· · Written Assignment: Read the case studies provided below. Write your differe
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· Written Assignment: Read the case studies provided below. Write your differential lactation diagnosis statement for each. Provide rationales. Design care-plans for each case, with rationales. A care-plan provides step by step instructions for the mother/family to therapeutically move the challenging/abnormal situation into resolution. It is a step by step list of interventions that you want her and or her family to implement at home between your sessions with her.
Make a differential lactation diagnosis statement for the three cases below and design careplans for them. Be sure to address every aspect of the situation in your plan.
Instructions:
Differential diagnosis statement sample: Sore nipples and compromised milk transfer with concomitant slow infant weight gain secondary to shallow infant attachment at breast. (These statements are long-winded because we work with three clients; the mother, the baby and their relationship.)
Your careplan should look like this: (These are just example statements. Your plan should fit the case history.)
1. Call with questions or concerns (phone number). Rationale: xxxxx
2. Feed the baby every 2 hours or on cue, whichever comes soonest. Rationale: xxxx
3. Pump as needed to stockpile milk. Rationale: xxxx
4. Eliminate dairy from your diet according to pamphlet directions. Rationale: XXXXX
etc.
Case 1: A mother is three weeks postpartum. She had a normal physiological birth at home with no complications. The baby was skin to skin for 2 hours post birth, did breast crawl and had an excellent first feed. He was in near continuous contact with his mother after she took a shower, about two hours post-birth. Her milk came in on day 2-3. Her baby, born at 7# 5 ounces, lost only 2 ounces from birth weight and regained it by day five. The baby is stooling regularly, is sleeping well even though he has his days and nights still mixed up. Mother is getting plenty of rest and feels energetic. She has a postpartum doula helping her at home, her church is bringing meals for another two weeks and her mom comes to help with housework three times per week. She is taking her encapsulated placenta: 2 pills, 3 times per day. She pumps whenever she feels overfull, which is happening regularly.
Her chief complaint: “My breasts feel so full my shoulders and back hurts. My bras don’t fit and I have had a plugged duct on one side and I feel like I am getting another on the opposite breast.”
Differential lactation diagnosis statement:
What is your care-plan for this situation?
Case 2: This mother is six weeks postpartum. She was induced at 40 weeks because the doctor did not want the baby to get “too big for her pelvis.” She had pitocin for 12 hours, an epidural for 10 hours and she pushed for two hours. She was confined to bed for most of her labor, which she describes as excruciating in spite of the epidural. She had a third degree tear on her perineum. Her baby was 7# 3 ounces at birth and left the hospital weighing 6# 10 ounces. Mother has been using a nipple shield since day four and her milk did not fully come in until day five. She supplemented with formula starting on day 2 and has continued supplementing since then. The baby receives 10 ounces of cow milk based formula per 24 hours by off brand bottle. The baby has gained 1# 8 ounces.
Her chief complaint: “My milk supply is low. I want to increase my milk supply and exclusively breastfeed for at least 6 months.”
Differential lactation diagnosis statement:
What is your care-plan for this situation?
Case 3: This primiparous mother had an uneventful birth in hospital, unmedicated. Her labor lasted 20 hours. She gave birth at a baby friendly hospital with a midwife. She had skin to skin contact and her baby did breast crawl and self-attachment. The baby, born at 8# is now 4 weeks, and has gained 1# 6 ounces. The mother feeds her baby on demand. You observe the feed. The mother is not using anything to prop up the baby, leans forward putting her nipple in front of the baby’s mouth by stretching her breast to the baby’s mouth. The baby is on her back and the mother tickles her cheek with her finger to get the baby to turn her head toward the breast. The baby opens her mouth about halfway and then grasps the nipple, biting down first, then starts to suck. The mother’s pain level is 7 of 10 (with 10 being the worst possible pain.)
Her chief complaint: “My nipples are so sore I dread feeds. I have used APNO, lanolin, and ice on my nipples before feeds and tried a nipple shield. Nothing helps.”
Differential lactation diagnosis statement:
What is your care-plan for this situation?
Explanation / Answer
Case 1- Care plan:
In this case, the patient is experiencing the normal postprandial changes, i.e. enlarged breast. Poor fitting bras can cause shoulder and back pain. The care plan in this case include,
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