Pages: 4, Double spaced
Order type: Coursework
Language: English (U.S.)
ORIGINAL DISCUSSION POST: “For this discussion we are doing a case study. Your patient is a 28 year old refugee from Burma. She delivered a premature baby at 32 weeks. She is a primipara whose birth plan from her doctor’s office indicates that she planned to exclusively breast feed. She speaks no English, and has no family in the area. Her baby is in the NICU with respiratory distress and hyperbilirubinemia.
? What are your patient’s teaching needs?
? What resources might you anticipate to meet these needs?
? How can you make sure you are meeting these needs?
? Put together a teaching plan that meets all of her learning needs – include mother and baby in
? Remember to use scholastic resources to support your discussion and responses. “
Response From Classmate 1 from the above discussion post:
NURSING 310: Discussion 2
For this discussion we are doing a case study. Your patient is a 28 year old refugee from Burma. She delivered a premature baby at 32 weeks. She is a primipara whose birth plan from her doctor’s office indicates that she planned to exclusively breast feed. She speaks no English, and has no family in the area. Her baby is in the NICU with respiratory distress and hyperbilirubinemia.
What are your patient’s teaching needs? Teaching on why her baby is in the NICU. Teaching about ways to help with patients plan to exclusively breastfeed. If her baby is in the NICU she won’t be able to breastfeed her baby like she had planned. Lactation consultant. Teaching on pumping. Teaching on what respiratory distress is. Teaching on what hyperbilirubinemia is.
What resources might you anticipate to meet these needs? The help from her doctor’s office. An interpreter. Social services. Written information in the language appropriate for the patient. Lactation consultant.
How can you make sure you are meeting these needs? Follow up. Ask questions. Communication
Put together a teaching plan that meets all of her learning needs – include mother and baby in this plan.
What is respiratory distress in a newborn? It is a breathing disorder in premature newborns which usually affects a newborn that is born before the due date. Typically, 6 weeks or earlier than the due date. A premature infant isn’t able to make enough surfactant, which is the liquid that coats the inside of the lungs and helps keep them open so when the infant is born, it can breathe in air.
What is hyperbilirubinemia? It is an increased amount of bilirubin due to the liver being immature. This is common in premature newborns in that their liver is not fully developed. This causes yellowing of the skin and eyes.
Perineal care if patient had vaginal birth
Incision care if patient had cesarean section
Vaginal bleeding and what to expect and when to notify physician
How often to pump? You should pump as much as a full-term newborn would nurse. This is about 8-10 times a day.
How should I store the milk I pump?
• Freshly expressed milk can stay out at room temperature for up to 4 hours.
• Freshly expressed milk is good for up to 48 hours in the refrigerator.
• Previously frozen but completely thawed breast milk (or fortified breast milk) is good for 24 hours in the refrigerator.
• Breast milk can remain frozen for up to 3 months, or up to 12 months in a detached deep freezer.
• When traveling, breast milk can be kept in an insulated cooler, with ice packs, for up to 24 hours. (US, 2017)
• Wear a supportive bra 24 hours a day
• Expose your nipples to air whenever possible
• If your breasts are engorged, take a warm shower or apply a warm compress
• Don’t use soap on your nipples
Response from classmate 2 on the above “original discussion post topic”
What would your patients teaching needs be?
A 28 year old refugee from Burma delivered a premature baby at 32 weeks. She is a primipara and she wants to exclusively breast feed. She doesn’t speak English and has no family for support. Her baby is in the neonatal intensive care unit with respiratory distress and hyperbilirubinemia.
Cultural barriers to learning arise when the client’s language, beliefs or values are different from those of the healthcare team (Alexander 2015). The language barrier sometimes means the patient may not get all of the information that she needs. This patient will need specific teaching to accommodate her cultural beliefs. This would be done by identifying any specific beliefs that affect health or lifestyle. Transcultural teaching would be the teaching style that is most appropriate for this patient. She is a first time mom with no support, so these would be the things that I would focus on while providing education.
What resources do you anticipate using to meet these goals?
To ensure that there is no barrier in communication I would assure that an interpreter that speaks her language is present. If there is not an interpreter available I would see if there is another nurse that speaks the language and has a similar background available to speak with her. I would use teaching material and pamphlets in her language to help with the teaching process. Visual aids, like pictures and videos can be helpful to demonstrate a skill if literature in her language is unavailable. In her case, she is a new mom who would like to breastfeed. So videos about newborn care and breastfeeding would be easy to understand. This patient doesn’t have family support, so I would provide her with community resources or social services that can help her and her baby find state and federal resources as well.
How can you make sure that you’re meeting your patient’s learning needs?
The goal of educating patients is to come to a mutually agreeable plan between cultural practices. To ensure that the patient is comprehending the teaching, I would allow her to demonstrate procedures that were taught to evaluate her comprehension. I would also allow time for her to ask any questions that she had. Some other suggestions the text book provides for evaluating learning outcomes are: written measurements, such as tests, oral questioning and asking the client to repeat information that was provided, and client reports by follow up phone calls and home visits.
This client’s baby is in the NICU with hyperbilirubinemia and respiratory distress. Her baby may need to be hospitalized for a while, so this is something I would include in the teaching plan. She wants to breast feed so I would instruct her to start as soon as she could. Sometimes when they are in the NICU, babies are unable to be breast fed, so I would instruct her how to use a breast pump so she can start to establish her milk supply. I would educate her about post- partum care for herself including perineal and breast care, as well as bowel and bladder function. Some medication may be prescribed for her or her baby. I would educate her on the proper use and timing of these medications, as well as what adverse effects to look for. Her new born may need extra care because of it’s preterm birth, so I would make sure she knows when and how to make follow up appointments for her baby. Many new moms experience post-partum blues or depression. I would instruct her to inform her healthcare provider if she notices these becoming a problem.
Response from classmate 3 from the above “original discussion post”
What are your patient’s teaching needs? Explaining to the parent what the prognosis and treatment regimen will be for the baby. Initially prognosis and treatment will be provided by the physician. It will be my job as the nurse to educate and reinforce care to the mother. (Motacki, 2017) Informing the new mother of what is expected of her in the infant care. Preparing the mother to participate in the care of the child to prepare for discharge. (Motacki, 2017) All interactions with mother will be provided by hospital approved translator services.
What resources might you anticipate meeting these needs? Hospital translator for one. Social worker/ case manager to assist the patient with resources needed for discharge. E.g. home health nurse, supplies, insurance assistance for future care needs of the child. Providing a referral while patient is in hospital, e.g. to teach mother how to breast feed correctly. Working hand in hand with respiratory therapy, and mother to educate how to care for the infant’s needs.
How can you make sure you are meeting these needs? Overseeing care that is provided. Having the mother answer questions and providing returned demonstrations to assess the level of comprehension. (Motacki, 2017) Reinforcing whatever maybe necessary in the teaching process. (Motacki, 2017) Being sure that all other staff members are on board, making sure that care is being followed through.
Put together a teaching plan that meets all her learning needs – include mother and baby in this plan. Remember to use scholastic resources to support your discussion and responses
1. Mother work with nurses and resp team. Team will provide teaching on equipment that will be needed for the care of the child. This includes pulse oximeters, suction equipment if necessary ECT. How to identify signs and symptoms of respiratory distress in the infant. Signs and symptoms of resp infection and when to report to the physician. Educate the mother to keep sick individuals away from the newborn while resp problems exist.
2. Educate the mother how to bond with child while in hospital. Facilitating the mother to touch and hold the child. (Silvestri, 2014)
3. Educate the mother to follow through on all doctor’s appointments when discharged.
4. Educate the mother to provide frequent feedings to the patient to “hasten passage of meconium and encourage excretion of the infant’s bilirubin”. (Silvestri, 2014)
5. Reinforce phototherapy treatment to mother and possible complications.
6. Educating plan of care to mother/goals.
1. Be sure that the patient is staying well hydrated to maintain blood volume.
2. Prepare the infant for phototherapy
3. Monitoring the patient resp status closely and for signs and symptoms of infection.
4. Monitoring the patient for further decline of the resp status
5. Encouraging baby/mother bonding
6. Providing comfort needs to the infant
answer the following question:
Extensive education would be required throughout the baby’s anticipated lengthy stay in the NICU. What if this mother had other complications? You mentioned high blood pressure – what if this mother had pre-eclampsia? What if the mother had an infection that caused the premature labor? How might these conditions impact your education and support?