Breastfeeding Newborn UNFOLDING Reasoning Amanda Stevens, 26 years old and baby Grace! RATED A+

Amanda Stevens, 26 years old and baby Grace Primary Concept Reproduction Interrelated Concepts (In order of emphasis) • Pain • Patient Education • Clinical Judgment • Communication • Collaboration NCLEX Client Need Categories Percentage of Items from Each Category/Subcategory Covered in Case Study Safe and Effective Care Environment • Management of Care 17-23% • Safety and Infection Control 9-15% Health Promotion and Maintenance 6-12% Psychosocial Integrity 6-12% Physiological Integrity • Basic Care and Comfort 6 -12% • Pharmacological and Parenteral Therapies 12 -18% • Reduction of Risk Potential 9 -15% • Physiological Adaptation 11 -17% You received shift report on Amanda and Grace and are about to go in and complete your morning assessments. The night nurse reported Grace has not breastfed well since the initial feeding after birth. Amanda has difficulty getting Grace to latch. Once she does latch, she only sucks a few times and pulls off. Amanda is not able to express any colostrum. She doesn’t ask for help with nursing and states that Grace must not be hungry. Grace has not voided since delivery and had one small meconium stool since birth. History of Present Problem: Amanda Stevens is a 26-year-old female, G1 P1, accompanied by her husband, Brad. She presented to the maternity unit complaining of contractions every five minutes for the past three hours. She was dilated to 6 cm, 50% effaced, -2 station and admitted for labor. Brad was very supportive throughout her labor. She received an epidural for pain control and delivered by spontaneous vaginal delivery (SVD) a baby girl 12 hours later at 39 5/7 weeks gestation. Amanda’s blood type is A+ and is Group B strep (GBS) negative. Baby Grace was 7 pounds 8 ounces (3.4 kg), 20 inches (50.8 cm) long with APGARS of 9 at one minute and 9 at 5 minutes. Delayed cord clamping for one minute occurred and then she immediately went to breast and latched with minimal assist and nursed for ten minutes. Initial