Question

what should the nurse include in the teaching plan for the parents of this infant?

Answer 1

Teaching plan for the parents of this infant are :-

1. Umbilical cord care : -

- Umbilical cord stump is an excellent medium for bacterial growth and can become easily infected.

-Plastic cord clamp is removed when the stump has dried (24-48 hours after birth).

-Stump and base should be assessed for edema, redness and purulent drainage with each diaper change

-If soiled, the area is cleansed with plain water and dried thoroughly.

-Diaper is folded down and away from the stump

-The stump deteriorates through dry gangrene, resulting in an odor

-Average separation time is 10-14 days, dried blood can be seen in the umbilicus at separation.

2. How to breastfeed (latching, sucking, normal feeding patterns) :-

-Positioning is as such, recline with newborn lying prone, skin to skin with mom's bare chest. the mom should support the baby's neck and shoulders with her hand and not push on the occiput. baby's body is held in alignment during latch and feeding.

-To facilitate latch the mother supports her breast in one hand with the thumb on top and four fingers underneath at the back edge of the areola.

-Indications that feeding is going well include a tugging feeling on the nipple but no pinching or pain, baby sucks with cheeks rounded instead of dimpled, baby;s jaw glides smoothly with sucking, swallowing is audible.

-Newborns need to breastfeed at least 8 - 12 times in a 24 hour period. during the first 48 hours after birth most babies do not awaken this often to feed

3. How to bottle feed the baby :-

-Traditionally, parents are told to position patient in semi reclining position and to hold the bottle so that fluid fills the nipple and none of the air in the bottle is allowed to enter it

-A more physiologic approach is held at more of a horizontal angle and is called "paced bottle feeding" which allows the baby to pause between bursts of sucking. it slows the flow of milk from the bottle so the baby is more in control.

-When the baby pauses, the parent withdraws the nipple, allowing it to rest on the baby's lip until he or she is ready to resume

5. Diapering :-

-Diaper rash can be medicated with anticandidal ointments with each diaper change.

-The infants skin should be allowed to dry completely before applying another diaper.

-Do not attempt to retract the foreskin, the HCP will let you know when he is old enough (usually around 3).

-Use disposable diaper wipes or soft cloths and water with gentle cleanser if needed.

6. Bathing :-

-Bathing every 2-3 days is often enough.

-Do not bath immediately after feeding period because increased handling can cause regurgitation.

-Water temperature should be between 38 and 40C (100 to 103.9F).

-NEVER LEAVE INFANT ALONE IN BATH, TEST TEMPERATURE BEFOREHAND

-Clean behind ears daily, begin with face washing then proceed to body, top to bottom.

-Wash genitals last.

-If the hair is to be washed, wrap the infant in a towel with the head exposed to prevent heat loss

-Use mild cleanser with neutral pH and preferably no preservatives

7. Safety & security in hospital :-

- Never leave the newborn in the hospital room without direct supervision

-Request a second staff member to verify the identity of any questionable person who wants to take the baby from the mother's room

-Use caution when posting photos of the new baby on the internet and publishing public notices about the birth

-Know how to identify legitimate hospital personnel - baylor grapevine has word of the day

8. Elimination patterns :-

-Should urinate at least 3-6x for first 1-3 days, minimum of 6-8x voiding after, urine should be pale yellow.

-Stool should transition from meconium to soft yellow or golden yellow.

-Formula fed may have as few as one stool every other day after first few weeks, stools are pasty to semiformed.

-Breastfed infants should have at least three stools every 24 hours for first few weeks, stools are looser and resemble mustard mixed with cottage cheese.