Nursing care plan?

the objectives of breastfeeding are

1) to provide adequate nutrition

2) to prevent trauma to the nipples

3) to facilitate maternal-infant attachment

Can anyone give a suggestion for a nursing diagnosis and care plan for a rather traditional lady partsl delivery(no problems). I was thinking of something with breast feeding because this is a first time mother and both she and her husband were concerned that the baby wasn't getting anything. Although I explained to her that it is normal for the baby to sleep a lot the first 24 hours after birth, they were still concerned. Every time she put baby to breast she would latch on, take a few sucks and then fall asleep again. This is due by tomorrow morning so any suggestions would be of great help. Thanks for all replies in advance! I actually need 2 full plans so any thoughts would be greatly appreciated. Guess I should purchase a care plan book specifically for maternity!

look at diagnoses dealing with hydration, risk for hyperbilirubinemia, and breastfeeding. Start with a diagnosis, move from there using ADPIE. babies do sleep a lot the first day but they have to eat at least Q6h, and more often if they are breastfed, LGA, SGA, or infant of diabetic mother. Generally its Q 2-4h for breast, and Q3-4h for bottle at my facility.

What did you do to help mom get the baby to wake up? What else could you do? Those would be implementations for your care plan.

Also look at mechanical things that would have impeded breastfeeding, such as flat nipples, tongue sucking, cleft palate, inverted nipples, etc. If anything mechanical is there, then think what you would do to solve the problem.

If the delivery went well, look for your 'risk for' diagnoses. What is a mother at risk for? What are her risk factors, and what can you do? If she had a precipitous birth, or has had many children, or is a VBAC then she is a hemorrhage risk. If she is breasfeeding she is risk for breast engorgement, pain, mastitis/infection. What would you do? Again use ADPIE, and you will find your careplan.

Good luck! :)

I am glad to see the risk for hyperbilirubinemia mentioned. I had a very sleepy newborn and the nurses kept telling me not to worry about it and just let him sleep. A day after discharge he was back in the hospital with bili levels over 25. It was very difficult for me because our fragile breastfeeding relationship was stressed further (I couldn't be readmitted with the baby and could only visit him at the NICU). In hind sight I wonder if it wouldn't have been better to wake the baby regularly (at least every four hours) to encourage breastfeeding. I had a lactation consultant fix me up with up a finger feeder that was frustrating to use and did not seem to help. It was a friend and birth instructor who saved our breastfeeding relationship with a simple suggestion: ice on baby's ears. There was actually nothing wrong with the baby's suck. He just would stay awake long enough to latch on successfully.

Shoot...I have to find my notes from OB. I know we used something like knowledge defecit r/t first child or something to that effect. I will look for my notes and careplans tomorrow and if I find them I will post some for your.

I am sorry I didn't respond to this yesterday, but here are some more ideas just in case you are still working on it:

pain r/t cramping during nursing - non-medical interventions could include blanket from the warmer for the abdomen or a k-pad

risk for DVT

definetly knowledge deficit with both self care as she is a prime, newborn cares, if it was a boy, how about knowledge deficit related to care of the circumcised member (assuming he was circ'd)

risk for constipation R/T either pain medication or fear of having a BM (I always tell them anticipation is worse than the actual event :wink2: )

risk for falls r/t blood loss, exhaustion, epidural not completely worn off

Good luck