The Complete Nursing Diagnosis and; Care Plan for Postpartum Care

The postpartum period is a vulnerable time, and healthcare providers are well aware of the physical and emotional changes that can occur. To ensure that this time is as successful as possible, they will create a nursing care plan to support new moms and their babies. This plan typically addresses basic healthcare needs, like providing information about infant growth, verifying successful breastfeeding, and helping manage sore nipples. In addition, healthcare providers may also offer resources and support services for mental health issues, such as sleep deprivation and anxiety. With healthcare professionals by your side, you can feel confident that your postpartum experience will be positive. Ineffective Breastfeeding Nursing is an integral part of healthcare, and our professional nurses are dedicated to providing the best care for both mother and baby. With a combination of specialized knowledge from nursing teams and healthcare providers, as well as resources available through support groups – mothers receive the necessary guidance in creating realistic breastfeeding goals which can be successfully achieved with additional family support. Ultimately, by educating all members involved within their realm of expertise; nurses strive towards giving patients optimal experiences when it comes to successful breastfeeding journeys. Nursing Diagnosis: Ineffective Breastfeeding Causes of Related Factors:

• Infancy prematureness
• Birth Defect in a Baby (cleft palate)
• The infant has a weak sucking reflex.
• Related to the mother’s lack of knowledge about proper feeding techniques, resulting in a poor milk supply.

Defining Characteristics

• Inadequate infant intake
• Insufficient emptying of each breast per feeding
• Infant not being able to latch onto the mother’s breast correctly
• Infant arching and crying at the breast, infant exhibiting fussiness and crying within the first hour after breastfeeding;
• Observable signs of inadequate infant intake;
• Infant not responding to comfort measures;
• Persistent sore nipples beyond the first week of breastfeeding

Nursing Assessment: Rationale 1. Take a test of the mother’s knowledge. To get an accurate picture of the patient’s needs and expectations, it is important for us to assess her nursing expertise as well as understand any potential cultural misunderstandings or inaccuracies. 2. Assess the mother’s body and evaluate the findings Carefully monitor the baby’s nurses for a secure latch and strong suck during feedings. Evaluate both breasts to ensure proper engagement of milk ducts and recognize common nursing issues such as engorgement, mastitis, or inverted nipples. 3. Assess the baby’s oral cavity and assess for signs of thrush or other yeast infections. Babies who are prone to yeast infections, such as thrush when it occurs in the mouth during breastfeeding, require special attention and care. Prompt treatment is essential if signs like white patches on the tongue or around the mouth appear; healthcare professionals should be consulted right away. (Sarah Marshall, MD) 4. Assess the mother’s nipples and breast tissue for any breaks, cracks, lumps, or discoloration. Nursing plays an important role in overall breast health. We know that lumps can appear out of the blue, and our job is to monitor any changes so we can make sure patients receive prompt care if needed. By keeping a watchful eye on possible irregularities or suspicious areas, nurses provide peace of mind for those under their care. 5. Evaluate the baby’s eyes and assess for signs of anemia, jaundice, or dehydration. It’s important to keep an eye on a newborn baby’s eyes, as any changes in color or discharge could be indicative of serious conditions. A dull yellowish hue may signal dehydration or jaundice; redness and/or excessive fluid can signify infection. Parents should monitor their infant closely for these signs so they receive appropriate care if needed. 6 Take a temperature reading to see if the baby has a fever or not. If the infant has a fever, it’s important to identify the cause of it and if it needs further medical attention. Risk for Impaired Attachment Assessment Being a pregnant woman in today’s world brings with it many feelings of anxiety and uncertainty, especially when facing the prospect of isolation due to an infection. But even if separated from their newborn is necessary after they are born prematurely or have medical conditions, experienced nurses can be supportive by encouraging skin-to-skin bonding between mother and baby – which has been proven to bring comfort during this difficult transition (Brito et al., 2021). Desired Goals/Outcomes:

• The client will demonstrate an enduring bond through parent-infant interactions.
• Actively taking charge of the newborn’s physical and emotional well-being.
• They are confidently willing to take on the role of a loving caretaker for their young ones.

Nursing Interventions: Rationale 1. Determine whether or not there are any underlying problems or causes that might make it impossible to breastfeed. When breastfeeding is not possible due to factors outside of the baby’s control (such as the use of certain medicines by the mother, the presence of HIV in the mother, or newborn galactosemia), appropriate formula feeding should begin (WHO, 2021). 2. Figure out the shape of the bust and nipple. Successful breastfeeding requires either a normally formed nipple and/or breasts, or the early discovery and treatment of any anomalies, along with ongoing encouragement and support Joshi, H., Magon, P., & Raina, S. (2016). 3. keep track of how well the mother is able to position herself, provide clues, and aid the newborn in latching on. Getting breastfeeding off to a strong start relies on correct positioning and proper latching by the baby. Ensuring these steps are taken properly is essential for successful nursing. (Banginwar, A., Toweir, A., Goyal, R., & Ziyo, F. (2014). 4. Determine if the newborn is able to appropriately grasp and squeeze the areola with their lips, tongue, and jaw, and make note of this information. For breastfeeding to be effective, the baby must be able to “competent suck.” It’s necessary for the jaws to squeeze the milk sinuses underneath the areola. This is accomplished by placing the tongue over the lower gum, which creates a trough around the breast, and by placing the jaws far back on the areola, sealing the trough with flanged lips (Palmer et al, 2015). 5. Observe the baby while they are breastfeeding and make note of how they are sucking and swallowing. When a baby sucks enough, you can see the development of muscles in that area just above the ears. Babies suck at a pace of once per second while breast milk is actively flowing, and the rate of swallowing increases with the amount of milk available (Mayerl, C., Edmonds, C., Gould, F., & German, R. (2021). 6. Take note of any outward manifestations of oxytocin release and evaluate them. The let-down reaction (breast tingling, milk dripping, and uterine cramping) is a sign of oxytocin release and is required for milk transfer to the newborn (Uvnas-Moberg, 2015). 7. Assess and document the baby’s condition during feeding. An alert and content baby is in the ideal state for successful breastfeeding. When infants are either too tired or famished, nursing can become a daunting task; however, with some patience and perseverance, it can be accomplished.  (Brandt, Andrews, Kvale, 2014). 8 Determine how well you know the psychophysiology of lactation and the specific treatments for underlying disorders. It is essential to provide personalized care to each of our clients. The mother of a newborn has the added responsibility to gain knowledge and build mental and emotional strength when caring for her child. Because every mother-child relationship varies, our nursing care plans must be adapted to meet those individual needs. By analyzing each mother’s individual skill set and addressing any specific needs, we can create an effective plan that meets both mother’s and child’s requirements. As a nurse, it is paramount to empower mothers with accurate information tailored specifically toward them so they can properly navigate the new motherhood journey with confidence. (Anna Gavine, 2016). 9. Examine psychological and social factors that influence ambivalence about breastfeedings, such as anxiety, aspirations, values, and lifestyle. An important factor in successful lactation and assisting the breastfeeding relationship between mother and infant is often overlooked: the mental attitude of the mother. It can make a significant difference during the postpartum period when it comes to milk supply, improving the ability of the baby to suck with a poor sucking reflex and increasing lactation hormones. The more relaxed and confident that a mother feels about nursing, the more successful their journey will be into breastfeeding. Having an open mind and trusting relationship with pediatricians is also beneficial for new mothers as it continues to provide support throughout their breastfeeding experience. (Krol, K., & Grossmann, T. (2018). 10. Take a look at your system of people who can help you. Breastfeeding is an incredibly rewarding experience for many mothers, but it can also be challenging. Although support from family members and loved ones is invaluable, support groups made up of other nursing mothers can provide a special kind of support that many find to be extremely beneficial. Participants in support groups bond over their shared experiences and are able to offer emotional support which can help breastfeeding become more successful for everyone involved. Support groups can also offer helpful advice and strategies that family members may not know about, such as proper positioning once the baby latches on or how to tell if the baby is getting enough milk. With the right support in place, breastfeeding is greatly more likely to be effective and an enjoyable experience for people involved. (Dietrich Leurer, M., & Misskey, E. (2015). 11. Encourage ease and relaxation to lessen suffering and stress. It is important to remember that the most important factor in successful breastfeeding is facilitating ease and relaxation. This allows women who are breastfeeding infants to truly embrace their experience without unnecessary stress, which can often be a result of discomfort due to maternal breast anomalies or other issues. Comfort items such as a large pillow and proper breastfeeding pillows can significantly assist with making the process easier, and if genetic breast factors are an issue, seeking consultation from a lactation consultant may help alleviate any physical pain associated with nursing. Women should not undermine the importance of ease and comfort when it comes to breastfeeding, as this could cause them to give up too soon when support is available. (Levene, I., Bell, J., Cole, C., Stanbury, K., O’Brien, F., Fewtrell, M., & Quigley, M. (2022). 12. Ensure that the baby is positioned correctly so that it can latch onto the nipple, and encourage the mother to try again at the next opportunity. High levels of practical and emotional support for the mother can prevent many of the issues that can cause her to stop nursing (Krol, K., & Grossmann, T. (2018). Using alerting tactics (such as providing a variety of auditory, visual, and tactile stimulation by unwrapping the child, positioning the infant upright, or chatting to the infant) or comforting techniques (as needed), return the infant to a quiet-alert state. The baby can be coaxed into a calm, aware condition by a number of different means. A fussy infant may calm down after hearing a familiar phrase repeated, making it simpler to begin breastfeeding (WHO, 2015). When the baby seems to be having trouble swallowing, instruct the mother to massage the breast, burp the baby, and switch to the other breast. Early weaning may occur if mothers feel their milk supplies are insufficient. At each meal, breastfed infants should take food from both breasts. Milk production can be improved and milk output can be stimulated with a little breast massage (Triansyah, A., Stang, Indar, Indarty, A., Tahir, M., & Sabir, M. et al. (2021). 15. Determine if newborn feedings are adequate. Objective criteria for baby intake include test weights when necessary, bowel movements, growth in line with age, and the frequency and quality of feedings. (Meier et al, 2000) 16. It is strongly recommended that exclusive, successful breastfeeding be encouraged, and the use of additional bottle feedings be actively discouraged. As well as raising the risk of allergies and discouraging exclusive breastfeeding, giving a baby formula or other complementary foods might send the subliminal message that the mother’s breast milk is not sufficient, which can discourage breastfeeding (Masters, I., Gijsbers, B., & Bartholomew, L. (2018). 17. Recognize mom’s feelings, and back her up whether she decides to stick with the original plan or try something new. The mother has to feel confident and capable so that she can make educated decisions about newborn feeding, which is a crucial first step in mothering (E Phuma-Ngaiyaye, 2016). 18. Provide proper referrals and diligent follow-up. Successful feeding and parenting are more likely when healthcare providers work together. This is especially true when it comes to neonatal nutritionists, physical therapists, occupational therapists, home-visiting nurses, and lactation specialists (MacGillivray, S 2016). 19. If the mother is unable to successfully breastfeed, assist them in accepting and learning an alternative method. If a woman decides to switch to a different manner of feeding her baby, she will need guidance and information (NCBI, 2015). References:  Skin-To-Skin Contact and Suckling in Early Postpartum: Effects on Temperature, Breastfeeding, and Mother-Infant Interaction – ProQuest. (2023). Retrieved 4 January 2023, from https://www.proquest.com/openview/2b87e210c1b073b76f66f46fdca825ae/1?pq-origsite=gscholar&cbl=2026366&diss=y (2023). Retrieved 4 January 2023, from https://samples.jblearning.com/9781284091045/9781284091045_CH05_Pass04crx.pdf EA;, V. A. H. B. L. M. (n.d.). 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Krol, K., & Grossmann, T. (2018). Psychological effects of breastfeeding on children and mothers. Bundesgesundheitsblatt – Gesundheitsforschung – Gesundheitsschutz, 61(8), 977-985. doi: 10.1007/s00103-018-2769-0

Mayerl, C., Edmonds, C., Gould, F., & German, R. (2021). Increased viscosity of milk during infant feeding improves swallow safety through modifying sucking in an animal model. Journal Of Texture Studies, 52(5-6), 603-611. doi: 10.1111/jtxs.12599

Levene, I., Bell, J., Cole, C., Stanbury, K., O’Brien, F., Fewtrell, M., & Quigley, M. (2022). Comparing the effect of a lactation-specific relaxation and visualization intervention versus standard care on lactation and mental health outcomes in mothers of very premature infants (the EXPRESS trial): study protocol for a multi-center, unmasked, randomized, parallel-group trial. Trials, 23(1). doi: 10.1186/s13063-022-06570-9

Triansyah, A., Stang, Indar, Indarty, A., Tahir, M., & Sabir, M. et al. (2021). The effect of oxytocin massage and breast care on the increased production of breast milk of breastfeeding mothers in the working area of the public health center of Lawanga of Poso District. Gaceta Sanitaria, 35, S168-S170. doi: 10.1016/j.gaceta.2021.10.017

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