Question

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Basic Concept ACTIVE LEARNING TEMPLATE: STUDENT NAME CONCEPT Discharge Instructions s/p SVD;baby girl;breastfeeding 19, 25, 26 REMEW MODULE CHAPTER Related Content Underlying Principles Nursing Interventions EOEEPAEVENTION WHO? WHEN? WHY? HOW? ADVANCE DIRECTIVES Provide client teaching on breast care perineal care activity/sleep exercises (kegel's) nutrition contraception warning signs postpartum depression F/U appointment newborn nutrition breastfeeding car seat safety home safety cold stress Shaken baby syndrome warning signs F/U pediatric visit ACTIME LEARNING TE

Answer 1

Breast care

• Instruct the client to use general hygiene and wash the breasts once daily.
• If engorgement occurs,breastfeed frequently,apply warm packs before feeding,apply ice packs between feedings and massage the breasts.
• The client should not use soap on the breasts because it tends to remove natural oils,which increase the chance of cracked nipples.
• If cracked nipples develop ,the client should expose the nipples to air for10 to 20 minutes after feeding,rotate the position of the infant for each feeding and ensure that the infant is latched on to the areola,not just the nipple.
• The bra should be well -fitted and supporting.
• Breasts may leak between feedings or during coitus;place breast pad in bra.

Perineal care

• Apply icepacks to the perineum during the first 24 hours to reduce swelling.
• After the first 24 hours,apply warmth by sitz baths.
• Instruct the client to administer perineal care after each voiding.
• Encourage the use of an analgesic spray as prescribed.
• Administer analgesics as prescribed if comfort measures are unsuccessful.

Activity and Sleep

• Monitor sleep-wake cycle.
• Encourage her to continue to pre-sleep routines
• Promote a relaxing ,low-stress environment such as dumming lights monitoring noise and traffic.
• Plan activities to allow for undisturbed sleep for severa hours
• Encourage routines normally at home.
• Sleep while infant is sleeping.
• Rest when possible to encourage healing

Excercises

• Walking and post partum kegel excercise should begin as soon as possible with a gradual increase to normal ADLs.
• Kegel extremely important to regain muscle tone that is often lost as pelvic tissues are stretched and torn during pregnancy and birth.
• Women who practice Kaegel excercise can benefit in the future by maintaining urinary incontinence,rest,no heavy lifting,walking.
• K egel excercise strengthens muscle tone and bladder control

Nutrition

• Discuss caloric intake with breast feeding and non-breast feeding mothers.
• Nutritional needs depend on prepregnancy weight,ideal weight for health and whether the client is breast-feeding.
• if the client is breast-feeding,calorie needs increase by 200 to 500 cal/day and the client may require increased fluids and the continuance of prenatal vitamins .

Contraception

• Hormonal contraceptives may cause a decrease in the milk supply and are best avoided during the first 6 weeks after birth.
• Oral contraceptives containing estrogen are not recommended for breast feeding mothers;progestin-only birth control pills are less likely to interfere with the milk supply.

Coital

• Fatigue may affect interest in sexual activity.
• Sexual activity can usually be safely resumed by 5 to 6 weeks after birth.
• Water soluble lubrication may increase comfort.

Warning signs

• Vag inal bleeding has increased.
• Fits
• Difficulty breathing
• Headaches
• Calf pain,redness or swelling,shortness of breath or chest pain.

Post partum depression

• Acknowledge the clients feelings and demonstrate a caring attitude.
• Determine availability of family support and other support systems and resources as needed.
• Encourage and assist the client to verbalize her feelings.
• Monitor newborn for appropriate growth and development expectations.
• Assist the significant other and other appropriate family members to discuss feelings and identify ways to assist the client.

F/U appointment

• Follow -up for vag inal delivery is 6 weeks.
• Discharge teaching starts at admission so care instructions are a reinforcement of everything that has been taught throughout the hospital stay.
• Patients are reminded not to place anything in the va gina such as tampoons ,until after they have seen their provider at the 6 week check up .

Newborn nutrition breast feeding

• Put the infant to the mothers breast as soon as the mothers and infants condition are stable.
• Stay with the client each time she nurses until she feels secure and confident with the infant and her feelings.
• Assess LATCH .

Car seat safety

• Until 20lbs and 1 year old ,there should be two staps at shoulders,two at hips and 1 at crotch.
• Breastplate at armpit level.
• Handle in down position.

Home Safety

• Avoid small toys,food as it cause choking.
• Drowning-bath tub,toilet,bucket.
• Baby proof home-electrical cords,medicines,cleaning supplies,stove.

Cold Stress

• Newborns do not shiver to produce heat
• Newborns have brown fat deposits,which produce heat.
• Prevent heat loss resulting from radiation by keeping the newborn away from cold objects and outside walls
• Prevent heat loss resulting from evaporation by keeping the newborn dry and well wrapped
• keep the temperature in room warm.

SIDS

• SIDS prevention by back -to-sleep

Shaken baby syndrome

• Signs and symptoms result from violent shaking and impacting head of small child or infant.

Warning signs

• Haemorrhages in retina
• Skull fractures
• Swelling of the brain.
• Subdural hematomas
• Leg and arm fractures
• Look for handle bruises

F/U paediatric visit

• Complete physical Assesment of the newborn.
• Immunizations are given during the follow-up visits.