Newborn Nutrition – Patient 1
Client is a G1, P1 27-year-old woman who gave birth to a full-term baby girl through spontaneous vaginal delivery. Client has self-reported to be positive for human immunodeficiency virus (HIV).
done
That’s right!
Rationale:
For newborns who are learning how to suckle, a slow-flow nipple is recommended to prevent choking. Bottles and nipples should be washed with warm, soapy water and then boiled to sterilize them to prevent contamination and infection. Newborns should be offered 15-30 mL of formula per feeding. The amount will increase over time. Ready-to-use formula should not be diluted, but concentrated or powdered formula will need diluting with water. Instructions can be found on all packaging. Infants should be burped regularly while feeding to expel any air that has gotten into the stomach. Bottles of formula should not be placed in the microwave, because it heats fluids in an uneven manner that can result in burns. Concentrated or powdered formula should be diluted with sterile bottled water, or boiled tap water. Ready-to-use formula should not be diluted. Unused formula should be refrigerated and disposed of within 24 hours. The caregiver should hold the infant and bottle while feeding to enhance bonding. It is unsafe to place a blanket, pillow, or other prop near the infant. Infants should not be coaxed to finish a bottle; rather, they should be observed for signs of satiety, such as turning away from the bottle, pursing lips tightly together, or spitting out the nipple. Infants should be in a semi-reclining position while feeding. Unused formula should be covered and kept in the refrigerator for no more than 24 hours. Expired formula should be disposed of. Infants do not need any supplemental water. Formula provides all the fluid needs for the infant.
Newborn Nutrition – Patient 2
Patient Data
0800
Phone message from client: “Hi. I brought my baby home from the hospital yesterday, and I think there’s something wrong with him. He cries the whole time he is awake and only sleeps for 20 minutes and then wakes up crying again. He doesn’t seem to be eating well enough. He only nurses for about 5 minutes or so at a time. My breasts are huge and red, and they hurt. Milk is leaking all the time. I’m so tired. What do I do? Please call me back. I’m so worried there’s something wrong with my baby.”
one
That’s right!
Rationale:
Anytime a new mother reports concern with her infant, it requires the nurses’ attention. A 3-day old infant should feed for at least 15 minutes in a session (Lowdermilk, p. 544). It may take as long as 5 minutes for the milk-ejection (let-down) reflex to occur during the early days after birth. (Murray, p. 790). Infants should sleep for several hours at a time, but inadequate feeding is not the only plausible reason for the infant to be sleeping for only 20 minutes. The client’s milk has likely come in, resulting in large, painful breasts that leak. It is common for a new mother to experience exhaustion and concern.
Newborn Nutrition – Patient 2
Patient Data
0800
Phone message from client: “Hi. I brought my baby home from the hospital yesterday, and I think there’s something wrong with him. He cries the whole time he is awake and only sleeps for 20 minutes and then wakes up crying again. He doesn’t seem to be eating well enough. He only nurses for about 5 minutes or so at a time. My breasts are huge and red, and they hurt. Milk is leaking all the time. I’m so tired. What do I do? Please call me back. I’m so worried there’s something wrong with my baby.”
0900
The nurse returns call to client.
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That’s right!
Rationale:
An infant who has taken bottles or pacifiers may push the nipple out of the mouth or suck poorly during breastfeeding. The infant may become confused about the way to suckle from the breast and is using sucking movements for bottle feeding or for a pacifier. With latching-on difficulty, the infant sucks on the end of the nipple or fails to open his or her mouth widely enough for proper flow of milk. Engorgement is the swelling of the breasts with milk and is most common in the early days of breastfeeding. A 3-day- old infant should have at least three wet diapers a day if he or she has sufficient intake of milk. If the mother can pump milk in addition to breastfeeding, she has an adequate supply. Nipples should protrude and be erect during breastfeeding. Flat or inverted nipples are difficult for an infant to latch onto. Jaundice is a yellowing of the skin.
Newborn Nutrition – Patient 2
Patient Data
0800
Phone message from client: “Hi. I brought my baby home from the hospital yesterday, and I think there’s something wrong with him. He cries the whole time he is awake and only sleeps for 20 minutes and then wakes up crying again. He doesn’t seem to be eating well enough. He only nurses for about 5 minutes or so at a time. My breasts are huge and red, and they hurt. Milk is leaking all the time. I’m so tired. What do I do? Please call me back. I’m so worried there’s something wrong with my baby.”
0900
The nurse returns call to client. Infant has had two wet diapers in 24 hours. Infant has not been given a pacifier or supplemental bottle. The client’s breasts are swollen, but not red. Client has no fever. Client reports the infant is not opening his mouth very widely when he feeds, and client experiences a sharp pain in her nipples while breastfeeding. The infant feeds for about 5 minutes in the football hold before detaching and crying.
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That’s right!
Rationale:
The infant is displaying failure to latch on, as observed through limited feeding time, and client experiences a sharp pain in her nipples while feeding him. Failure to latch on can result in the infant not receiving enough fluids and nutrients, which can lead to jaundice. Sleepiness would manifest as the infant falling asleep while feeding and not detaching to cry. Nipple confusion occurs as a result of the infant being offered a pacifier or supplemental bottle and suckling differently with each. Becoming tongue-tied or developing a cleft palate are not risk factors relating to breastfeeding difficulties.
Newborn Nutrition – Patient 2
Patient Data
0800
Phone message from client: “Hi. I brought my baby home from the hospital yesterday, and I think there’s something wrong with him. He cries the whole time he is awake and only sleeps for 20 minutes and then wakes up crying again. He doesn’t seem to be eating well enough. He only nurses for about 5 minutes or so at a time. My breasts are huge and red, and they hurt. Milk is leaking all the time. I’m so tired. What do I do? Please call me back. I’m so worried there’s something wrong with my baby.”
0900
The nurse returns call to client. Infant has had two wet diapers in 24 hours. Infant has not been given a pacifier or supplemental bottle. The client’s breasts are swollen, but not red. Client has no fever. Client reports the infant is not opening his mouth very widely when he feeds, and client experiences a sharp pain in her nipples while breastfeeding. The infant feeds for about 5 minutes in the football hold before detaching and crying.
The nurse is determining interventions that will help the client successfully breastfeed.
The nurse would recommend which interventions for the mother to try in effort to accomplish the goal of getting the infant to latch on properly?
Select all that apply.
1. Continue to feed the infant in the football hold.
2. Roll her nipples to get them erect before breastfeeding
3. Have the mother hunch forward while breastfeeding
4. Hold her breast with her thumb underneath and four fingers above while breastfeeding
5. Pump for a few minutes just before breastfeeding her infant
6. Help the infant open the mouth widely before attachment to the breast
7. Place cold cabbage leaves on her breasts between feedings
8. Give the infant a pacifier.
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That’s right!
Rationale:
Rolling of the nipples to get them erect is an effective solution at getting an infant to latch on, because it helps the nipple protrude. The erection of the nipples aid in the propulsion of milk through the ducts to the nipple pores. Use of a breast pump for a few minutes just before feedings will help the let-down reflex initiate. Pain with latch and breastfeeding can be caused by a latch which is too shallow; the nurse will recommend making sure the infant mouth is open wide before initiating latch to assure a deeper latch. Because the client’s use of the football hold has not been effective thus far, it is recommended that a different position be used. The mother should have proper back support while breastfeeding and should not hunch forward. This would cause undue stress on her back. The proper hand position for breastfeeding is one in which the client places her thumb above the breast and four fingers below. Cold cabbage leaves compressed to the breasts is an effective mechanism for reducing engorgement and will not assist in helping the infant latch on properly. Giving the infant a pacifier may lead to nipple confusion and will be detrimental to the efforts of getting the infant to latch properly.
0800
Phone message from client: “Hi. I brought my baby home from the hospital yesterday, and I think there’s something wrong with him. He cries the whole time he is awake and only sleeps for 20 minutes and then wakes up crying again. He doesn’t seem to be eating well enough. He only nurses for about 5 minutes or so at a time. My breasts are huge and red, and they hurt. Milk is leaking all the time. I’m so tired. What do I do? Please call me back. I’m so worried there’s something wrong with my baby.”
0900
The nurse returns call to client. Infant has had two wet diapers in 24 hours. Infant has not been given a pacifier or supplemental bottle. The client’s breasts are swollen, but not red. Client has no fever. Client reports the infant is not opening his mouth very widely when he feeds, and client experiences a sharp pain in her nipples while breastfeeding. The infant feeds for about 5 minutes in the football hold before detaching and crying.
The nurse needs to provide breastfeeding education to the client. To facilitate latching on, the
mother may need to try using a different breastfeeding position.
For each breastfeeding position, click to specify the correct information that would be helpful
for the nurse to share with the mother.
Each breastfeeding position may provide more than one advantages. Each category must
have at least one response option selected.
Cradle =
Advantages:
- Infant’s head and body are supported by the arm on the same side of the breast being
used for feeding. - Mother’s other hand is free to hold the breast.
Cross-cradle =
Advantages: - Infant’s head and body are supported by the arm on the same side of the breast being
used for feeding. - Best when infant has a fractured clavicle.
- Best for smaller or preterm infants.
Football =
Advantages:
- Preferred by mothers who have abdominal incision.
- Allows the mother to see the position of the infant’s mouth on the breast.
Side-lying =
Advantages: - Allows the mother to rest while feeding.
- Preferred by mothers who have perineal pain.
Newborn Nutrition – Patient 2
Patient Data
0800
Phone message from client: “Hi. I brought my baby home from the hospital yesterday, and I think there’s something wrong with him. He cries the whole time he is awake and only sleeps for 20 minutes and then wakes up crying again. He doesn’t seem to be eating well enough. He only nurses for about 5 minutes or so at a time. My breasts are huge and red, and they hurt. Milk is leaking all the time. I’m so tired. What do I do? Please call me back. I’m so worried there’s something wrong with my baby.”
0900
The nurse returns call to client. Infant has had two wet diapers in 24 hours. Infant has not been given a pacifier or supplemental bottle. The client’s breasts are swollen, but not red. Client has no fever. Client reports the infant is not opening his mouth very widely when he feeds, and client experiences a sharp pain in her nipples while breastfeeding. The infant feeds for about 5 minutes in the football hold before detaching and crying.
1200
Client reports that the infant breastfed for 15 minutes before sleeping for 1 hour.
The client called at 1200 to report that the infant had breastfed for 15 minutes before sleeping
for 1 hour.
For each statement made by the client, click to indicate whether the statement indicates an
understanding of the teaching provided.
“I will wake my baby every 3 hours to feed again.” = Understanding
“I expect my nipples to crack and bleed.” = Needs Further Teaching
“If this doesn’t get easier, I’ll just stop breastfeeding and switch to formula.”
= Needs Further Teaching
“My baby should have three poopy and six to eight wet diapers every day.” = Understanding
“The cross-cradle hold worked, so that’s the only one I’ll use from now on.” = Needs Further
Teaching
“I will watch closely for redness or lumps in my breasts.” = Understanding
RATIONALE:
Infants should be woken every 3 hours during the day and every 4 hours at night to breast
feed. Painful, red, cracked, blistered, or bleeding nipples are signs of possible mastitis and
should be reported to a healthcare provider. Abruptly stopping breastfeeding can lead to
mastitis. Infants who are receiving enough fluids and nutrition should have approximately
three bowel movements and six to eight wet diapers in a 24-hour period. As infants grow, the
optimal position for breastfeeding may change. Localized edema and tenderness and a hard
area may be palpated on the breast if there is a plugged duct. If not resolved, mastitis may
result.
done
That’s right!
Rationale:
Infants should be woken every 3 hours during the day and every 4 hours at night to breast feed. Painful, red, cracked, blistered, or bleeding nipples are signs of possible mastitis and should be reported to a healthcare provider. Abruptly stopping breastfeeding can lead to mastitis. Infants who are receiving enough fluids and nutrition should have approximately three bowel movements and six to eight wet diap