TEACHING PLAN FOR BREASTFEEDING DESCRIPTION OF THE LEARNER:
The learner is Benilda Gonzale 32 years old female born on june 2, 1979 who was admitted for Low Section Cesarean section section surgery. The learner is resideing at Bayo st. San Vicente, Baguio City, singe, Jehova’s Witness as her religion. She is able to understand and communicate in Filipino, Ilocano and English but prefers being instructed using the Filipino language . LEARNING NEED: Additional guidelines in breastfeeding LEARNING DIAGNOSIS: Knowledge Deficit: provision of care related to lack of knowledge regarding breastfeeding. breastfeeding. GOAL: After the series of nursing education, the patient would be able to demonstrate proper breastfeeding techniques. BEHAVIORAL LEARNING OBJECTIVES
LEARNING CONTENT
Upon pon com completi letio on on the the top topic regardin regarding g breastfee breastfeeding ding,, the patient patient will be able to: 1. Enumerate 4 out of 5 Advantages of Breastfeeding Breastfeeding advantages of breastfeeding to to the Mother the mother.
2. Enumerate
4 out of 4 Advantages of Breastfeeding Breastfeeding advantages of breastfeeding to to the Baby the newborn.
3. Demonstrate the proper Lactation and Proper positioning techniques in Positioning Techniques in feeding the newborn. Breastfeeding; Promoting Adequate Sucking
4. Demonstrate the proper Techniques for Burping the technique in burping the Breast-fed Baby newborn after intake of milk.
5. Enumerate 3 out of 3 ways of Preventing or r elieving or preventing Engorgement engorgement of nipples.
6. Enumerate 3 out of 4 factors
that could
Relieving
Promoting Healing of Sore worsen sore or Nipples
TEACHING STRATEGY, METHODS AND ACTIVITIES
TIME ALLOTMENT AND RESOURCES NEEDED
Lect Lectur ure e hand-outs
disc discus ussi sion on,, 10 minutes, hand-out
Lect Lectur ure e hand-outs
disc discus ussi sion on,, 10 minutes, hand-out
METHOD OF EVALUATION
Instant Instant oral feedback feedback:: The patient will be able to share her r ealization, unde unders rsta tand ndin ing, g, and and the their appr appre ecia ciatio tion regarding the advantages of breast breastfee feedin ding g to the patient herself. Instant Instant oral feedback feedback:: The patient will be able to share her r ealization, unde unders rsta tand ndin ing, g, and and the their appr appre ecia ciatio tion regarding the
advantages of breastfeeding to the baby. Return demonstration: the patient would be Demonstration, 30 minutes, visual aids able to demonstrate the proper positioning techniques in feeding the newborn with a pillow as a substitute for a baby. Return demonstration: the patient would be Demonstration, 20 minutes, visual aid able to demonstrate regar ding proper the proper burping burping techniques techniques in feeding the newborn with a pillow as a substitute for a baby. Instant oral feedback: the patient would be Lecture discussion, 10 minutes, hand-out able to enumerate all hand-outs ways of preventing or relieving engorgement of nipples and expresses ways on how she can apply these things to her daily living. Instant oral feedback: the patient would be Lecture discussion, 10 minutes, hand-out able to verbalize 3 or all the causes of sore
painful nipples.
7. Demonstrate ways of promoting Promoting Healing of Sore Demonstration, healing of sore nipples. Nipples
or painful nipples. Return demonstration: the patient would be able to show the ways 15 minutes, visual aids on promoting healing of regarding promoting sore nipples. healing of sore nipples Instant oral feedback: with pictures the patient would be able to verbalize in her
3. Demonstrate the proper Lactation and Proper positioning techniques in Positioning Techniques in feeding the newborn. Breastfeeding; Promoting Adequate Sucking
4. Demonstrate the proper Techniques for Burping the technique in burping the Breast-fed Baby newborn after intake of milk.
5. Enumerate 3 out of 3 ways of Preventing or r elieving or preventing Engorgement engorgement of nipples.
6. Enumerate 3 out of 4 factors
that could
Relieving
Promoting Healing of Sore worsen sore or Nipples
advantages of breastfeeding to the baby. Return demonstration: the patient would be Demonstration, 30 minutes, visual aids able to demonstrate the proper positioning techniques in feeding the newborn with a pillow as a substitute for a baby. Return demonstration: the patient would be Demonstration, 20 minutes, visual aid able to demonstrate regar ding proper the proper burping burping techniques techniques in feeding the newborn with a pillow as a substitute for a baby. Instant oral feedback: the patient would be Lecture discussion, 10 minutes, hand-out able to enumerate all hand-outs ways of preventing or relieving engorgement of nipples and expresses ways on how she can apply these things to her daily living. Instant oral feedback: the patient would be Lecture discussion, 10 minutes, hand-out able to verbalize 3 or all the causes of sore
painful nipples.
or painful nipples. Return demonstration: the patient would be able to show the ways 7. Demonstrate ways of promoting Promoting Healing of Sore Demonstration, 15 minutes, visual aids on promoting healing of healing of sore nipples. Nipples regarding promoting sore nipples. healing of sore nipples Instant oral feedback: with pictures the patient would be able to verbalize in her 8. Discuss the reason why Weaning the Baby Lecture discussion, 10 minutes, hand-out own words the reason mothers should wean the handouts behind weaning the newborn gradually. baby gradually.
LEARNING CONTENT
INTRODUCTION: It is universally agreed that breast milk is the preferred method of feeding a
painful nipples.
or painful nipples. Return demonstration: the patient would be able to show the ways 7. Demonstrate ways of promoting Promoting Healing of Sore Demonstration, 15 minutes, visual aids on promoting healing of healing of sore nipples. Nipples regarding promoting sore nipples. healing of sore nipples Instant oral feedback: with pictures the patient would be able to verbalize in her 8. Discuss the reason why Weaning the Baby Lecture discussion, 10 minutes, hand-out own words the reason mothers should wean the handouts behind weaning the newborn gradually. baby gradually.
LEARNING CONTENT
INTRODUCTION: It is universally agreed that breast milk is the preferred method of feeding a newborn, because it provides numerous health benefits to both the mother and the infant; it remains the ideal nutritional source for infants through the first year of life (Kleinmann, 2004). Nurses are prime people to teach women about the benefits of breast-feeding and provide anticipatory guidance for problems that may occur. ADVANTAGES OF BREASTFEEDING TO THE MOTHER Breastfeeding may serve a protective function in preventing breast cancer. The release of oxytocin from the posterior pituitary gland aids in uterine involution (the reduction in size of the uterus after childbirth). Oxytocin is released whenever a mechanical stimulus is initiated by the sucking mechanism of the infant. Successful breast-feeding can have an empowering effect, because it is a skill only a woman can master Breast-feeding reduces the cost of feeding and preparation time. Breast-feeding provides an excellent opportunity to enhance a true mutual bond between mother and child. ADVANTAGES OF BREASTFEEDING TO THE BABY Breast milk contains secretory immunoglobulin A (IgA), which binds large molecules of foreign proteins, including viruses and bacteria, keeping them from being absorbed from the gastrointestinal tract (stomach) into the infant. Lactoferrin, is an iron-binding protein in breast milk that interferes with the growth of pathogenic bacteria. The enzyme lysozyme in breast • •
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LEARNING CONTENT
INTRODUCTION: It is universally agreed that breast milk is the preferred method of feeding a newborn, because it provides numerous health benefits to both the mother and the infant; it remains the ideal nutritional source for infants through the first year of life (Kleinmann, 2004). Nurses are prime people to teach women about the benefits of breast-feeding and provide anticipatory guidance for problems that may occur. ADVANTAGES OF BREASTFEEDING TO THE MOTHER Breastfeeding may serve a protective function in preventing breast cancer. The release of oxytocin from the posterior pituitary gland aids in uterine involution (the reduction in size of the uterus after childbirth). Oxytocin is released whenever a mechanical stimulus is initiated by the sucking mechanism of the infant. Successful breast-feeding can have an empowering effect, because it is a skill only a woman can master Breast-feeding reduces the cost of feeding and preparation time. Breast-feeding provides an excellent opportunity to enhance a true mutual bond between mother and child. ADVANTAGES OF BREASTFEEDING TO THE BABY Breast milk contains secretory immunoglobulin A (IgA), which binds large molecules of foreign proteins, including viruses and bacteria, keeping them from being absorbed from the gastrointestinal tract (stomach) into the infant. Lactoferrin, is an iron-binding protein in breast milk that interferes with the growth of pathogenic bacteria. The enzyme lysozyme in breast milk apparently actively destroys bacteria by lysing (dissolving) their cell membranes, possibly increasing the effectiveness of antibodies. Leukocytes in breast milk provide protection against common respiratory infectious invaders. Macrophages, responsible for producing interferon (a protein that protects against viruses), interfere with virus growth. The bifidus factor is a specific growth-promoting factor for the beneficial bacteria Lactobacillus bifidus. The presence of L. bifidus in breast milk interferes with the colonization of pathogenic bacteria in the gastrointestinal tract, reducing the incidence of diarrhea. Breast milk contains the ideal electrolyte and mineral composition for human infant growth. It is high in lactose, an easily digested sugar that provides ready glucose for rapid brain growth. The protein in breast milk is easily digested, and the ratio of cysteine to methionine (two amino acids) in breast milk favors rapid brain growth in the early months. It contains nitrogen in compounds other than protein, so that an infant can receive cell-building materials from sources other than just protein. Breast milk contains more linoleic acid, an essential fatty acid for skin integrity and less sodium, potassium, calcium and phosphorus than do • •
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many formulas. Breast milk also has a better balance of trace elements, such as zinc. These levels of nutrients are enough to supply the infant’s needs, yet they spare the infant’s kidneys from having to process a high renal solute load of unused nutrients. Breast-fed newborns appear to be able to regulate their calcium/phosphorus levels better than infants who are bottle fed. Decreased calcium levels in a newborn can lead to tetany (muscle spasms). LACTATION AND PROPER POSITIONING TECHNIQUES IN BREASTFEEDING - Breast milk looks like nonfat milk. It is thin and almost blue-tinged in appearance. - Before breastfeeding, mothers must wash their hands to be sure they are free of pathogens picked up from handling perineal pads or other sources. Washing her breasts is not necessary unless she notices caked colostrums (first breast fluid characterized as a thin yellowish fluid secreted by the breasts during the second trimester onwards but most evident in the first 2 to 3 days after birth and before the onset of true lactation) on the nipples. - Lying on her side with a pillow under her head is a good position to assume when she is first attempting to breastfeed. This relieves fatigue because it allows the infant to rest on the bed. - Another position that the mother can utilize is sitting position with a pillow under the baby. Using a football hold with the baby supported on a pillow also may be helpful, especially if the mother had a cesarean birth. - Brushing the infant’s cheek with a breast nipple stimulates a newborn’s rooting reflex. The baby then turns toward the breast. Do not try to initiate a rooting reflex by pressing a baby’s face against the mother’s breast; this will cause the child to turn away from the mother and toward your hand. - If a woman has large breasts, the infant may have trouble breathing while nursing because tissue presses against the nose. The mother can prevent this happening by grasping the areolar margin of her breast between her thumb and forefinger, holding the bulk of the breast supported while her infant feeds. This also makes the nipple more protruberant. - Frequent feeding is advantageous to sustain a milk supply, because the more often the breasts are emptied, the more efficiently they will fill and continue to maintain a good supply of milk. - Help the infant break away from the breast when they are finished feeding. Insert a finger in the corner of the infant’s mouth or pull down the infant’s chin to release suction. Otherwise, the baby may pull too hard on the nipple, causing crack or soreness. PROMOTING ADEQUATE SUCKING Often, a newborn being breast-fed drops off to sleep during the first few feedings. To stimulate both milk production effectively and ensure adequate fluid intake, help the mother attempt to keep the infant awake, •
urging him/her to suck. To accomplish this, stroking the back of the newborn, changing their position during feeding, rubbing their arms and chest, changing their diaper, gently tickling the bottom of a baby’s feet are ways on waking the infant effective. If the infant is not sucking well, the mother can use breast massage after a feeding to empty her breasts manually. This helps ensure good milk production for the time when the infant is ready to suck. TECHNIQUES FOR BURPING THE BREAST-FED BABY Some infants seem to swallow little air when they are breast-fed, whereas others swallow a great deal. As a rule, it is helpful to bubble (burp) newborns after they have emptied the first breast and again after the total feeding. Placing the baby over one shoulder and gently patting or stroking the back is an acceptable position. However, this position is not always satisfactory for a small infant, who has poor head control. Holding the baby in a sitting position on the lap, then leaning the child forward against one hand, with the index finger and thumb supporting the head, is often the best position to use. This position provides head support but leaves the other hand free to pat the baby’s back. Laying the baby prone across the lap is another alternative position. PREVENTING OR RELIEVING ENGORGEMENT The primary method for relieving engorgement is emptying the breasts of milk by having the infant suck as much as before. If an infant cannot grasp a nipple strongly because of engorgement, warm packs applied to both breasts for a few minutes before feeding, combined with massage to begin milk flow, often facilitates drainage and promotes breast softness so the infant can suck. Manual expression or the use of a breast pump to complete emptying of the breasts after the baby has nursed can help maintain or promote a good milk supply during the period of engorgement. Assure the mother that symptoms of engorgement are healthy; it is an indication that her breasts are producing milk. Engorgement is only temporary and should begin to subside 24 hours after it first becomes apparent. PROMOTE HEALING OF SORE NIPPLES Painful nipples result from the strong sucking action of a newborn.
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This may be worsened by the following factors: Improper positioning of an infant (failure to grasp the areola as well as the nipple) Forcefully pulling an infant from the breast Allowing an infant to suck too long at a breast after the breast is emptied Permitting a nipple to remain wet from leaking milk To help prevent soreness, encourage the mother to position her baby slightly differently for each feeding. This helps prevent the same area of the areola from receiving the majority of pressure.
Expose nipples to air by leaving her bra unsnapped for 10 to 15 minutes after feeding. Discourage the use of plastic liners that come with nursing bras; it is preferable to have air always circulating around the breasts. Applying vitamin E lotion after air exposure may toughen the nipples and prevent further irritation. Advise mothers not to use a hand pump with sore nipples, because the pressure may cause fissures to worsen. An electric or battery-operated pump usually can be used; these devices exert less pressure on the nipples. WEANING Weaning is defined as accustoming the infant to discontinue breast feeding by substitution of other nourishment. At any age, breast-feeding should be discontinued gradually to prevent engorgement and pain in the mother’s breast while still providing satisfaction for the infant. To do this, the mother could first omit one breastfeeding a day, substituting a bottle-feeding or milk from a glass or cup. Then she could omit two breast-feedings, then three, and so on, until the child is feeding entirely from a bottle, glass, or cup. If weaned before 12 months, infants should be weaned to formula, not whole milk, so that they continue to receive the added vitamins and low solute load of commercial formulas. REFERENCES: Maternal and Child Health Nursing: Care of the Childbearing and Childrearing Family, 5 th edition, by Pillitteri, Adele, et al. Taber’s Cyclopedic Medical Dictionary, 18 th edition, by Thomas, Clayton L., et al Principles of Anatomy and Physiology, 9 th edition, by Tortora, Gerard J., et al
