UNIT 4 POSTPARTUM CARE AND BREASTFEEDING CHAPTER 24 PG 589 PDF Flashcards
(35 cards)
Promoting Self Care
Activity and Rest
Perineal Care
* Perineal Hygiene
* Topical Medications
* Ice Packs
* Sitz Baths
Nourishment
* Formula Feeding Mom
* Breastfeeding Mom
Elimination
* Voiding Patterns
* Bowel Patterns
What is engorgement
Some women experience engorgement at this time due to an increase in blood and lymphatic fluid as milk production increases. Engorged breasts are hard and un- comfortable and mild temperature elevation can occur; the fullness of the nipple tissue can make it difficult for the infant to latch on and feed. With frequent breastfeeding and proper care, engorgement is a tempo- rary condition that typically lasts only 24 to 48 hours
Is rest recommended for Mothers to rest?
The breastfeeding mother should rest as much as possible, especially in the first 1 or 2 weeks after birth. Fatigue, stress, and worry can nega- tively affect milk production and ejection (let-down). The nurse can encourage the mother to sleep when the baby sleeps. Breastfeeding in a side-lying position promotes rest for the mother. The father of the baby, the mother’s partner, grandparents, other relatives, and friends can help with household chores and caring for other children.
Proper Perineal hygiene
Interventions for Perineal Lacerations, Episiotomy, and Hemorrhoids
- Perform hand hygiene before and after cleansing the perineum and changing pads.
- Wash the perineum with mild soap and warm water at least once daily.
- Cleanse from the symphysis pubis to the anal area.
- Apply the peripad from front to back, protecting the inner surface of the pad
from contamination. - Wrap the soiled pad, and place in a covered waste container.
- Change the pad with each void or defecation or at least four times per day.
- Assess the amount and character of the lochia with each pad change.
Ice Compress for Perineal Area
Interventions for Perineal Lacerations, Episiotomy, and Hemorrhoids
Apply a covered ice pack or perineal pad with an enclosed ice pack to perineum from front to back:
* During the first 24 h following birth to decrease edema formation and
increase comfort
* After the first 24 h following birth as needed to provide an anesthetic
effect
Sitz bath
Interventions for Perineal Lacerations, Episiotomy, and Hemorrhoids
- Prepare bath by thoroughly scrubbing with a cleaning agent and rinsing.
- Pad with a towel before filling.
- Fill one-third to one-half full with water of the correct temperature, 38°C–
40.6°C (100.4°F–105.1°F). Some women prefer cool sitz baths instead. If this
is the case, add ice to water to lower the temperature to a comfortable level. * Encourage the woman to use the sitz bath at least twice a day for 20 min. - Place call bell within easy reach.
- Teach the woman to enter the bath by tightening gluteal muscles and keeping
them tightened and then relaxing them after she is in the bath. * Placedrytowelswithinherreach. - Ensureherprivacy.
- Checkthewomanin15min.
Squeeze bottle method off Cleaning Perineum
Interventions for Perineal Lacerations, Episiotomy, and Hemorrhoids
Fill the bottle with tap water warmed to approximately 38°C (100.4°F) (comfortably warm on the wrist).
* Instruct the woman to position the nozzle between her legs so squirts of water reach the perineum as she sits on the toilet seat. Explain that it will take the entire bottle of water to cleanse the perineum.
* Remind her to blot dry with toilet paper or clean wipes.
* Remind her to avoid contamination from the anal area by wiping “front
to back.”
* Apply clean pad.
Topical Medications for Perineal Pain and Hemmoroids
Interventions for Perineal Lacerations, Episiotomy, and Hemorrhoids
- Apply anesthetic cream or spray after cleansing the perineal area: use sparingly three or four times per day.
- Apply witch hazel pads after cleansing the perineum.
- Apply hemorrhoidal cream, as ordered, to the anal area after cleansing.
Should Mom cleanse perineum back to front post partum?
A. Yes
B. No
B. No
- Remind her to avoid contamination from the anal area by wiping “front
to back.” - Apply clean pad.
What is tubal ligation?
, the fallopian tubes are cut, tied or blocked to permanently prevent pregnancy. Is often done during cesarean deliveries
Post Operative Care for Cesarean deliveries
*Epidural is used for Cesarean deliveries
-headache
-hypotension
-temporary nerve damage
Teachings
*SPLINT INCISION SITE WHEN COUGHING OR SNEEZING OR VOMITING TO DECREASE RISK OF DEHISCENSE
*DO NOT LIFT ANY HEAVY THINGS
*Mother is at fall risk due to numbness in her legs
*Monitor epidural sight for clear drainage
*Monitor for signs of infection on cesarean
-swelling
-green, yellow drainage
-pain at incision site
-dehiscence
-foul odor of incision site`
Recovery from Anesthesia
- Monitor respirations
-Monitor Blood pressure
Anesthesia can decrease respiration rate
and can decrease blood pressure (SLOW THE SYSTEM DOWN)
-Assess for bowel sounds
-Monitor if there’s paralytic ileas
Benefits of Breastfeeding for Mom
-Reduce risk for breast cancer
-Reduce risk for ovarian cancer
-Reduce risk of hypertension
-Reduce risk for type 2 diabetes
-Increase secretion of oxytocin which increases involution rate
-Enhance mother and baby bonding
Benefits of Breastfeeding for Baby
REDUCED RISK FOR
- Reduced infant and child mortality
- Reduced risk for Gastrointestinal infections
- Necrotizing enterocolitis in preterm infants
- Crohn’sdisease
- Ulcerative colitis
- Lower respiratory tract infections with hospitalizations
- Acute otitis media
- Obesity in childhood,adolescence,and adulthood
- Type 2 diabetes
- Acute lymphoblastic leukemia
- Sudden infant death syndrome
- Enhanced neurodevelopment outcomes,including higher intelligence
Which of the following hormones is responsible for the milk ejection reflex(MER) or let down reflex?
A. Estrogen
B. Prolactin
C. Oxytocin
D. Progesterone
Oxytocin is essential to lactation. As the nipple is stimulated by the suckling infant, the posterior pituitary gland is prompted by the hypothalamus to produce oxytocin. This hormone is responsible for the milk ejection reflex (MER), or let-down reflex
Physiology of Lactation
Prolactin levels are highest during the first 10 days after birth, gradually declining over time but remaining above baseline levels for the duration of lactation.
Prolactin is produced in response to infant suckling and emptying of the breasts (Fig. 24.3A). Milk production is a supply-meets-demand system (i.e., as milk is removed from the breast, more is produced). The incomplete removal of milk from the breasts can lead to decreased milk supply.
Oxytocin is essential to lactation. As the nipple is stimulated by the suckling infant, the posterior pituitary gland is prompted by the hypothalamus to produce oxytocin. This hormone is responsible for the milk ejection reflex (MER), or let-down reflex
How is Prolactin released?
by the baby sucking and emptying breast
What is a feeding or hunger cue for a baby?
feeding-readiness cues or early signs of hunger. Instead of waiting to feed until the infant is crying in a distraught manner or withdraw- ing into sleep, the mother should attempt to breastfeed when the baby exhibits feeding cues:
* Sucking or mouthing motions
* Hand-to-mouth or hand-to-hand movements
* Rooting reflex—infant moves toward whatever touches the area
around the mouth and attempts to suck
Can a mom who’s breastfeeding feed on demand or whenever the baby presents feeding cues?
A. Yes
B. No
A. Yes
How often should Breastfeeding moms feed baby?
2-3hrs or if baby presents feeding or hunger cues
How often should bottle feeding moms feed baby?
Every 3-4hrs
If your patient has decided not to breast feed what is one of the interventions you could recommend to prevent or relieve engorgement?
To reduce swelling of breast tissue surrounding the milk ducts, ice packs are often recommended in a 10- to 15-minutes-on, 45-minutes- off rotation between feedings. The ice packs should cover both breasts. Large bags of frozen peas make easy packs and can be refrozen between uses.
Fresh, raw cabbage leaves placed over the breasts between feedings can help relieve engorgement. The effect of the cabbage leaves may be related to the coolness of the leaves and phytoestrogens within them. They are washed, dried, chilled in the refrigerator or freezer, and then placed over the breasts for 15 to 20 minutes
Antiinflammatory medications such as ibuprofen can help reduce the pain and swelling associated with engorgement. Ibuprofen also helps reduce fever and aching in the breasts that are often associated with engorgement.
What are the different positions for breast feeding?
-(A) Football or clutch (under the arm) hold.
-(B) Across the lap (modified cradle or cross-cradle).
- (C) Cradling.
-(D) Side-lying.
Is cradling the most or (#1) effective positioning for breastfeeding?
A. True
B. False
B. False
The mother should be encouraged to use the position that most easily facilitates latch while allowing maximal comfort.
