Case A - A Mother with

Newborn Baby
FG 1
 A nurse paid a visit to the family that gave
birth to the first child a month ago. Mrs. N
said that since giving birth her child drinks
CASES breast milk and is interspersed with
formula milk because her milk production
is few.
ASSESSMENT
ASSESSMENT
 No. Family Health Tasks Assessment
1. Recognizing health problem a. Have you known about exclusive
breastfeeding?
Family b. Do you know until what ages your
children must get exclusive
Assessment breastfeeding?
c. From your previous story, you said
Based on Five that your breastmilk production was
few. Do you know the reason for the
Family Health problem?
Tasks d. In your opinion, what kind of foods
that help increase milk production?
e. What do you think about your
current dietary patterns? Is it good
or bad?
  What do you and your husband do to  how is your eating pattern before
prepare for your baby's presence? and after giving birth?
 at birth, what is your baby's weight?  what do you usually eat?
is there an increase after one month?
 During the pregnancy, how much
 Do you already know what you gain your weight?
immunizations should be given to
the baby?  after giving birth, how many pounds
has lost?
 do you know about normal baby
development?  do you have a history of smoking
and drinking alcohol?
List of  In daily, how do you take care of your
baby?
Question  Do you already know the correct
position when breastfeeding?
 when breastfeeding, do you feel pain
in the nipples?
 How is your breastmilk production?
 Do you know how to increase ASI
production?
 how is the pattern of defecation and
elimination of the baby? is there a
disturbance or not?
 No. Family Health Tasks Assessment
2. Making decisions about a. Why did you end up give your child
seeking health care formula milk?
b. Does anyone recommend you give
Family formula milk to your child?
c. Has the family ever discussed the
Assessment problem with health workers who
are near your house?
Based on Five 3. Providing care to all members a. Are you actively looking for
of the family information about exclusive
Family Health breastfeeding?
Tasks b. Has the family ever advised you to
check your health and consulted
health workers regarding the lack of
milk production?
c. Do you pay attention to your diet
after giving birth?
 No. Family Health Tasks Assessment

4. Modifying the family a. What have you done to increase

environment to ensure family milk production?
health b. Have you ever tried foods that help
increase milk production?
Family c. Have you ever received a
recommendation to consume herbal
Assessment medicine or specific food that can
Based on Five increase milk production?

5. Using health services a. Does the family know that there are
Family Health affordable health facilities around
Tasks the house?
b. In your opinion, have there been any
benefits for you from the health
facility?
c. How often do you visit the health
facility to consult about the
problem?
ASSESSMENT
ASSESSMENT
  What do you and your husband do to  how is your eating pattern before
prepare for your baby's presence? and after giving birth?
 at birth, what is your baby's weight?  what do you usually eat?
is there an increase after one month?
 During the pregnancy, how much
 Do you already know what you gain your weight?
immunizations should be given to
the baby?  after giving birth, how many pounds
has lost?
 do you know about normal baby
development?  do you have a history of smoking
and drinking alcohol?
List of  In daily, how do you take care of your
baby?
Question  Do you already know the correct
position when breastfeeding?
 when breastfeeding, do you feel pain
in the nipples?
 How is your breastmilk production?
 Do you know how to increase ASI
production?
 how is the pattern of defecation and
elimination of the baby? is there a
disturbance or not?
 Friedman Data Question
Assessment
Model
Family Data Type of What is client’s type of family? Is there other
Identification Family family that live in the same house?
Family - whether having food and drink that is
Cultural forbidden to eat?
Background - Is there any diet habit?
- Does the family visit a public health facility if
Assessment someone is sick?
phase 1 based - does client have traditional confidence in
nursing issues?
on Friedman Religious - What is family religion?
Identification - Are family members different in their
religious beliefs and practices?
- To what extent are families actively involved
in mosques, churches, temples or other
religious organizations?
- What religious practices does the family
follow?
- What beliefs in religious values are centered
in family life?
 Friedman Data Question
Assessment
Model
Family Data Social Class - Who is the breadwinner in the family?
Identification Status - Does the family receive help or replacement
funds? If so, what (from where)?
- Do families consider their income to be
adequate? How do families see themselves in
managing finances?
Assessment Stage of The current - What is the current stage of family
development stage of development?
phase 1 based and family family - The extent to which client’s family fulfill
history development developmental tasks that are appropriate to
on Friedman the current stage of development?
- Family history from birth to date, including a
history of development and events as well as
unique or health-related health experiences
(divorce, death, loss, etc.) that occur in family
life.
- The family of origin of both parents (what
kind of life they came from; their past and
present relationship with the parents
(grandparents) of their parents.
 Friedman Data Question
Assessment
Model
Environmental House - Evaluate privacy settings and how families
Data Characteristic feel about privacy settings.
- Evaluate the presence or absence of safety
hazards.
- Identification of family territorial units. Are
they comfortable using resources / services in
Assessment their environment ?
- In the bathroom, observe sanitation, water,
phase 1 based toilet facilities, whether or not soap and
towels? Do family members use the same
on Friedman towel?
- In the kitchen, observe the supply of sanitary
water and the adequacy of the refrigerator?
Greater - does anyone have the same condition, that
environmenta is, a mother with a baby in a residential
l and neighborhood?
community - is there a health care facility near the house?
characteristics
 Friedman Data Question
Assessment
Model
Family Structure Communicati - How well members become listeners and
on structure follow when communicating?
- How often are emotional messages
delivered?
- What dysfunctional processes are visible in
Assessment communication patterns?
- how the support during breastfeeding to
phase 1 based encourage the mother from husband
Power - Who made the decision?
on Friedman structure - Who wins important arguments or issues?
- Who can win if there is disagreement?
- Whose opinion is used if parents / husband
disagree? Are family members satisfied with
how the decision was made and who made
the decision
Role Structure - How competent members feel they perform
their role as a mother and as a father?
 Friedman Data Question
Assessment
Model
Coping, Stress, Stressor, - what are the stressors experienced by the
and Family strength, and client and husband?
Assessment Perception family - whether the stressor disturbs the exclusive
phase 1 based perception
Family coping
ASI process?
- how the mother cope with the stressor that
on Friedman strategies will lead to the problem, ex: there’s no help in
the house?
 Friedman Data Question
Assessment
Model
Family Function Affective - To what extent are family members caring for
function and supporting each other?
- How sensitive are family members in
responding to cues related to the needs and
Assessment feelings of other members
Functional - How adaptive is family practice in raising a
phase 1 based socialization child to a particular form of family and
situation?
on Friedman - How are children valued in this family?
- What cultural beliefs influence family
patterns in raising children?
- How do social factors influence parenting
patterns? Is this family at high risk of having
problems raising children? If so, what factors
put families at risk?
- Is the home environment sufficient for the
mother to play with her baby?
 No. Family Health Tasks Assessment
1. Recognizing health problem a. Have you known about exclusive
breastfeeding?
Family b. Do you know until what ages your
children must get exclusive
Assessment breastfeeding?
c. From your previous story, you said
Based on Five that your breastmilk production was
few. Do you know the reason for the
Family Health problem?
Tasks d. In your opinion, what kind of foods
that help increase milk production?
e. What do you think about your
current dietary patterns? Is it good
or bad?
 No. Family Health Tasks Assessment
2. Making decisions about a. Why did you end up give your child
seeking health care formula milk?
b. Does anyone recommend you give
Family formula milk to your child?
c. Has the family ever discussed the
Assessment problem with health workers who
are near your house?
Based on Five 3. Providing care to all members a. Are you actively looking for
of the family information about exclusive
Family Health breastfeeding?
Tasks b. Has the family ever advised you to
check your health and consulted
health workers regarding the lack of
milk production?
c. Do you pay attention to your diet
after giving birth?
 No. Family Health Tasks Assessment

4. Modifying the family a. What have you done to increase

environment to ensure family milk production?
health b. Have you ever tried foods that help
increase milk production?
Family c. Have you ever received a
recommendation to consume herbal
Assessment medicine or specific food that can
Based on Five increase milk production?

5. Using health services a. Does the family know that there are
Family Health affordable health facilities around
Tasks the house?
b. In your opinion, have there been any
benefits for you from the health
facility?
c. How often do you visit the health
facility to consult about the
problem?
 Deficient knowledge
related to Insufficient
knowledge of
resources
The Diagnosis

Insufficient breastmilk
production related to
maternal malnutrition
DEFICIENT KNOWLEDGE
Related to insufficient knowledge of resources
Diagnose
Deficient Knowledge Related to Insufficient Knowledge of Resources:
“Absence of cognitive information related to a specific topic, or its
acquisition”
Diagnose Outcomes Rationale Intervention
Deficient Knowledge Knowledge: Give education and Lactation
Related to Breastfeeding knowledge to the Counselling to
Insufficient parents related with Enhance
Knowledge of breastfeeding Breastfeeding
Resources Knowledge
 Provide
information about
psychological and
physiological
benefits of
breastfeeding
 Correct
misconceptions,
misinformation,
and inaccuracies
about breastfeeding
Diagnose Outcomes Rationale Intervention
Deficient Knowledge Knowledge: Give education and  Encourage
Related to Breastfeeding knowledge to the mother’s
Insufficient parents related with significant other,
Knowledge of breastfeeding family, or friends
Resources to provide support
(i.e., offer praise,
encouragement,
and reassurance,
perform household
tasks, and ensure
that mother is
receiving adequate
rest and nutrition)
 Encourage
attendance to
breastfeeding
classes and support
groups
Diagnose Outcomes Rationale Intervention
Deficient Knowledge Knowledge: Give education and Parent Education:
Related to Breastfeeding knowledge to the Infant
Insufficient parents related with • Determine
parent(s)’
Knowledge of breastfeeding
knowledge and
Resources readiness and
ability to learn
about infant care
• Monitor learning
needs of the family
• Provide
anticipatory
guidance about
developmental
changes during the
first year of life
• Teach parent(s)
skills to care for
newborn
Diagnose Outcomes Rationale Intervention
Deficient Knowledge Knowledge: Give education and Support Group:
Related to Breastfeeding knowledge to the • Arrange some
Insufficient parents related with meetings within 2
or 3 families with
Knowledge of breastfeeding
the same condition
Resources to talk and discuss
about each family’s
condition.
• Discuss the follow
up from each
family on their own
condition and share
within the
discussion
• Solve the problem
together within the
discussion
Diagnose Outcomes Rationale Intervention
Deficient Knowledge Bottle Feeding Helping the mother to  Hold infant during
Related to Performance decrease the risk of not feeding
Insufficient giving bottle feeding  Position infant in a
Knowledge of properly and perform semi-Fowler’s
Resources the proper bottle position for
feeding performance feeding • Burp the
infant frequently
during and after the
feeding
 Place nipple on top
of tongue
 Control fluid
intake by
regulating softness
of nipple, size of
the hole, and size
of the bottle
Diagnose Outcomes Rationale Intervention
Deficient Knowledge Knowledge: Infant To make parents know Teaching: Infant
Related to Care how to care for their Nutrition 0-3 Months
Insufficient infant Instruct parents to:
• Feed only breast
Knowledge of
milk or formula for
Resources first year (no solids
before 4 months)
• Always hold infant
when giving bottle
• Discard leftover
formula and clean
bottle after every
feeding
 NURSING DIAGNOSIS:
INSUFFICIENT BREASTMILK
PRODUCTION
related to Maternal Malnutrition
  Insufficient milk supply or production has been and continues to
be a major reason given by mothers for early (6-8 weeks)
termination of breastfeeding (Bevan, Mosley, Lobach, & Salimano,
Insufficient 1984).
Breastmilk  According to the Nutrition Committee set up by the Canadian
Pediatric Society and American Academy of Pediatric (1962),
Production ideally, for infants, breastmilk should be the only source of
nutrition for the first four to six months.
Factors that Breastfeeding behavior
may be
Maternal physiological factors
contribute to
milk Maternal psychological factors
production
According to Newton & Newton (1967),
mothers who have a more positive
attitude toward breastfeeding give more
successful milk than women who express
negative feelings toward breastfeeding
 Diagnosis : Insufficient Breastmilk Production related to maternal
malnutrition

Planning / Goals:
 After 48 hours of nursing interventions

Nursing Care  Achieve an effective breastfeeding

 Mother knows to avoid alcohol or nicotin and also know about
Plan Healthy foods to consume during Pregnancy and after birth
 Mother will be able to increase milk production and identify ways
to produce more milk
 Baby will be able to gain weight, feel content after feeding, have
normal urine output, and bowel movements
Nursing Interventions
For insufficient breastmilk production related to maternal
malnutrition and ineffective latching on to breast
  Suggested Nursing Interventions for Problem Resolution:
 Lactation Counseling
 Nutrition Therapy
 Nutritional Monitoring
Interventions
 Additional Optional Interventions:
 Weight Gain Assistance
  Definition: Assisting in the establishment and maintenance of
successful breastfeeding.
Lactation 1. Assist in ensuring proper infant attachment to breast

Counseling 2. Instruct on various feeding positions

3. Instruct mother on signs of milk transfer
(5244) 4. Discuss ways to facilitate milk transfer
5. Discuss strategies aimed at optimizing milk supply
 Definition: Administration of food and fluids to support metabolic
processes of a patient who is malnourished or at high risk for
becoming malnourished
1. Monitor appropriateness of diet orders to meet daily
Nutrition nutritional needs, as appropriate
2. Determine food preferences with consideration of cultural and
Therapy (1120) religious preferences
3. Encourage intake of high-calcium foods, as appropriate
4. Encourage intake of foods and fluids high in potassium, as
appropriate
 5. Provide patient with high-protein, high-calorie, nutritious
finger foods and drinks that can be readily consumed, as
appropriate
Nutrition 6. Present food in an attractive, pleasing manner, giving
Therapy (1120) consideration to color, texture, and variety
7. Instruct patient and family about prescribed diet
8. Refer for diet teaching and planning, as needed
 Definition: Collection and analysis of patient data pertaining to
nutrient intake
1. Monitor trends in weight loss and gain by weigh client regularly
2. Monitor caloric and dietary intake
Nutritional 3. Monitor mental state (e.g., confusion, depression, and anxiety)
Monitoring 4. Identify recent changes in appetite and activity
(1160) 5. Determine meal patterns
6. Determine factors affecting nutritional intake (e.g., knowledge,
availability, and accessibility of quality food products in all food
categories, etc)
 Definition: Facilitating gain of body weight
1. Weigh patient at specified intervals, as appropriate
2. Monitor daily calories consumed
3. Encourage increased calorie intake
Weight Gain 4. Instruct on how to increase calorie intake
Assistance 5. Consider patient’s food preferences (personal/cultural/religion)
(1240) 6. Discuss with patient and family socioeconomic factors that may
contribute to inadequate nutrition
7. Provide rest periods, as needed
8. Serve food in a pleasant, attractive manner
9. Reward patient for weight gain
  Bulechek, G. M., Butcher, H. K., Dochterman, J. M. M., & Wagner,
C. M. (2013). Nursing Interventions Classification (NIC) (6th ed.). St.
Louis: Elsevier.
 Herdman, T. H., & Kamitsuru, S. (2018). NANDA International, Inc.
Nursing Diagnoses Definitions and Classification 2018–2020 (11th
Bibliography ed.). New York: Thieme.
 Moorhead, S., Johnson, M., Maas, M. L., & Swanson, E. (2018).
Nursing Outcomes Classification (NOC): Measurement of Health
Outcomes (6th ed.). St. Louis: Elsevier.