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INEFFECTIVE BREASTFEEDING Nursing Care Plan

Exclusive breastfeeding is called when an infant has received only breastmilk from his/her mother or a wet nurse, or expressed breastmilk, and no other liquids or solids, with the exception of drops or syrups consisting of vitamins, mineral supplements or medicines.

ASSESSMENT
Subjective:
"I have difficulty every time I have to breastfeed my first baby," as verbalized by the patient.

Objectives:
I observed from the patient that she had a swollen and sore nipples. Red rashes around the nipple area are present. Vital signs are taken and noted as follows: Body temperature is 36.5 degrees Celcius, blood pressure is 120/80 mmHg, respiratory rate is 17 cycles per minute, and pulse rate  of 88 beats per minute.
DIAGNOSIS:
 Ineffective breastfeeding related to nipple sores secondary to red rashes around the nipple area.

PLANNING
After 8 hours of nursing intervention, the patient will be able to breastfeed her baby effectively and nipple sores and rashes will be diminished.

INTERVENTION

Established rapport to the patient to provide trust and quality nurse-client interaction since the affected body part is considered a private part. Assess mother's knowledge and previous experience with breastfeeding. Identify cultural beliefs and practices regarding lactation, let down techniques, and maternal preferences. Provide emotional support to mother and instruct the mother the proper breastfeeding. Note incorrect myths/misunderstandings especially in teenage mothers who are more likely to have limited knowledge and concerns about body image issues.


Determine whether lactation failure is primary like maternal prolactin deficiency, inadequate mammary gland tissues, breast surgery that has damage the nipples, areola enervation. Perform physical assessment, noting appearance of breast and nipples, minimal or no breast enlargement during pregnancy. Note prematurity and infant anomaly such as cleft lift or cleft palate to determine special equipment or feeding needs. Review feeding schedule to note increased demand for feeding at least 8 times/day, taking both breasts at each feeding for more than 15 minutes on each side of use of supplements with artificial nipple.

Provide health teachings such as, wear 100% cotton fabrics, avoid nipple shields or nursing pads that contains plastics. Don't use soap, alcohol, or dying agents on nipples. Apply ice before nursing and soak warm water before attaching to infant to soften nipple and remove dried milk. Apply ice before nursing and begin with least sore side to established let-down reflex. Recommend  using a variety of nursing positions because it helps to provide support with the mother as well as the baby.

Inform mother about early infant feeding cuts like rooting, lip smacking, sucking fingers or hand versus late cues of crying. Early recognition of infant hunger promotes ring timely and more rewarding feeding experience for infant and mother. Recommend avoidance or overuse of supplemental feedings and pacifiers unless specially indicated because it can lessen infant's desire to breastfeed and increase risk of early weaning. Schedule follow up visit with health care provider 48 hours after hospital discharge and 2 weeks after birth for evaluation of milk intake and breastfeeding process.

EVALUATION
After 8  hours of nursing intervention, the patient was breastfed her baby effectively and nipple sores and rashes was diminished.

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