N13 - Maternal and Child Nursing 2nd Semester AY 2021-2022

Subjective Cues

Objective Cues

• Mother presently breastfeeding
• Mother asked about certain milk formula that would satisfy Joshua’s nutritional needs.
• Said her neighbor feeds her baby, the same age as Joshua, formula X and is bigger than Joshua
• Inquired about multivitamins fit for Joshua just like what her neighbor gives to her baby
• Feels that Joshua is not growing enough
• Starting a new office job from Monday to Friday
• She will be leaving Joshua to her 18-year old sister who does not have any children

• First time mother
• Husband works abroad
• No other adults in the household
• Joshua’s age: 4 months old
• Maria has a 1 ½ year old daughter.
• Weight gain is normal
• Weight, height, length, and head circumference are within normal range
• Good head control, can roll over, has social smile
• Active with a good suck

Problem

Rationale

Goals and Objectives

Interventions

• Interrupted Breastfeeding r/t mother’s employment status a.e.b. verbalizing the need to carry out weaning

• Breastfeeding may be stopped because of the client’s new employment. This is a concern because infants should be exclusively breastfed until 6 months of age.

After the nursing interventions, the client will:

• Demonstrate proper breastmilk production by pumping
• Demonstrate proper storage of breastmilk

 The nurse will:

• Encourage continued lactation upon new employment
• Discuss three possible options for milk expression (nonelectrical and electrical pumping methods)
• Instruct appropriate handling of expressed milk

• Deficient Knowledge r/t insufficient knowledge about breastfeeding benefits and a.e.b. expression of concerns about Joshua’s growth

• First time mothers usually lack knowledge about the benefits of breastfeeding for infants younger than six months. Factors such as comparing the growth of the client’s baby to the development of the neighbor’s baby as well as the mother’s employment may contribute to her decision to stop breastfeeding and shift to infant formula which may compromise the infant’s nutritional status and development.

• Enumerate at least 3 benefits from continued breastfeeding on an infant’s development
• Verbalized the desire to continue breastfeeding beyond infancy in her own words

• Discuss the psychological and physiological benefits of breastfeeding
• Discuss the misconception about breastfeeding

• Risk of Impaired Parenting a.e.b. uninvolved father, working mother, and the adolescent’s insufficient knowledge about parenting skills 

• The presence of the parents is important for the infant’s development. With the father working abroad and the daily job of the mother, they may not be able to provide the needs of the baby. Moreover, the baby may develop stranger anxiety. In addition to this, the knowledge of the mother’s 18-year old sister regarding child management is not enough.

• The father will verbalize the importance of maintaining his parenting skills to support the infant’s growth and development in his own words.
• The mother will enumerate at least three ways to develop a nurturing environment for the infant
• The mother’s 18-year old sister will identify three ways to protect the infant from possible harm under her care

• Encourage the parents to continuously communicate with the infant
• Provide guidance about the developmental changes during the first year of life
• Assist the adolescent in interpreting infant cues
• Discuss how to make home environment safe for infant

• Readiness for Enhanced Health Management a.e.b. inquiry of multivitamins fit for the infant  

• As a first time mother, it is normal that she is concerned about the baby’s health status. Seeing as she is concerned about vitamin supplements, it may mean she is ready to take actions to enhance her baby’s health status.

• Discuss the importance of vitamin supplements for a 4-month old infant in at least two sentences.

• Discuss the supplements needed and the proper dosage for a 4-month old breastfed infant

Anticipated Problems

Deficient Knowledge r/t insufficient knowledge about infant care a.e.b. inability to provide child’s needs, frustration with child, and inappropriate care-taking skills

Caregiver Role Strain

• The infant will be left under the care of Client M’s 18-year old sister who has no experience with infants. She may not be able to take care of the infant properly and experience frustration.
• Client M, with her new employment, may lack time for her personal needs which may compromise her role as the infant's mother.

• There is a risk in insufficient partnership in providing the needs of the couple due to the different work schedule.

Stress Overload

• The 18-year old sister is still considered an adolescent who may have problems of her own. Taking care of a child during the weekdays may impact her social life, academic performance, and her views about herself which can cause her stress.
• As a first time mother, Client M may experience stress from work and caring for infant especially if her significant other is not present.  

• Client M also has a 1 ½ year old toddler. Separation anxiety may develop between the children and the mother when she starts working.