zoom lecture

cluster feeding

• baby gets fussy; can be discouraging for mom and dad

• happens 24 hours after birth

• when they put the baby down, the baby wants to go back on the breast

• crying is a late sign of hunger

• important bc moms need a lot of encouragement

• families think the baby is starving

• colostrum is really filling, its thick and nutritious (lots of antibodies too)

  • regular milk comes in 2-3 days after birth

babies that need supplementation breast milk

• hypoglycemia

• preterm babies

  • donor milk or formula

  • sometimes through an OG or NG tube

• cleft palate

ch 16 case study

cracked nipples = baby is not latching properly

uterus deviated to the right = bladder is full

mom hasnt voided (shes supposed to by 6 hours after birth) which means risk for hemmorhage

peri ice pack, motrin, witch hazel, tylenol, lining pads all the way across the episiotomy, peri bottles, abdominal binder for c sections, percocets, may decrease pain

priority physical problem with this patient is that she needs to void and her pain

• pain is causing her to not want to void, ambulate

PRIORITY nursing diagnosis: Acute pain

• also ineffective bonding (because shes at risk for postpartum depression)

interventions

• administer pain medications per MD orders and educate patient on meds/side effects

  • always put “per MD orders” and tell what meds you would use

  • some professors wont allow you to put this as an intervention bc the MD gives these orders not you

• peri ice packs

• educate on topical reliefs

• peri bottle

• sitz baths

outcome/goal

• patient will be comfortable within the next 2 hours

education

• provide patient with support and medical/natural remedies to alleviate pain and swelling

• teach patient about meds, frequent bladder emptying, changing of pads to prevent infection, hand hygiene, etc.

nursing diagnosis

• one physical and one psychosocial (can be 2 physical if need be)

3 interventions

outcome/goal

education

second case study:

placental abruption

PRIORITY nursing diagnosis: Altered Tissue Perfusion

• if you are bleeding out, you have no RBCs and that means no oxygen to tissues

first assessments

• FHR (bradycardia or decelerations)

• TOCO/ palpate abdomen (rigid)

• assess bleeding

  • is it dark red?

• ultrasound

• cervical exam (MD does this)

Nursing actions

• set up an IV (high hemorrhage risk means 2 IVs)

  • advanced maternal age

  • placental abruption

  • not her first baby

• prepare OR for c-section

• grab hemorrhage kits and code cart

Cytotec

• given PO or vaginally

Cervadil

• looks like a tampon string