Question

After Maria, Raul, and Juan have been home for 24 hours, the nurse makes a follow-up phone call to Maria. She is in tears and states she is unable to get Juan to eat from the breast. She has tried several times but ended up giving Juan a bottle. She is asking for assistance with latch-on. SELECT THE FIRST TWO NURSING ACTIONS IN THE ORDER THAT THEY SHOULD BE IMPLEMENTED:

a)"Position your baby skin-to-skin with you for a few minutes."Skin-to-skin helps the mother relax- releasing oxytocin before attempting latch-on. The baby's inborn reflexes for feeding are switched on during skin-to-skin.
b)"Hold your baby like a football."The football or clutch hold is recommended for early feedings as the mother can easily see the baby's mouth as she directs the nipple in for latch-on.
c)"Roll your nipple between your thumb and index finger to stand out. Express a drop or two of milk."Rolling the nipple stimulates the erectile tissue to make the nipple stand out for easier latch-on. Expressing milk lubricates the nipple and entices the newborn to open his mouth as he smells and tastes the milk.
d)"Support the breast with the thumb on top and 4 fingers underneath the breast."Supporting the breast in this manner, like taking a bite from a large sandwich, ensures adequate breast tissue is taken into the mouth for latching on. If the baby only latches to the nipple, this will cause trauma and nipple pain.
e)"Tickle your baby's bottom lip with the nipple. Watch for him to open wide, then quickly bring him to the breast."Anti-inflammatory medications can help reduce pain and swelling associated with engorgement. It can also reduce aching and low-grade fever often associated with engorgement. Medication is suggested last if other measures are not effective.

Answer 1

The first two nursing actions Maria should take to help Juan latch on for breastfeeding are: (1) place him skin-to-skin to stimulate oxytocin release and (2) stimulate the nipple and express some milk to help Juan latch.

Step-by-step explanation:

When assisting Maria with latch-on difficulties for her baby Juan, the first two nursing actions should be implemented in the following order:

1. Skin-to-skin contact: Encourage Maria to position Juan skin-to-skin with her to relax and release oxytocin, which aids in the let-down reflex and activates the baby's inborn reflexes for feeding.
2. Nipple stimulation and milk expression: Instruct Maria to roll her nipple between her thumb and index finger to help the nipple stand out, making it easier for Juan to latch on, and to express a drop or two of milk to entice him to open his mouth as he smells and tastes the milk.