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Running Head: NUTRITIONAL EDUCATION
Educating a mother with an infant with jaundice
Educating a mother with an infant with jaundice
A four-day-old female baby, who weighed 3kg at birth, born at an appropriate gestational
age by twenty-six-year-old Maryanne (pseudonym), is having jaundice, leading to her admission
to the pediatric ward. Maryanne is A+ primiparous with gestational diabetes. The pregnancy was
uneventful, and she gave birth vaginally after augmentation of labor with Pitocin. The baby was
discharged on her day two when her weight had reduced by four percent from her birth weight
and appeared to have mild facial jaundice. Maryanne breastfed the baby well (every three hours)
and had two wet diapers and one diaper with had meconium stain for the 24 hours. While at
home on day three, the mother gave her water after realizing that she was hardly satisfied with
the regular and frequent breastfeeding. Besides, Maryanne noticed that jaundice was increasing
in degree but did not seek medical care after she was assured by a relative that jaundice is
common among babies and that it subsides on its own. She realized that jaundice was
exacerbating, and the baby was slowly turning yellow not only on the face but also on the skin,
which pushed her to make an appointment with a pediatrician. On the day of the appointment
with the physician (day four), she narrated the baby’s condition. She reported breastfeeding as
frequently as possible (every three hours) and that she had been using two diapers every day.
The baby’s urine is dark yellow, and the stool is dark green. Vitals include T 37.9, pulse
154, RR 57, BP 64/46. Baby’s weight 2.7kg (25 percentile), length 55cm (25 percentile), and
head circumference 36cm (75 percentile) and very jaundiced and irritable. Her anterior fontanel
is sunken, tacky oral mucosa, and jaundice appears to spread to the lower extremities. There is
neither cephalohematoma nor bruising, and both sclera are icteric. Baby’s muscle tone and
activity are normal, and other physical exam parameters are normal. Lab results were as follows:
her total bilirubin was 20mg percent and a direct fraction of 0.8 mg percent. This led to her
admission to the pediatric unit for chemotherapy, supplementary formula food, nutrition
education, lactation teaching, and consultation. Care is initiated immediately to lower the baby’s
bilirubin to at least 12%, after which she will be discharged home on breast milk feeding and
follow up with the pediatrician as well as the lactation consult.
According to both the subjective and objective data, it is apparent that Maryanne has
deficit knowledge not only regarding jaundice, it causes, pathophysiology, management at home
but also breastfeeding and its relationship to jaundice and jaundice management which impacts
the baby’s care and health (Kaplan et al., 2019). A relative told her that jaundice is common
among infants and often subsidies on its own, and she bought the idea leading to the worsening
of the degree of jaundice. Similarly, Maryanne opted to give her baby water when she did was
not satisfied with three hourly breastfeeding instead of increasing the frequency to even two-hour
breastfeeding or considering a supplement to avoid symptoms of jaundice. However, I appreciate
Maryanne’s effort in ensuring that she breastfeeds every three hours and seeking care even after
being told that jaundice is a common condition and goes away on its own. It is necessary to teach
the mother on jaundice comprehensively to ensure that she is well conversant with jaundice, the
relationship between breastfeeding and jaundice management and how to go about it when the
baby is jaundiced at home or does not seem to be satisfied with breast milk which may interrupt
In this case, one greater nursing diagnosis is a knowledge deficit related to jaundice,
breastfeeding and its relationship to jaundice, and lack of prior exposure, as evidenced by the
statement of the problem and misconception about jaundice. The desired outcome is to have the
mother verbalize an understanding of jaundice, its cause, treatment, and likely outcome. Also,
the mother will recognize the possible signs and symptoms of jaundice, inappropriate or
unsatisfactory breastfeeding that may lead to complications such as jaundice or show signs of the
same that necessitate seeking medical assistance. Lastly, the mother will demonstrate the proper
care of the baby throughout and demonstrate an understanding of how to manage mild to
moderate jaundice at home.
The interventions and rationales will include the following. Firstly, I provide the mother
with detailed information related to neonatal jaundice, including its pathophysiology, signs and
symptoms, implications. I will often encourage Maryanne to ask questions and seek clarification
when she does not understand any points, and I will reinforce my points as appropriate. This
helps to promote understanding of jaundice, correct misconceptions and reduces the fear that
may impact care for the child while at home (Kaplan et al., 2019). Secondly, I will discuss home
management of jaundice (mild to moderate) before seeking medical care such as signs of
increased breastfeeding, exposure to sunlight, and observing the baby more frequently and
following up on serum testing programs. I believe that when parents understand the home
remedy of mild jaundice, they can adequately and appropriately care for the baby at home.
Similarly, the mother’s understanding of jaundice will foster care and cooperation post-discharge
and maintain great collaboration with the follow-up team to promote care.
Thirdly, I will help Maryanne to understand the relationship between breastfeeding and
neonatal jaundice and how adequate breastfeeding can be a remedy to jaundice. I will provide the
mother with information about excellent breastfeeding and maintaining adequate milk supply via
milk pump, and possibly reinstating breastfeeding as a way to lower bilirubin level in case
jaundice interrupts breastfeeding. This will promote the mother’s understanding of adequate
breastfeeding, maintaining an adequate milk supply that meets her baby’s demand, and
understanding that breastfeeding can be interrupted by jaundice can how it can help lower
bilirubin. Lastly, I will teach the mother the means of assessing a baby for increased bilirubin,
such as blanching the skin to show its color and weight monitoring. This will make the mother
quickly recognize the signs and symptoms of jaundice and seek medical assistance as soon as
possible for relevant action (Ullah, Rahman & Hedayati, 2016). I will need a formula milk
product for demonstration, short video clip on latching, and some images showing the signs and
symptoms of jaundice. I will also provide the mother with a leaflet showing the information on
jaundice and breastfeeding for future reference.
I will begin the session by greeting Maryanne and introducing myself. After that, I will
explain to her about the baby’s progress and update her on every treatment and discharge plan
then finally tell her why I had asked to meet her and the goals of the teaching. I will tell her that I
have come to teach her on jaundice, breastfeeding as a remedy to prevent jaundice and warrant
good health for the baby, maintenance of adequate breast milk to ensure the baby is satisfied to
warrant maturation of liver to eliminate excess bilirubin to avoid neonatal jaundice, and home
management of mild to moderate jaundice. The aim of the teaching session will include having
Maryanne verbalizing a greater understanding of jaundice, including its cause, sign and
symptoms, and treatment. Similarly, she will report a greater understanding of how to breastfeed
and when to consider breastfeeding adequate to ensure maturation of the liver and prevent
neonatal jaundice. Maryanne will always state the relationship between breastfeeding and
jaundice and how to prevent neonatal through adequate breastfeeding. Also, she will demonstrate
the ability to care for the baby while at home, assessing possible signs and symptoms of
increased bilirubin as well as dehydration, which may show unsatisfactory breastfeeding and
Neonatal jaundice is a condition where the baby’s skin or eyes appear yellow, and a
mother or a caregiver will quickly notice this by either blanching the skin or keenly looking at
the child’s eye in a place called sclera in the eye in a well-lit place. It is common among term
babies, and about eighty percent of babies born in American have it at some instances in their
lives (Ullah, Rahman & Hedayati, 2016). Why is jaundice common in babies? We all have a
substance called bilirubin in our blood. Bilirubin is the substance that is produced by our red
blood cells and eliminated by the liver. Their increased level leads to jaundice both in babies and
adults; however, it is less common in adults because of their mature and well-developed liver
removes its excess. Before a baby is born, his mother’s liver does the work of eliminating excess
bilirubin from the baby’s blood.
Usually, babies develop jaundice a few days after birth because the mother’s liver no
longer removes excess bilirubin, and their liver takes days to develop to the extent of removing
excess bilirubin leading to build up that causes jaundice (Ullah, Rahman & Hedayati, 2016).
Note that often adequate breastfeeding accelerates the speed of liver development as well as adds
to baby’s immunity, thus preventing jaundice and other conditions. This is why exclusive and
adequate breastfeeding is encouraged. Neonatal jaundice will occur when the infant’s liver is not
well developed thus may be unable to eliminate certain elements found in albumin in the body
produced by the body’s red blood cells known as unconjugated bilirubin. This is what makes the
skin or sclera to appear yellow. Neonatal jaundice can either be physiologic or pathological;
however, the former is common after four days of childbirth, and the latter comes early before
the baby gets to four days. Often, when a baby does not make enough breast milk or feed
appropriate, she will be dehydrated and have low calories, thus leading to neonatal jaundice,
which occurs early.
Later onset often attributed to the presence of a substance in the mother’s breast milk that
reduces the maturity of the life and ability to eliminate bilirubin (Lori et al., 2020). Laboratory
test on total serum bilirubin is the most effective way to diagnosis bilirubin. However, there are
symptoms such as drowsiness, inability to breastfeed well, lethargy, yellow skin and sclera,
greater and unexplained weight reduction that are signs and symptoms of jaundice. Whenever
you notice these symptoms, kindly seek medical assistance. Yellowing of the skin, which you
can notice through either blanching the skin or pressing the forehead, is the most common
symptom. Note that, though jaundice is common, it can complicate to fatal conditions which may
risk life; thus, it is mandatory always to seek medical assistance when you realize anything
abnormal with the baby.
Moreover, we may produce breast milk and feed the baby as required, but unfortunately,
breast milk may not be enough for the baby, and this may put the baby at a higher risk of
increased bilirubin (Ullah, Rahman & Hedayati, 2016). Breast milk helps in the baby’s liver
development. The liver is the organ in the body that eliminates excess bilirubin manufactured by
the baby’s red blood cells. When a baby does not breastfeed well either due to inadequate breast
milk or other conditions, her liver will not develop adequately, and he will not adequately
remove excess bilirubin from his body leading to excess level driving to neonatal jaundice. You
are a great mother because you realized that the baby was not satisfied with whatever breast milk
you were producing. Now that you understand how breastfeeding can lead to neonatal jaundice,
we can dwell on how you can improve breastfeeding and breast milk to ensure that your baby is
adequately breastfed to avoid neonatal jaundice. Sometimes we can improve on breastfeeding as
well as milk production by improving latch, but how? You will have to line the baby with her
nose just opposite the nipple then support the breast as you gently stroke her lips with the nipple
and make sure the nipple aim to roof of her mouth. Then support the baby’s head at the neck and
shoulder, leaving it to freely tip back a little as you hold the baby onto the breast. This may also
improve the baby’s breastfeeding and promote milk production as the baby breastfeeds.
I want to congratulate you on maintaining the three hourly breastfeeding as this is a great
attempt to ensure your baby gets enough breast milk to enable the development of her liver to
eliminate excess bilirubin and prevent neonatal jaundice. However, when you realize that the
baby needs more milk, you should breastfeed as frequently as every two hours as long as you
have breast milk to warrant that the baby gets almost adequate breast milk for liver development
(Ullah, Rahman & Hedayati, 2016). When the milk is not enough, do not go for water but
supplement it with appropriate formula after medical advice. However, this should only apply
when you have breastfed the baby, and you are convinced that she is not satisfied because breast
milk has numerous natural nutrients that promote liver development and increases its functioning
to remove excess bilirubin (Lori et al., 2020).
Besides, breast milk passes a certain degree of immunity to the baby will strengthen its
ability to fight conditions such as neonatal jaundice, thus increasing wellbeing (Ullah, Rahman &
Hedayati, 2016). I hope you understand how adequate breastfeeding is good at preventing a baby
from having jaundice and please anytime you have any question or need clarification, feel free
since today is your time that I dedicated wholly for this an would want all of us to learn and
come out victors in fighting neonatal jaundice. Do not substitute breast milk with formula
unnecessarily, please; there may be risks to your breast and general health as well as the baby’s
health. Though most formula-fed babies rarely develop jaundice, breast milk is the ideal food for
babies because of its natural nature and other benefits such as increasing bonding, improving
immunity, among others. Hence ensure you breastfeed your baby at least 8-12 times a day to
ensure that he is satisfied with breast milk to develop his liver that effectively removes the excess
bilirubin that causes jaundice.
Additionally, sometimes when a patient has jaundice, she may not be willing to
breastfeed (Ullah, Rahman & Hedayati, 2016). In this case, do not stop breastfeeding, continue
pampering the baby to breastfeed and seek medical assistance immediately. This is because
adequate breastfeeding is a remedy on its own against neonatal jaundice; thus would help
fighting jaundice. This is why you hear people say jaundice goes away on its own. It is the power
of breast milk that treats jaundice in babies that makes is subsidies sometimes without medical
intervention. Also, in such cases, always assess the skin by blanching under natural sunlight or
fluorescent light to assess the hydration status and yellowing of the baby’s skin. Always
remember also to feed well because your body too will need nutrients to manufacture milk and
know that your diet determines the quality of milk, so it is good to maintain a balanced diet.
While at home, you can manage mild neonatal jaundice through increasing feeding of the
baby and ensuring diffused exposure to sunlight through a well-lit window for about ten minutes
(Lori et al., 2020). Also, keep track of the baby’s weight and bilirubin levels. Note that you
should avoid exposure to the baby’s skin to direct sunlight since studies confirm that it is
susceptible to thermal injury. Exposing the baby to sunlight lowers the baby’s body bilirubin
level thus will manage mild to moderate jaundice at home. Likewise, you can set the special type
of light known as phototherapy at home that helps lowers the baby’s bilirubin; however, you
need the help of a doctor to closely monitor the baby, frequency, and duration of phototherapy as
often as possible. Any time you assess the baby an realize that his skin and white part in his eye
are yellow for more than three weeks or worsening and does not respond to either breastfeeding,
formula or and home remedies call a doctor, visit any nearby health facility or call our
emergency number, and you will get help as soon as possible. Maryanne showed a greater
understanding of jaundice, cause, symptoms, and pathophysiology. She also said that she learned
a lot, particularly relating to breastfeeding and how it helps prevent and manage jaundice. Lastly,
she showed an understanding of how to manage mild jaundice at home and asked positive
questions on jaundice management, symptoms, and home management, which I answered to her
Throughout the teaching, I will constantly encourage questions and will be reinforcing my
points. Finally, I will end the session by thanking Maryanne for allowing me to teach her and
cooperating throughout and will wish her and the baby good health as they are discharged home.
I will then provide a hospital emergency landline number, which she can contact any time she
has a problem that may need medical assistance.
Kaplan, M., Zimmerman, D., Shoob, H., & Stein‐Zamir, C. (2019). Post‐discharge neonatal
hyperbilirubinemia surveillance. Acta Paediatrica.
Lori Kenari, R., Aziznejadroshan, P., Haghshenas Mojavaeri, M., & Hajian-Tilaki, K. (2020).
Comparing the effect of kangaroo mother care and field massage on serum bilirubin level
of term neonates with hyperbilirubinemia under phototherapy in the neonatal ward.
Caspian J Intern Med 2020; 11 (1): 34-40. Hyperbilirubinemia commonly occurs during
the first week of birth and one of the most common causes of hospitalization among term
and preterm neonates (1, 2). According to available evidence, 60% of term infants have
clinical symptoms including sclera and yellowish skin caused by an increase in
.... Caspian J Intern Med, 11(1), 34-40.
Ullah, S., Rahman, K., & Hedayati, M. (2016). Hyperbilirubinemia in neonates: types, causes,
clinical examinations, preventive measures and treatments: a narrative review
article. Iranian journal of public health, 45(5), 558.
1. Purpose: To document and evaluate teaching skills necessary to provide teaching to an
individual client with a demonstrated need. With the completion of this assignment the student
will be able to achieve the following objectives.
a. Demonstrate ability to thoroughly assess the learning styles of an individual or family
using given developmental or cultural models.
b. Demonstrate ability to anticipate learning needs based on developmental or cultural
c. Identify and utilize teaching/learning principles to facilitate achievement of learning
goals and outcomes.
d. Select and prioritize learning strategies based on the developmental or cultural
assessment to achieve learning goals and outcomes.
e. Support rationales for teaching plan using teaching and learning theories from required
readings with references.
2. Nursing Competencies:
a. Assessing and identifying developmental, cultural, and socioeconomic factors affecting a
b. Providing evidence-based health information and teaching based on developmental,
cultural, and socioeconomic factors affecting a client or family
c. Integrating teaching/learning activities into client interactions bas ...