postpartum
The student nurse places the preterm infant on the mother's bare chest and covers it with a warm blanket. As part of the evaluation, the nurse asks the reason for this intervention. Which response indicates the student needs further learning?
"It reduces the distress in the patient. The preterm infant is not placed on the patient's chest to reduce distress. Rather, this intervention is done to ensure skin-to-skin contact with the infant and promote the mother-infant attachment. The infant is at risk of losing heat, so placing the infant on the mother's chest prevents the quick loss of heat, thereby improving thermoregulation. Finally, placing the infant on the mother's chest also helps initiate breastfeeding and strengthens the bond between the infant and the mother.
The nurse is caring for a North American, postpartum patient who is visually impaired. The nurse finds that the mother is having a difficult time establishing attachment with the infant. What suggestion would the nurse give the mother to create an effective interaction with the infant?
"Nod and smile while talking to the infant." The infant wants to interact with the mother by looking at the mother's eyes and facial expressions. Visually impaired mothers may show impassive facial expressions, which makes the infant uninterested. The infant may abandon the mother and try to interact with other family members. The mother can interact efficiently by nodding and smiling frequently while talking. This conceals the impassive facial expressions of the mother. Because the father cannot improve the facial expressions of the mother by standing nearby, the father cannot improve the interaction between the mother and infant by standing nearby. As the infant looks at the face of the mother to interact, holding the newborn's hand while talking will not improve the interaction either. The mother should give spontaneous responses to the child's actions. Waiting for others to tell her about the infant's actions may not be helpful in this situation.
A patient reports having difficulty ejecting milk while breastfeeding the infant. Which nursing interventions would help the patient breastfeed the newborn with greater ease? Select all that apply.
A. Teach the patient about the infant's rooting and sucking reflexes. B. Ask the patient to breastfeed the newborn immediately after birth. C. Explain frequent milk expression and early skin-to-skin contact to the patient The patient reports having problems with lactation. Thus the nurse should assist in establishing and maintaining a successful breastfeeding process for the patient. To do this, the nurse should teach the patient about the infant's rooting and sucking reflexes. The patient should be asked to immediately breastfeed the child after birth. Then the nurse has to explain frequent milk expression and early skin-to-skin contact to the patient for optimized milk supply. Placing the newborn skin-to-skin with the parent immediately after birth is not useful for breastfeeding. The nurse has to talk to the patient about the infant's capabilities for interaction while teaching the patient how to nurture the infant in the first year of life, but these interventions are not in response to problems with lactation.
The patient reports that her older child is not getting to know the newborn. Which nursing interventions can help the older sibling accept the baby? Select all that apply.
Ask the parents to provide gifts to the older sibling on behalf of the baby. Instruct the parents to encourage the sibling to touch and hold the newborn. Instruct the parents to spend some time with their older child An older sibling may feel rejected by the parents after the arrival of a newborn. Instructing the parents to spend time with their older child may help the older child adapt to these changes. The parents can also provide small gifts to the older sibling during the hospital visit, which helps instill positive feelings in the sibling about the infant and help promote acceptance. The sibling is slowly encouraged to touch and hold the infant, which helps develop a bond between them. The patient should not continuously hold the baby in the presence of the older child, as this may increase feelings of jealousy and sibling rivalry. The sibling should be closely supervised when playing with the newborn to ensure the safety of the newborn, because the sibling may not be able to take proper care of infants.
The nurse is caring for an adolescent postpartum patient. The nurse finds that the adolescent father considers the transition to be very stressful. Which nursing interventions would help the adolescent father have a more comfortable transition? Select all that apply.
Asking the father to be present during the postpartum home visits Asking the father to accompany the mother and baby for baby care checkups Asking the father to participate in the teaching sessions of infant care During the hospital stay, it is good to include the father in the teaching sessions on infant care. This enables the father to have more knowledge about baby care. Asking the father to be present at the postpartum home visits would assist the couple in reducing the problems with baby care. By accompanying the baby and mother to the baby care checkups, the father can gain knowledge about baby care and can also comfort the mother. This makes the transition easier for the couple. Performing the baby care activities requires the involvement of both parents. It is not good to keep up only with household activities, leaving the baby behind with the mother, because this could cause the father to feel powerless and ridden with guilt.
the nurse is caring for a postpartum patient with visual impairment. Which interventions should the nurse follow to interact with the patient efficiently? Select all that apply.
Assess the patient's capabilities. Take suggestions from the patient. Provide written materials in Braille Assessing the capabilities of the patient helps in planning the methods to educate the patient efficiently. Taking the suggestions from the patient is beneficial as it gives the patient a chance to tell the nurse what is more effective when it comes to the nurse's teachings. Providing the patient with written materials in Braille helps her understand the instructions efficiently. Educating the mother just orally will not be sufficient, because there are certain instructions that can be understood only through demonstration. Educating the patient's partner alone is not helpful, because both parents are equally responsible for looking after the infant.
A patient sings, verbalizes, and coos at the baby when the baby cries. Following this, the nurse finds that the baby averts the eyes and yawns. Which of the patient's actions would make the infant become fussy again?
Continuing to coo at the infant When a baby averts the eyes and yawns, the patient should be taught to decrease the active responses, such as singing and cooing. If the patient continues cooing, the infant may become fussy and cry again. Placing the baby in the cradle, waving hands at the infant, and making eye contact will not cause the infant to become fussy. Rather, these actions are helpful in making the infant quiet and alert.
Which culturally appropriate beliefs should the maternity nurse use to incorporate parental-infant attachment into the plan of care? Select all that apply.
Jordanian mothers have a 40-day lying-in after birth. Japanese mothers rest for the first 2 months after childbirth Jordanian mothers have a 40-day lying-in after birth, during which their mothers or sisters care for the baby. Japanese mothers rest for the first 2 months after childbirth. Asian mothers must remain at home with the baby up to 30 days after birth and are not supposed to engage in household chores, including care of the baby. Hispanic practice involves many food restrictions after childbirth, such as avoiding fish, pork, and citrus foods. Vietnamese mothers may give minimal care to their babies and refuse to cuddle or further interact with the baby to ward off "evil" spirits.
Which statement regarding postpartum depression (PPD) is essential for the nurse to be aware of when attempting to formulate a plan of care?
PPD can easily go undetected PPD can go undetected because parents do not admit voluntarily to this type of emotional distress out of embarrassment, fear, or guilt. PPD symptoms range from mild to severe, with women having good days and bad days. Screening should be done for mothers and fathers. PPD may also occur in new fathers. The nurse should include information on PPD and how to differentiate this from the baby blues for all patients on discharge. Nurses also can urge new parents to report symptoms and seek follow-up care promptly if they occur.
The nurse observes several interactions between a postpartum woman and her new son. What behavior (if exhibited by this woman) does the nurse identify as a possible maladaptive behavior regarding parent-infant attachment?
Seldom makes eye contact with her son The woman should be encouraged to hold her infant in the en face position and make eye contact with him. Talking and cooing to her son is a normal infant-parent interaction. Cuddling is a normal infant-parent interaction. Sharing her son's success at feeding is a normal infant-parent interaction.
While speaking to the newborn's father in a well-child visit, the nurse finds out that the newborn's father is feeling depressed and bored, as the mother spends most of her time with the infant. What instruction should the nurse give to the father in this situation?
Share your feelings with your partner." Postpartum women spend most of their time caring for the infant, especially those mothers who breastfeed and may not easily be able to share child care duties with their partners. As a result, the infant's father may feel depressed, bored, and jealous of the infant. The infant's father should express these feelings so that the mother can make more time for her partner. It is not appropriate to tell the father to spend more time with his friends, as this does not solve the problem in the home. Even if the father comes home early from work, the mother may not be able to spend time with the father, so this suggestion is not necessarily helpful. Engaging in other activities may relieve the infant's father from boredom but not from depression and jealousy. The father would get relieved of these feelings by having the mother's attention and care.
The nurse is caring for a postpartum patient with a hearing impairment. The nurse finds that the patient's partner is also hearing-impaired. What does the nurse suggest to both parents to improve vocalization in the newborn?
Show the infant recordings of television programs While interacting with the parents of an infant who are hearing-impaired, the nurse should suggest that the parents show video recordings to the infant to improve vocalization, as this helps the newborn become familiar with human voices. Interacting with the child using sign language can enhance communication, but may not help to improve vocalization. Playing rhymes and music at a very high volume may damage the eardrum of the infant and can lead to hearing impairment. Asking a family member or friend to talk to the baby is a good solution, but it may not be a practical solution if the parents care for the child independently.
A new parent reports inadequate sleep leading to fatigue. Which measures does the nurse suggest to promote sleep in the new parent? Select all that apply.
Take a nap when the infant sleeps. Make the bedroom dark and quiet while sleeping. Take help from family members for care of the infant. The parent may not get enough sleep because of the demands of infant care and household responsibilities. Therefore the parent should adjust sleep time to the infant's sleep time, and nap when the infant sleeps. Sleep can be promoted by making the bedroom dark and quiet. The family members can help the parent with infant care to give the parent time to rest. Performing strenuous exercise is not advised, because it can cause fatigue in the new parent. Increasing coffee consumption can interfere with the sleep quality by stimulating the central nervous system (CNS).
The nurse tells a postpartum patient, "You should stop talking and cooing to your baby now." What is the reason behind this instruction?
The infant was crying incessantly Pouting or crying, arching of the back, and general squirming are usually signals to end an interaction with the infant. Therefore, the nurse should ask the patient to stop talking and cooing to the infant. The nurse would not give such an instruction to the patient if the infant smiled, reached out for the patient, or raised an eyebrow upon seeing the patient. The infant smiles or laughs when stimulated by game playing. The infant greets parents by waving hands and reaching out for the parents. The infant raises an eyebrow to show loving attention toward the parents.
A mother who had a vaginal delivery reports being restless and having insomnia and regular episodes of headache 4 days after childbirth. What would the nurse infer about the mother's clinical condition from these symptoms?
The mother likely has postpartum blues The depressed phase after pregnancy and delivery is known as postpartum blues, or "baby blues," where the mother may experience restlessness, insomnia, and headache. Episiotomy would cause other symptoms related to pain, such as restlessness and insomnia, but it would not cause the mother to experience headaches. The pink phase of the postpartum period is the period where the woman experiences a sense of heightened joy and feelings of well-being. Anesthesia is not given during vaginal delivery, so this is not a factor in her postpartum symptoms.
The nurse observes that the newborn is responding well to the parent. Which behavior from the newborn did the nurse observe to come to this conclusion?
The newborn was dancing in tune with the parent's voice When parents speak, infants tend to get excited and dance in tune with the parent's voice. This indicates that the infant is responding well to the patient. The newborn should ideally look at the parent when the parent tries to communicate. If the newborn looks toward the wall, it indicates that the newborn is not responding well to the parent. If the newborn keeps the upper and lower limbs still when the parent interacts, it indicates that the newborn is not responding well to the patient.
In follow-up appointments or visits with parents and their new baby, it may be useful if the nurse can identify parental behaviors that can either facilitate or inhibit attachment. What is a facilitating behavior?
The parents hover around the infant, directing attention to and pointing at the infant Hovering over the infant, as well as obviously paying attention to the infant, is a facilitating behavior. Reluctance to name the infant is an inhibiting behavior. Failure to interpret the actions and needs of the infant is an inhibiting behavior. Lack of fingertip, palmar touch, and holding represents an inhibiting behavior.
The nurse assesses a patient 3 days after childbirth. Which behaviors would indicate that the mother has adjusted well in the postpartum period? Select all that apply.
The patient desires to take charge of the infant The patient handles physical discomfort and emotional changes The patient will be in a taking-hold phase or dependent-interdependent phase 2 to 10 days after childbirth in which she will be more willing to take care of the baby and become a competent mother. During this period, the mother is more focused on child care and handles physical discomfort and emotional changes well. These behaviors in the patient indicate that the patient is well adapted to the postpartum period. The patient is excited and talkative and has the desire to review the birth experience within the first 24 hours after birth (dependent/taking-in phase) but not later. The patient indicates an interest in sexual intimacy during the letting-go phase, but not in the taking-hold phase.
The nurse observes that a patient of Southeast Asian descent avoids cuddling and touching her newborn. What can the nurse infer about the patient from these observations?
The patient may be trying to protect the child from evil spirits Patients of Southeast Asian descent believe that minimal touching and cuddling of the newborn after birth protects the child from evil spirits. If the patient had postpartum blues, the patient may show different symptoms such as crying episodically. If the patient does not hold or feed the child, it would indicate that the patient is afraid of handling the child. Avoiding cuddling and touching the newborn does not indicate that the patient is improving the baby's strength and immunity. Southeast Asians believe that massaging the newborn would be helpful in improving the baby's strength and immunity.
the nurse observes that a postpartum patient does not talk or smile during breastfeeding but instead quietly maintains her gaze on the infant. What does the nurse infer from this observation?
The patient wants the infant to suck the milk without interruption While learning to breastfeed, women may refrain from talking or smiling excessively so that the infant will not be distracted and will continue to feed. The patient does not avoid talking to soothe and quiet the infant; instead, she may gently stroke the infant to provide comfort after feeding. Avoiding speaking with the infant is not helpful for coping with depression and is not a typical behavior of postpartum blues. The mother's quiet behavior during breastfeeding does not indicate that she has not properly bonded with the baby.
While caring for a patient, the nurse notices that the newborn's paternal grandparents visit the newborn and leave after an hour. The maternal grandparents, on the other hand, stay all day with the couple to look after the newborn. What could be the reason for this in terms of traditional paternal grandparents' cultural behaviors?
They do not feel responsible for the care of the newborn or new mother While no family follows just one pattern, in American culture the paternal grandparents are typically considered secondary to the maternal grandparents after the baby is born. This is because a woman may be closer to her own parents and feel more comfortable accepting their help than that of her partner's family. As a result, paternal grandparents may be naturally less involved with the newborn. There are no cultural rules in the American culture dictating that paternal grandparents care for the second-born child or bond with the baby only after 6 months. Grandparents are not typically responsible for the financial expenses of the baby in the United States.
While assessing a Japanese patient, the nurse finds that the patient breastfeeds and bottle-feeds the infant until the infant is 2 or 3 months old. What is the reason behind this?
This provides adequate rest to the patient People belonging to the Japanese culture prefer to both breastfeed and bottle-feed their infants, as this helps the mother get adequate rest. If the infant's hunger is not satisfied with breastfeeding alone, then the nurse can conclude that the patient has reduced milk production. It is more difficult to digest formula than that of the mother's milk. Therefore both breastfeeding and bottle-feeding the milk will not help to improve digestion in the infant. If the patient is conscious about her physique, she would completely avoid breastfeeding the infant.
While teaching the patient about breastfeeding, the nurse instructs the patient to rub the infant's back after feeding. What is the reason for this instruction?
To provide comfort to the infant Patting or gently rubbing the infant's back provides comfort to the infant after feeding. Gentle stroking on the infant's back helps to soothe and quiet the infant. Making eye contact with the infant helps to develop a bond and enhances the trust between the mother and infant. Touching the infant with the mother's fingertips and caressing the infant's trunk help to develop attachment with the infant.
When helping a woman cope with postpartum blues, what suggestions should the nurse offer? Select all that apply.
Use La Leche League or community mental health centers Get plenty of rest. Plan to get out of the house occasionally Suggestions for coping with postpartum blues include: (1) Remember that the "blues" are normal and that both the mother and the father or partner may experience them. (2) Get plenty of rest; nap when the baby does if possible. Go to bed early, and let friends and family know when to visit and how they can help. (Remember, you are not "Supermom.") (3) Use relaxation techniques learned in childbirth classes (or ask the nurse to teach you and your partner some techniques). (4) Do something for yourself. Take advantage of the time your partner or family members care for the baby—soak in the tub (a 20-minute soak can be the equivalent of a 2-hour nap), or go for a walk. (5) Plan a day out of the house—go to the mall with the baby, being sure to take a stroller or carriage, or go out to eat with friends without the baby. Many communities have churches or other agencies that provide child care programs such as Mothers' Morning Out. (6) Talk to your partner about the way you feel—for example, about feeling tied down, how the birth met your expectations, and things that will help you (do not be afraid to ask for specifics). (7) If you are breastfeeding, give yourself and your baby time to learn. (8) Seek out and use community resources such as La Leche League or community mental health centers.
When making a visit to the home of a postpartum woman three days after birth, the nurse should recognize that characteristically the woman would do what?
Vacillate between the desire to have her own nurturing needs met and the need to take charge of her own care and that of her newborn. Vacillating between the desire to have her own nurturing needs met and the need to take charge of her own care and that of her newborn is characteristic of the taking-in stage, which lasts for the first few days after birth. Expressing a strong need to review events and her behavior during the process of labor and birth is characteristic of the taking-in stage, which lasts for the first few days after birth. One week after birth, the woman should exhibit behaviors characteristic of the taking-hold stage. This stage lasts for as long as 4 to 5 weeks after birth. Reestablishing her role as a spouse/partner reflects the letting-go stage, which indicates that psychosocial recovery is complete
