her life whereby the baby becomes a separate entity from her.
• Accepting the infant as he or she really is.
• Giving up the fantasy of what it would/could have been.
• Independence returns; may go back to work or school.
• May have feelings of grief, guilt, or anxiety.
• Reconnection/growth in relationship with partner (Rubin, 1963b, 1967).

Question 17

Fatherhood

Answer 17

Men’s preparation for the role of father is vastly different from women’s preparation for motherhood. In general, men do not fantasize about being a father, nor do they role-play being a father during childhood. During pregnancy, men mentally evaluate how they were fathered and how they want to father, but the reality of becoming a father may not occur until the child is born (May, 1982). Additionally, expectant fathers often picture themselves parenting older children rather than infants

Question 18

Evidence-Based Practice: Expectant Fathers’ Beliefs and Expectations

Answer 18

The purpose of this qualitative study was to gain a deeper understanding of expectant fathers’ experiences as they prepared to parent a new infant-
Five major themes emerged from the data:

1. Being there: Men talked about the importance of being present in their child’s life.
2. Fathering older children: Men talked more frequently about parenting older children versus infants. They focused on father roles with children beyond infant and toddler periods.
3. Preparation for life in society: Men talked about the importance of fathers preparing their children to be successful in their community and society. They identified their father roles as educator and life coach, providing emotional support to their children in dealing with life’s challenges, serving as a positive role model, and facilitating their children’s engagement within the community.
4. Heaviness of the fathering role: Men described fathering as an extremely difficult task that included being responsible for another life and the importance of providing financial and concrete support to their children,
5. Parenting support: Men indicated that they relied on women versus men for support in their role as father. The women were usually their partner, their mother, or other female relatives.

Question 19

Implications -fatherhood

Answer 19

Implications:

1. Providing opportunities for expectant fathers to talk about their preparation and feelings regarding their new and emerging role of father.
2. Father involvement that begins in pregnancy is associated with positive maternal and infant outcomes. The provision of prenatal and postpartum education interventions can assist men in understanding the importance of early father involvement in the care of their infant and its effect on the infant’s development. Early parenting behaviors include rocking, soothing and carrying their infant.

Question 20

Influences of a mans interpretation of what it mean to be a father

Answer 20

The meaning of “father” varies based on the man’s interpretation of the role and its expectations and responsibilities. This is influenced by:

● How he was fathered.

● How his culture defines the role.

● In some cultures, men are not expected to be involved in the birthing process and/or care of the infant.

● By friends and family, and by his partner.

Question 21

Factors affecting a mans transition to fatherhood

Answer 21

The man’s partner has a major influence on the degree of the man’s involvement in infant and child care. For the man to be an involved father, his partner needs to share this desire and to be supportive. Becoming a father evolves over time as the man has increasing contact with his infant, increasing knowledge of infant and infant care, and increasing experiences in infant care. Factors that influence the man’s transition to fatherhood are:
● Developmental and emotional age.
● Cultural expectations.
● Relationship with his partner.
● Knowledge and understanding of fatherhood.
● Previous experiences as a father.
● The way he was fathered.
● Financial concerns. ● Support from partner, friends, and family.

Question 22

Nursing actions-fathers

Answer 22

● Provide information on infant care and infant behavior.

● Demonstrate infant care such as diapering, feeding, and holding.

● Providing information and demonstrating infant care skills enhances the father’s comfort in caring for his infant.

● Praise the father for his interactions with his infant.

● Praising can encourage continued interactions with his infant.

● Provide opportunities for the father to talk about the meaning of fathering.

● Talking about the meaning of fathering assists in identifying his beliefs regarding the role.

● Facilitate a discussion with the father and his partner to identify mutual expectations of the fathering role.

● Mutually agreed-upon expectations can decrease the level of stress within the relationship.

Question 23

Adolescent parents

Answer 23

Adolescent parenting is a stressful life experience in that the adolescent is taking on the role responsibilities of being a mother or father while at the same time working through the developmental tasks of being a teenager. Additionally, adolescent parents have few life experiences that prepare them for the role conflicts and strain experienced by first-time parents.

Adolescent mothers often live with their parents or other relatives following the birth of their child, while adolescent fathers tend to not live with the adolescent mother and their child. Adolescent parents, due to having fewer life experiences and coping skills, are more likely to use harsher parenting practices such as yelling and screaming (Urban Child Institute, 2014). The children of adolescent parents have more difficulty in acquiring cognitive and language skills and social and emotional skills

Question 24

Nursing actions -adolescent parents

Answer 24

● Assess level of knowledge.

● Information needs to be appropriate and relevant for the individual and/or couple for learning to occur.

● Present information at an age-appropriate level.

● Learning styles and teaching strategies are different for young teens and older teens. Information needs to be provided in a manner that will engage the adolescent parent in the learning process.

● Include the adolescent father in infant care teaching sessions.

● Adolescent fathers need information and encouragement in developing care behaviors.

● Involve the maternal grandparent in teaching sessions focused on infant care.

● Grandparents need a review of infant care since most teen mothers live with their parents during the first year.

● Discuss with the adolescent parents their expectations of each other regarding child care and support.

● Realistic and mutually agreed-upon expectations decrease the level of stress within the relationship.

● Involve adolescent fathers in prenatal care based on adolescent mother’s comfort level.

● Adolescent fathers who are involved during the prenatal period have greater involvement with infants following the birth.

Question 25

Evidence-Based Practice: Adolescent Parents

Answer 25

Implications for nursing care: Public health programs that include home visits can lower risky behaviors in adolescent mothers and increase their likelihood of attending and completing college.

Question 26

Same sex parents

Answer 26

Once the couple has decided who will conceive, they must decide how they will conceive. Most lesbian couples use artificial insemination (AI) and thus must decide whether they want a known or unknown sperm donor. They will gather information about sperm banks and obtaining sperm. Lesbian couples share similar feelings as heterosexual couples who are using AI. They often find the process to be stressful due to the monitoring of ovulation and the timing of insemination, and the process becomes more stressful when pregnancy does not occur within the first few months of AI
During the postpartum hospitalization, the couple needs information regarding care of their infant and of the postpartum woman. The postpartum couple views themselves as coparents and plans to equally share in the care of their child. It is important to include both women in teaching sessions regarding infant care. Most lesbian mothers breastfeed their infants and it is not uncommon for both mothers to breastfeed their infant (see Critical Component below). It is important for nurses to ask the mothers if they both plan to breastfeed and if so, assist both in breastfeeding and provide information on induction of lactation and use of lactation supplementation.

Question 27

Induction of Lactation

Answer 27

Several methods can be used to induce lactation for nonbirthing mothers. These include hormonal therapy, manual and/or electric pumping of the breast, use of an at-breast supplementation device, or a combination of these methods. The nonbirthing mother should begin preparing her breasts for lactation several months before the birth of the baby.

Question 28

Roles of mother in lesbian couples

Answer 28

Lesbian couples take on the role of birth mother and co-mother during their transition to parenting. They will experience similar stress-producing issues as heterosexual couples as they take on their new roles, but research findings indicate that lesbian parents report less parental stress than heterosexual couples
Lesbian couples report lower parental stress related to feelings of incompetence as a parent and social isolation compared to heterosexual couples
lesbian couples are egalitarian in their roles and equally share in the care of their infant (Borneskog et al., 2014). These relationship traits might influence the lower levels of parental stress.

Question 29

Non child bearing mother

Answer 29

The non-childbearing mother, who is not visibly pregnant, might experience stress related to “invisibility and lack of support from their work or social community”
This is enhanced if the non-childbearing mother has not “come out” at work or in her social community. The non-childbearing mother experiences another stressor related to parental rights, as rights for the nonbirth mother vary from state to state. Even when the couple is legally married, the non-childbearing mother may not automatically have parental rights. It is recommended that the non-childbearing mother legally adopt the couple’s child.

Question 30

Children by lesbian parents

Answer 30

Children raised by lesbian parents are well adjusted and have similar emotional, social, and cognitive development as children of heterosexual parents. A longitudinal study by Farr compared adoptive children of same-sex couples and heterosexual couples, collecting data when the children were preschool age and then 5 years later. The results from this study indicated no difference between the children of same-sex parents and heterosexual parents. Same-sex-parented children were well adjusted at each data collection point. The same-sex parents were capable in their parenting role and satisfied with their couple relationship

Question 31

Nursing actions- lesbain mothers

Answer 31

● Self-assessment of the nurse’s attitudes, beliefs, and knowledge of homosexuality

● Personal beliefs, attitudes, and knowledge can have a positive or negative influence on patient–nurse interactions and nursing care.

● Nurses need to be respectful of people with diverse lifestyles.

● Assess the couple’s knowledge of infant care and parenting roles.

● Important to evaluate couple’s knowledge level and then reinforce and add to the knowledge base

● Include both mothers in teaching sessions that focus on infant care.

● Lesbian couples tend to be egalitarian in their roles and equally share the care of their infant (Lindsey, 2015).

● Clarify if both mothers are planning to breastfeed their infant; if so, provide breastfeeding teaching and support to each mother.

● Often both mothers will breastfeed their infant and both need assistance.

● Encourage both mothers to hold infant and engage in infant care.

● Bonding and attachment is important for each parent’s mother–child relationship.

Question 32

Bonding and attachment

Answer 32

Bonding and attachment between parents and children are critical factors in the transition to parenting and parental role attainment.

Bonding is defined as the emotions that begin during pregnancy or shortly after birth between the parent and the infant
Bonding is unidirectional from parent to infant. Attachment is an emotional connection that forms between the infant and his or her parents (Bowlby, 1969). It is bidirectional from parent to infant and from infant to parent. Attachment has a lifelong impact on the developing individual. The quality of this attachment influences the person’s physical and emotional development and is the foundation for the formation of future relationships. With each interaction, the parent and infant become more acquainted with each other, recognizing and becoming sensitive to each other’s behaviors. This leads to reciprocal behaviors and emotional bonds between parent and infant over time

Question 33

Bonding and Attachment Behaviors

Answer 33

Bonding and attachment are affected by time, proximity of parent and infant, whether the pregnancy is planned/wanted, and the ability of the parents to process through the necessary development tasks of parenting. Other factors that influence bonding and attachment behaviors are:

● The knowledge base of the couple.

● Past experience with children.

● Maturity and educational levels of the couple.

● Type of extended support system.

● Maternal/paternal expectations of the pregnancy.

● Maternal/paternal expectations of the infant.

● Cultural expectations.

Question 34

Risk Factors for Delayed Bonding and/or Attachment

Answer 34

● Maternal illness during pregnancy and/or the postpartum period that interferes with the woman’s ability to interact with her infant

● Neonatal illness such as prematurity that necessitates separation of the infant from the parents

● Prolonged or complicated labor and birth that leads to exhaustion for both the woman and her partner

● Fatigue during the postpartum period related to lack of rest and sleep
● Physical discomfort experienced by women postbirth

● Age and developmental age of the woman, such as adolescent or developmentally challenged

● Outside stressors not related to pregnancy or childbirth (e.g., concerns with finances, poor social support system, or need to return to work soon after the birth)

Question 35

BONDING BEHAVIORS UNIDIRECTIONAL: PARENT → INFANT

Answer 35

En face
Calls baby by name
Cuddles baby close to chest
Talks/sings to baby
Kisses the baby
Breastfeeds the baby or holds the baby close when bottle-feeding

Question 36

ATTACHMENT BEHAVIORS BIDIRECTIONAL: PARENT ↔ INFANT

Answer 36

Parents respond to the infant’s cry.
The infant responds to the parents’ comforting measures
Parents stimulate and entertain the infant while awake.
Parents become “cue sensitive” to the infant’s behavior

Question 37

Nursing actions & expected findings

Answer 37

● Review the prenatal and labor record for risk factors that place woman/couple at risk for delayed bonding/attachment.

● Assess for risk factors that could delay bonding and attachment.

● Early identification of couples at risk can lead to early interventions to enhance bonding/attachment.

● Assess cultural beliefs.

● Type of interactions between parents and infants can vary based on cultural beliefs.

● Assess for bonding and attachment by observation of parent–infant interaction.

● Assessment data provides information for individualizing nursing actions.

● Expected assessment findings:

● Parents hold the infant close.

● Parents refer to the infant by name or proper sex.

● Parents respond to the infant’s needs.

● Parents speak positively about the infant.

● Parents appear interested in learning about the infant.

● Parents ask appropriate questions about infant care.

● Parents appear comfortable holding and caring for the infant.

Question 38

Maladaptive assessment findings

Answer 38

● Maladaptive assessment findings:

● Parents call the infant “it.”

● Parents avoid eye contact with the infant (this can be viewed as adaptive based on culture).

● Parents do not respond to the infant’s cries.

● Parents are emotionally unavailable to the infant.

● Parents allow others to care for the infant, showing no interest (this can be viewed as adaptive based on culture).

● Parents demonstrate poor feeding techniques such as propping bottles, not burping the infant, or seeming to be uncomfortable and/or irritated when nursing.

Question 39

Nursing actions cont..

Answer 39

● Teach parents about bonding and attachment and the importance of these to the child’s development of future relationships.

● Understanding why it is important enhances likelihood of increased bonding and attachment behaviors by parents.

● Instruct parents regarding the importance of parents responding to the infant’s cues such as crying, cooing, and movement.

● Attachment is bidirectional.

● Promote bonding and attachment by:

● Initiating early and prolonged contact between the parent and infant (Fig. 13–2).

● Initiating rooming-in or couplet care.

● Providing positive comments to parents regarding their interactions with the infant.

● Encouraging mothers to breastfeed.
● Encouraging the woman and her partner to talk about their birth experience and feelings regarding becoming parents.

● Promote attachment between mothers and infants separated due to either maternal illness or neonatal complications by:

● Recommending that family members take pictures of the infant and bring them to the mother to keep in her room.

● Assisting parents to the NICU or nursery so that they can see and touch their infant.

● Providing opportunities for parents to care for the infant in the NICU or nursery.

● Instructing the woman on breast milk pumping and encouraging her to bring breast milk to the NICU for use with her infant.

● Informing parents that they can call the NICU or nursery any time of the day or night and talk with the nurse caring for their infant.

Question 40

Parent infant contact

Answer 40

Early contact between the parents and their infant fosters the development of attachment and integration of the infant into the maternal and paternal relationship.

Question 41

reciprocity

Answer 41

As they interact and perform their roles, they find themselves becoming more aware of the cues that make them respond to each other. This interaction cycle of behavior is called reciprocity, a biorhythmic or inherent rhythm that exists between the parents and infant and becomes stronger with each interaction and the passing of time. This sequence of events strengthens the bonding and attachment processes that are the foundation for all the child’s future relationships as he or she grows.

Question 42

maternal touch

Answer 42

New mothers begin to progress through the transition of maternal touch with the first physical contact with their infants (Rubin, 1963a). Most mothers do not instantly feel close to their infants and progress through three stages before feeling comfortable holding her infant close to her body. In the earlier stages, the breastfeeding woman can feel awkward in holding her infant close to feed. Progression through the stages usually occurs over a few hours when a mother has early and continuous contact with her infant. It can take several days if the mother has limited contact with her infant, which can occur if the infant is ill and admitted to an intensive care nursery. These stages, as described by Rubin, are:

Question 43

Stages of maternal touch

Answer 43

● Initial stage: The woman touches her infant tentatively with her fingertips.

● Second stage: The woman, as she becomes more comfortable with herself as a mother, uses her hand to stroke her infant’s head or body.

● Final stage: The mother holds her infant in her arms and brings her infant close to her body.
Rubin’s maternal touch is a component of the acquaintance process through which mothers and infants transition. Mothers go through multiple stages of awareness during early contact with their infants. The first time the new mother touches and meets her infant, she is excited about her infant’s features and verbally responds to sounds and expressions the baby makes. Later, after the new mother enters the final stage of maternal touch, she will hold her infant en face, a position in which the mother and infant are face-to-face with eye contact (Fig. 13–3). The en face position provides a positive connection that facilitates the bonding process. Some cultures believe that you should not gaze into the infant’s eyes.

Question 44

Paternal infant contact

Answer 44

The new father, when holding his child for the first time, may feel awkward and uncomfortable and have a fear of injuring the baby. These feelings will decrease over time with continued contact with the infant.
When expectant fathers participated in the labor and birth of their children in roles that were comfortable for them, they had a greater sense of belonging, which led to deeper engagement in the father role. Reinforcement of this type of involvement has had positive benefits to the family unit and strengthened early and positive parental involvement in the bonding and attachment process. Early physical contact with the infant provides an opportunity for the new father to become comfortable touching and holding, which fosters a more active role in caring for his infant.

New fathers experience an intense preoccupation about and interest in their infants. Greenberg and Morris (1974) identified these behaviors as engrossment (Fig. 13–4). These behaviors can vary based on the cultural beliefs of the couple.

Question 45

The Infant’s Impact on the Father

Answer 45

identified the concept of engrossment that new fathers experience during the postpartum period in relationship to their infants. They defined engrossment as an absorption, preoccupation, and interest with their infants. New fathers can be observed gazing at their infants for prolonged periods of time as if they are in a hypnotic trance. Greenberg and Morris described seven characteristics of engrossment:

● A visual awareness of the infant: Seeing their infant as attractive

● A tactile awareness of the infant: Having a desire to touch the infant

● An awareness of and positive comments about their infant’s distinct features

● A perception that their infant is perfect

● A strong attraction to their infant

● A feeling of strong elation

● An increase of self-esteem

Question 46

Nursing Actions for Parent–Infant Contact-assessment

Answer 46

● Assess for stages of maternal touch.

● Assessment data assists in developing individualized nursing care.

● Expected findings:

● Tentatively touching her infant’s extremities with her fingertips

● Progressing to fuller touch and examination of the infant

● Verbalizing positive comments about the infant

● Snuggling and providing comfort to the infant

● En face positioning to interact with the infant (varies based on cultural beliefs)

● Assess paternal–infant interactions.

● Expected findings (varies based on cultural beliefs)

● Spends prolonged periods of time gazing at the infant

● Assists with infant care

● Holds the infant close to the body

● Expresses delight in his infant’s features

● Verbally and physically expresses love and joy for both his infant and his partner

Question 47

Nursing actions- parental infant contact maladaptive findings

Answer 47

● Maladaptive findings (may be viewed as adaptive based on cultural beliefs)

● Displays little or no interest in the infant

● Makes negative comments about or to the infant

● Ignores the infant’s needs and cues

● Displays sadness or anger to the partner or infant

● Does not spend time with the infant or is emotionally absent

● Experiences mood swings

● Has conflict between family members over the infant

Question 48

Nursing actions parental infant contact- nursing support and education

Answer 48

● Provide early, continuous, and uninterrupted periods of time for parents to see, hold, and interact with their infant.

● Bonding and attachment occur over time and with continued contact.

● Facilitate rooming-in, which provides the opportunity for the infant and father to stay in the mother’s room throughout the hospital stay.

● Promote parental interaction with the infant by delaying unnecessary procedures.

● Provide adequate rest periods for the parents. This ensures they have the stamina and rest to take care of and provide emotional support to each other.

● Provide comfort measures to assist the parents in feeling rested and relaxed.

● Explain to new parents that they may not feel comfortable holding the infant close and that these feelings will decrease with increasing contact with their infant.

● Role model en face positioning.

● Role model appropriate behaviors by calling the infant by name and identifying normal infant behaviors.

● Use therapeutic listening and provide positive feedback to parents when they are verbalizing their feelings about their infant.

● Educate parents about the infant’s unique behaviors and temperament.

● Educate and give information to both parents using multiple models of learning.

● Teaching strategies need to fit the learning style of the parents.

● Provide culturally sensitive care to the family unit.

● The way parents interact with their infant can vary based on cultural beliefs.

Question 49

Cultural Competence

Answer 49

Cultural beliefs influence the ways parents relate to and care for their infants, including the role of fathers during the postpartum period and care of infants. An awareness of variations across cultural practices is an important component in providing appropriate care. Cultural beliefs can influence:

● The degree of the father’s involvement in infant care.

● The role extended family members have in the care of the infant and new mother.

● The method of infant feeding.

● Foods that are eaten and foods that are avoided during the postpartum period.

● When a woman can bathe and wash her hair.

● When the baby is named and who names the baby.

Question 50

COMMUNICATION BETWEEN PARENT AND CHILD

Answer 50

Communication is a bidirectional process that involves a sender and a receiver. People communicate through verbal and written words and through their eyes, ears, faces, and body gestures. Infants can see, hear, and smell; respond to their environments; and display displeasure. They engage in behaviors designed to evoke a response from individuals in their environments. They rely on vocal noises such as crying and cooing, as well as facial expressions and body movements to participate actively in relationship-building with other humans. The challenge to parents is learning the cues infants use to communicate their needs and pleasures.

Nurses are in the unique position to provide information about the infant’s ability to communicate. They can help parents identify infant behaviors and offer appropriate interventions to promote positive interactions. The following are examples of infant communication styles and cues:

● Crying

● Cooing

● Facial expressions

● Eye movements

● Smelling

● Cuddling

● Arm and leg movements

● Entrainment, a phenomenon in which the infant moves his or her arms and legs in rhythm with speech patterns of an adult.

Responding to and encouraging infant communication assists the infant in developing communication and language skills. The parents’ ability to recognize their infant’s positive response cues fosters their confidence in their parenting skills. Teaching parents how to identify their infant’s unique cues and behaviors promotes a positive relationship that empowers the dyad to continue to grow and learn as the infant matures and adds new skills and insights into the relationship.

Parents who are aware of and start to understand infant behaviors by becoming cue-sensitive will be able to identify:

● The best times to communicate with their infant.

● Ways to comfort.

● Methods to help infant self-comfort.

● When the infant is overstimulated and how to provide quiet times during these periods of fussiness.

Infants have very acute senses when interacting with their parents. Infants who are placed on their mothers’ abdomens will crawl to the breast. Infants also interact with their parents by responding to voices and touch. They look en face and root when stimulated. These initial interactions and ongoing interactions lead to synchrony events, which are reciprocal actions between parents and infants that show mutual expressions of contentment. These interactions are very pleasurable for parents and infants. Examples of synchrony events are:

● The mother holding the infant in an en face position. The response to this action is that they gaze into each other’s eyes and talk, coo, or smile at each other.

● The father placing his finger in the infant’s hand. The infant grabs the father’s finger and they gaze at each other.

Question 51

States behaviors and actions in infant

Answer 51

Deep sleep Minimal body twitches and eye movement; cycles between deep and light sleep Do not try to wake up or feed infant.

Light sleep More active body movement; may smile More easily aroused and stimulated

Drowsy Awakens easily; can be rocked back to sleep or made more awake May enjoy being held and cuddled
Responds to gentle stimuli
May self-comfort by sucking

Quiet alert Eyes open; quiet and attentive Best time for interacting

Active alert More sensitive to stimuli, active body movement; may be tired or hungry or need changing Decrease stimuli.
Provide a quiet environment.
Provide comfort measures.
The infant may attempt to self-comfort.

Crying Grimaces, cries, or whimpers
The infant may self-comfort.

Meet infant needs.

Question 52

Nursing actions-parental infant communications

Answer 52

● Review prenatal, labor and birth, and postpartum records for factors that might delay or hinder parent–infant communication and provide early interventions.

● Assess parent–infant interactions.

● Expected findings:

● Parents gently touch their infant and hold the infant close to the body.

● Parents talk to or sing to their infant.

● Parents, when culturally acceptable, hold their infant en face.

● Parents respond to their infant’s cues for interaction and care.

● The infant responds to his or her parents’ touch and voice.

● Role model communication with infant.

● Parents learn through incidental and intentional learning.

● Praise parents for their interactions with their infant.

● Provide teaching on infant communication:

● The infant’s ability and need to communicate

● Eye contact, when culturally appropriate

● Synchronized interactions

● Recognizing and interpreting the infant’s cues

● Entrainment

● Infant alertness states

Question 53

FAMILY DYNAMICS

Answer 53

Family dynamics are the unique ways in which family members interact and participate within the family. Adaptation to these dynamics determines the cohesiveness, or lack thereof, in the family unit.

There are several types of relationships and family compositions. The family structure can be as small as the mother and infant, or as large as two or more generations plus extended family members. Each has its own unique dynamics and structure that present challenges and offers rewarding experiences to nurses who come into contact with these various family compositions. Examples of family compositions include:

● Married or nonmarried male–female couples.

● Married and nonmarried same-sex couples.

● Adoptive couples.

● Adolescent women with partner, mother, and/or grandmother as support system.

● Adolescent women without support system.

● Single adult women with no partner.

● Blended families.

Family members are redefining who they are as individuals and their roles within the family. Adjustments within the couple’s relationship and family unit occur as the couple and family members incorporate and make room for the newest family member. Couples make adjustments within their relationship and learn how to support each other in their roles as parents. They reprioritize their other responsibilities and roles to fit their new roles and responsibilities. Siblings take on the role of older brother or sister and adjust to the decreased amount of time the parents have to interact with and care for them.

The family unit is affected and influenced by changes both within and outside the family. Outside influences, such as friends and relatives, may have positive or negative effects on the family. The couple needs to determine which resources are helpful and which are stressful, and from whom they can seek positive assistance. Nursing care is directed at assisting families in identifying their needs and adjustment during this period of transition.

Question 54

Coparenting

Answer 54

Coparenting is “a conceptual term that refers to the ways that parents and/or parental figures relate to each other in the role of parents” (Feinberg, 2003, p. 96). Coparenting:

● Occurs when the parents have shared responsibilities in child rearing.

● Consists of support for each other and coordination they exhibit in child rearing.

● Does not imply that parenting roles are or should be equal in responsibilities or authority (Feinberg, 2003).

● Develops during the transition to parenthood and is influenced by:

● The parent’s beliefs, values, desires, and expectations.

● The individual’s cultural background and the dominant culture of the society (Feinberg, 2003).

● The infant’s temperament

Question 55

Effect of Infant Temperament on Coparenting

Answer 55

Results:

● Infant difficulty reported by fathers at 3.5 months was associated with a decrease in supportive coparenting behavior.

● Supportive coparenting behaviors observed in fathers at 3.5 months was associated with a decrease in reported infant difficulties.

Recommendations:

● Early interventions to enhance coparenting are essential for families with temperamentally difficult infants.

Question 56

Multiparas

Answer 56

Multiparas may have more knowledge and practice regarding the care of infants, but they usually experience more exhaustion and have less help than with their first child.
● Concerns for her other children

● Will her other children feel abandoned?

● Concerns about being able to love the new child

● Does she have the capacity to love this new child as she does her other child?

● Concerns for her ability to care for more than one child

● Does she have the time and energy to care for an additional child?

● Concerns about her ability to get rest and sleep

● Will she be able to find time for sleep and rest?

● Concerns about having help at home to care for her and her expanding family

● Will family members and friends be willing to help her with a second child?

Question 57

Nursing actions for women who have multiple children

Answer 57

It is important that nurses who care for multiparous women provide them with opportunities to express their concerns, fears, and doubts in caring for and loving another child. Nurses can facilitate this transition by providing reassurance and suggesting strategies in caring for an additional child. Strategies for caring include:

● Spending quality time with the older child when the infant is sleeping.

● Carrying the infant in a sling to free hands for doing things with the older child.

● Having prepared meals ready to use during the day.

● Encouraging the partner to take on more responsibility for cleaning, cooking, and caring for the older child.

Question 58

Sibling Rivalry

Answer 58

Depending on the age of the siblings and birth order, children experience varying degrees of feeling displaced. Younger children experience a sense of loss over no longer being the “baby” of the family. Older children may have a sense of increased responsibility due to their parents’ expectation that they assist in caring for younger children.

Preparing for the new family addition should begin during pregnancy as the parents talk about the expected new baby (see Chapter 5). Providing opportunities for children to feel the fetus move and hear the fetal heartbeat are concrete ways to assist children in understanding the upcoming event. Discussion on what it will mean to have a new baby in the family can also help in adjustment.

Siblings should be introduced to their new brother or sister as soon as possible and spend time with mother and baby during the postpartum hospitalization. They should be allowed to hold and touch the new baby with supervision (Fig. 13–5).

Question 59

Sibling Adjustment

Answer 59

Actions that can facilitate their adjustment include the following:

● Spending time during the prenatal period talking about the upcoming arrival of a new baby

● Providing opportunities for siblings to feel the baby move and hear the heartbeat during the pregnancy

● Providing opportunities for siblings to spend time with their new brother or sister during the hospital stay

● Encouraging siblings to lie in bed with their mother during hospital visits

● Giving siblings a present from their new brother or sister

● Understanding the importance of quality time with other children, such as sitting and reading books with them, playing games, and listening to them

● Taking siblings on a special outing while the infant stays at home with a babysitter

● Explaining why babies cry and how they communicate

Question 60

Nursing Actions for Family Dynamics

Answer 60

● Review the records for relationship issues, pregnancy history, and delivery summary.

● Complications encountered during pregnancy and/or labor and birth can have a negative effect on family dynamics.

● Assess for prior experiences with infants.
● Assess for maladaptive behaviors and make referrals to social services or the community health nurse as indicated.

● Respect cultural beliefs and incorporate them in the nursing care.

● How an individual interacts within the family unit is influenced by his or her cultural beliefs.

● Provide information of the potential adjustments parents, couples, and siblings will encounter as they incorporate the infant into the family.

● Assist parents in identifying ways to assist their other children in their adjustments to the new family member.

● Provide positive verbal reinforcement for their family interactions.

● Provide opportunities for family members to talk about the adjustments within the family.

● Increased communication can decrease misunderstanding.

● Provide opportunities for couples to talk about the adjustments within their couple relationship and ways to enhance their relationship.

Question 61

PARENTS WITH SENSORY OR PHYSICAL IMPAIRMENTS

Answer 61

Parents with sensory impairments such as visual loss or diminished hearing, or those with physical impairments such as decreased mobility, present challenges to nurses and other health care professionals. These challenges can turn into opportunities to creatively adapt nursing care to meet the needs of these parents.
Visual impairment, auditory impairment, and physical impairment vary in degree. Visual impairment ranges from visual loss, where the person can read large print, to complete blindness, where the person has no usable vision. Auditory impairment ranges from mild to profound hearing loss. Those with mild hearing loss have enough hearing to carry on a conversation under ideal conditions. People with profound hearing loss usually rely on sign language to communicate and will not be able to converse orally with hearing people. Physical impairment can range from dependency on a cane to loss of motor control in the arms and legs.

Question 62

Working With Parents With a Sensory or Physical Impairment

Answer 62

It is important to treat parents with sensory or physical impairments as people and not as disabilities. They have the same capacity to love and nurture their infant. They have the same need for information and assistance in learning to care for their infant. They are aware of their limitation due to their impairment and, in most cases, have already developed strategies for caring for the infant. Nurses need to assess parents for their knowledge level and their plans for caring for their infants and then modify nursing care to meet the needs of the new parents.

Question 63

Nursing actions for visually impaired parents

Answer 63

● When reporting, use the person’s name. Do not refer to her as the “blind woman in room 211.”

● When entering a room, address the person by name and introduce yourself and anyone else who is in the room.

● When leaving a room, announce your departure and indicate if others are staying or leaving.

● Speak directly to the person in a clear manner. Do not exaggerate word pronunciation or speak in a loud voice.

● Keep doors, cabinets, and closets closed to prevent injury.

● Use sighted-guide when assisting with ambulation (the visually impaired person holds the elbow of the sighted person when walking). Avoid shoving, pushing, or grabbing unless in an emergency.

● Do not pull on the person’s cane to direct her.

● Do not play with a seeing-eye dog while it is in harness. Ask permission to touch the dog.

● Orient the person to the area of the room or new location after you have guided her to this new area.

● At a given point (the door or bed), orient the room by describing its contents in logical sequence of progressive order (e.g., “To the right as you lie in the bed is the night-stand with the phone and call button; beside that is the bed curtain and then a chair. Next to the chair is the door to the bathroom”).

● Describe the location of food on a plate according to the clock face (e.g., “Potatoes are at 2:00, meat is at 5:00”). Ask the woman if she needs assistance.

● Offer to read printed material or ask for the preferred manner for receiving information that is in printed form.

● Provide space for Braillers and other special equipment used by the woman.

● Provide teaching in a manner the parents can understand. Example of teaching instructions:

● Instruct the parents in diapering by having them diaper their child while you explain the steps.

● Provide discharge teaching and instructions in Braille or on audiotape.

Question 64

Nursing actions for hearing impaired parents

Answer 64

● Face the parents when speaking to them.

● Be articulate but do not exaggerate pronunciation.

● Speak in a normal voice volume.

● Be within 6 to 8 feet of the parents when speaking to them. Make sure that light from windows is behind the parents.

● Avoid putting your hand over your mouth or turning your back to the parents when you are speaking.

● When communicating information with the use of illustrations, provide time for parents to study the illustrations.

● If there is more than one speaker, take turns speaking with clear indications as to who is speaking.

● Minimize background noises (e.g., turn off volume of TV, close the door to the room).

● If there is misunderstanding, do not repeat words louder; instead use synonyms or other words that mean the same thing.

● Provide discharge teaching and information in written form that parents can easily understand.

● Use graphics and visuals when available.

● Ensure a registered interpreter for the deaf person is present when discussing medical information and teaching. When using an interpreter:

● Allow sufficient time for the interpreter to complete a thought.

● Speak directly to the patient and not to the interpreter.

● Avoid saying, “Tell him/her …”

● Check the parent for understanding or if he or she is getting too much information.

● Allow time for questions and concerns.

● A head nod by the parent may have different meanings, such as “yes” or “continue”; it may not mean that the parent understands.

● Flick lights on and off to get the attention of the parent. Do not shout, wave, or touch to get his or her attention.

● Be aware that hearing aids amplify sound 6 to 10 times, so shouting and loud noises can be uncomfortable.

● Provide closed-captioned TV, TDD/TTY (telephone device for deaf), writing pad, and implements.

● Discuss with the parents how they have adapted their home for the infant.

● Some parents will use a device that causes a light to flash in response to the infant’s cry, thus alerting parents to check on their infant.

● Some parents might use closed-circuit TV to monitor the infant while in another room.● Face the parents when speaking to them.

● Be articulate but do not exaggerate pronunciation.

● Speak in a normal voice volume.

● Be within 6 to 8 feet of the parents when speaking to them. Make sure that light from windows is behind the parents.

● Avoid putting your hand over your mouth or turning your back to the parents when you are speaking.

● When communicating information with the use of illustrations, provide time for parents to study the illustrations.

● If there is more than one speaker, take turns speaking with clear indications as to who is speaking.

● Minimize background noises (e.g., turn off volume of TV, close the door to the room).

● If there is misunderstanding, do not repeat words louder; instead use synonyms or other words that mean the same thing.

● Provide discharge teaching and information in written form that parents can easily understand.

● Use graphics and visuals when available.

● Ensure a registered interpreter for the deaf person is present when discussing medical information and teaching. When using an interpreter:

● Allow sufficient time for the interpreter to complete a thought.

● Speak directly to the patient and not to the interpreter.

● Avoid saying, “Tell him/her …”

● Check the parent for understanding or if he or she is getting too much information.

● Allow time for questions and concerns.

● A head nod by the parent may have different meanings, such as “yes” or “continue”; it may not mean that the parent understands.

● Flick lights on and off to get the attention of the parent. Do not shout, wave, or touch to get his or her attention.

● Be aware that hearing aids amplify sound 6 to 10 times, so shouting and loud noises can be uncomfortable.

● Provide closed-captioned TV, TDD/TTY (telephone device for deaf), writing pad, and implements.

● Discuss with the parents how they have adapted their home for the infant.

● Some parents will use a device that causes a light to flash in response to the infant’s cry, thus alerting parents to check on their infant.

● Some parents might use closed-circuit TV to monitor the infant while in another room.

Question 65

Nursing actions for parents with physical impairments

Answer 65

● Provide standard ADA-required facilities, such as raised toilets, wheelchair-accessible rooms and hallways, and easy-to-use call buttons.

● Keep the environment free of clutter.

● Assess the type of assistance needed by asking the parents.

● Discuss the type of assistance parents will need in caring for their infant at home.

● Assist parents in infant care.

● Assist parents in developing strategies to adapt infant care to their limitations.

● Make referrals to social services when indicated for additional assistance.

Question 66

Assisting parents with an impairment

Answer 66

Assisting Parents With an Impairment Nurses can best assist parents who have sensory or physical impairments by exploring, identifying, and implementing techniques, tools, and alternative ways to:
• Facilitate bonding and attachment.
• Teach parents about infant care.
• Promote a safe environment for the infant.
• Enhance the family dynamics.

Question 67

Post partum blues

Answer 67

Postpartum blues, also known as baby blues, occur during the first few postpartum weeks, last for a few days, and affect the majority of women. During this period, the woman feels sad and cries easily but is still able to take care of herself and her infant. (Postpartum psychological complications are discussed in Chapter 14.)

Possible causes of postpartum blues include:

● Changes in hormonal levels.

● Fatigue.

● Stress from taking on the new role of mother.

Signs and symptoms of postpartum blues are:

● Anger.

● Anxiety.

● Mood swings.

● Sadness.

● Weeping.

● Difficulty sleeping.

● Difficulty eating.

Question 68

Nursing actions-post partum blues

Answer 68

● Provide information to the couple regarding postpartum blues. The nurse should:

● Explain that this occurs in the majority of postpartum women.

● Explain the importance of rest in reducing stress.

● Explain to the woman’s partner the importance of emotional and physical support during this period of time.

● Explain that the woman or family should seek assistance from the health care provider if the symptoms persist beyond 4 weeks or if symptoms concern the woman or her family, as she may be experiencing postpartum depression.

Question 69

Problem 1 acute pain

Answer 69

Problem No. 1: Acute pain

Goal: Minimal pain

Outcome: Woman reports that her pain is controlled at a level at or below 2 on a 10-point scale.

Nursing Actions

1. Assess level, location, and type of pain.
2. Assist woman into a comfortable position.
3. Administer pain medications based on assessment data as per orders.
4. Provide an environment that is conducive to relaxation (i.e., low lights, decreased noise, and uninterrupted rest periods).
5. Teach woman relaxation techniques.
6. Demonstrate position when holding infant that promotes maternal comfort (i.e., woman lying on her side with infant next to her, avoiding external pressure on woman’s abdomen).

Question 70

problem 2 knowledge deficit

Answer 70

Problem No. 2: Knowledge deficit

Goal: Improved knowledge of infant care

Outcome: By time of discharge, mother will state she feels comfortable caring for her infant.

Nursing Actions

1. Assess women’s level of knowledge regarding infant care and cesarean births to identify learning needs and level of understanding.
2. Provide information at woman’s level of understanding.
3. Create an environment that is conducive of learning (i.e., turn off TV, close door to room, help mother into a comfortable position).
4. Medicate for pain, if needed, prior to teaching sessions to promote comfort.
5. Provide information on infant care, bonding and attachment, and post-cesarean birth recovery during several short teaching sessions.
6. Assist woman with infant care (i.e., bring infant to her so she can change diaper).
7. Praise mother for infant care behaviors.

Question 71

Problem 3 fatigue

Answer 71

Problem No. 3: Fatigue

Goal: Increased level of energy

Outcome: Woman states that she feels rested.

Nursing Actions

1. Assess level of fatigue.
2. Create an environment that is conducive to rest and sleep by:
   a. Clustering nursing activities to increase the amount of uninterrupted time.
   b. Providing pain management techniques (e.g., pain medications, back rubs).
   c. Closing door to room and dimming lights.
   d. Assisting woman into comfortable position.
3. Explain importance of rest in the healing process.
4. Provide information on high-energy foods.

Question 72

Problem 4 anxiety

Answer 72

Problem No. 4: Anxiety

Goal: Decreased level of anxiety

Outcome: Woman states that she feels comfortable holding and caring for infant.

Nursing Actions

1. Assess the woman’s beliefs, attitudes, concerns, and questions regarding infant care and mothering.
2. Discuss with the woman her labor and birth experience and clarify reasons for cesarean birth and any misconceptions.
3. Discuss with the woman the health of her infant and address her concerns.
4. Encourage the woman to hold infant by:
   a. Explaining the importance of mother–infant contact.
   b. Helping her into a comfortable position.
   c. Bringing infant to her.
5. Praise the woman for her infant care behaviors.