What is the priority nursing diagnosis for the parents of a newborn born with cleft lip and palate?

The postpartum period begins after the delivery of the infant and generally ends 6-8 weeks later, though can extend in certain cases. The mother’s body continues to go through changes as it returns to a prepregnancy baseline. Recovery depends on the delivery process and any complications endured. Psychological and emotional changes are expected as the parents form an attachment to their child and begin the parenting process with its many challenges. 

The Nursing Process  

Labor and delivery, postpartum, NICU, and obstetric nurses are skilled in caring for mothers and parents through all stages of pregnancy. Patients in the postpartum period will receive education and support from these nurses as they navigate recovery from birth, bonding with their infant, and maintaining their own physical, emotional, and psychological health. 

Nursing Care Plans Related to Postpartum Care 

Ineffective Breastfeeding Care Plan 

Difficulty with infant latching, pain with breastfeeding, or poor breastfeeding experiences can lead to ineffective breastfeeding.

Nursing Diagnosis: Ineffective Breastfeeding

Related to: 

• Infant prematurity
• Infant anomaly (cleft palate) 
• Poor sucking reflex of infant 
• Maternal anxiety or disinterest 
• Knowledge deficit 
• Interruptions in breastfeeding 
• History of ineffective breastfeeding attempts 

As evidenced by: 

• Expresses or observed difficulty in breastfeeding 
• Complaints of pain or nipple soreness 
• Insufficient emptying of breastmilk when feeding/inadequate milk supply 
• Infant displaying inadequate wet diapers or weight loss/inadequate weight gain 
• Failure to latch  

Expected Outcomes: 

• Mother will implement two techniques to improve breastfeeding 
• Infant will display effective breastfeeding as evidenced by appropriate weight gain 

Ineffective Breastfeeding Assessment

1. Assess knowledge.
Assess the mother’s knowledge about breastfeeding as well as cultural conflicts and any myths or misunderstandings.

2. Perform physical assessment.
Perform a breast assessment for engorgement, mastitis, and inverted nipples as well as an assessment of the infant’s ability to latch and suck.

3. Assess support system.
A supportive partner is an important factor in effective breastfeeding. Supportive family members and the healthcare team can also contribute.

Ineffective Breastfeeding Interventions

1. Provide 1:1 support.
Breastfeeding for new mothers may take time and practice. Allow 1:1 time with emotional support. Sessions can be 30 minutes or longer in the beginning.

2. Teach to recognize cues.
Educate the mother on early cues from the infant. Rooting, lip-smacking, and sucking fingers/hands signal a desire to eat. Recognizing cues for timely feeding promotes a better experience for mom and baby.

3. Prevent and treat breastfeeding complications.
If ineffective breastfeeding is related to nipple pain or engorgement, intervene accordingly. Heat or cool application and massage can ease engorgement. Apply lanolin to nipples and do not use harsh soaps. Use cotton bras or pads.

4. Coordinate with a lactation consultant.
Lactation consultants help instruct on breastfeeding positions, feeding schedules, increasing the milk supply, and using a breast pump.

Risk For Impaired Parenting Care Plan 

An inability to create or maintain an environment to promote growth and attachment of the parent and child.

Nursing Diagnosis: Risk For Impaired Parenting

Related to: 

• Premature birth 
• Multiple births 
• Unwanted pregnancy 
• Physical handicap of infant 
• Prolonged separation from the parent  
• Lack of maturity level for parenting 
• Low educational level 
• Low socioeconomic level 
• Young maternal age 
• Closely spaced pregnancies 
• Difficult birthing process 
• Sleep deprivation 
• History of depression or mental illness 
• Substance abuse  
• History of familial or intimate partner abuse 
• Lack of family or spousal support 

Note: A risk diagnosis is not evidenced by signs and symptoms as the problem has not yet occurred. Interventions are aimed at prevention. 

Expected Outcomes: 

• Parent will verbalize individual risk factors that increase the risk of impaired parenting 
• Parent will identify resources and personal strengths to overcome parenting barriers 
• Parent will participate in classes to promote effective parenting 

Risk For Impaired Parenting Assessment

1. Assess family support and dynamics.
Assess if the infant’s father is involved in parenting. Assess for other family support such as the mother’s parents or other family members. Assess for additional children in the home.

2. Observe attachment between parents and infant.
Observe the parent’s attitude toward the infant. Monitor interactions when feeding and changing the infant or a reluctance or indifference in parenting.

3. Determine challenges in the parent’s capabilities.
Young parents with an unplanned or unwanted pregnancy may lack the skills and knowledge for parenting. Consider the parent’s intellectual and emotional level as well as any physical weaknesses.

Risk For Impaired Parenting Interventions

1. Display positivity and allow time for bonding.
When interacting with the infant and parents, the nurse should display a positive attitude to model interactions. Provide plenty of time for bonding by keeping the infant in a bassinet at the bedside and educating the parents on how to feed, hold, swaddle, and bathe.

2. Encourage time for themselves.
Parental stress is linked to postnatal depression. Remind parents to identify positive outlets for themselves and to take time from parenting to reduce anxiety.

3. Perform a depression screening.
Post-partum depression can affect up to 18% of new mothers. Symptoms displayed often show a loss of sensitivity and response to their infant’s needs. This serious condition requires intervention for both mom and baby.

4. Offer community resources.
Young, single, or unprepared parents may require the support of community resources. Provide information on parenting classes and government assistance programs to aid in the safety and health of the infant.

Risk For Infection Care Plan 

Childbirth can carry an increased risk for infection from trauma, sepsis, and surgical procedures.

Nursing Diagnosis: Risk For Infection

Related to:

• Trauma to the abdominal wall (cesarean section) 
• Trauma to the uterus, genitals, and urinary tract 
• Episiotomy 
• Advanced maternal age 
• High BMI 
• Chronic conditions (diabetes, hypertension, immunosuppression) 
• Sexually transmitted diseases 
• Pre-term or post-term labor 
• Prolonged rupture of membranes (PROM) 
• Excessive internal exams 
• Endometritis 

Note: A risk diagnosis is not evidenced by signs and symptoms as the problem has not yet occurred. Interventions are aimed at prevention. 

Expected Outcomes:

• Patient will not develop an infection during the postpartum period 
• Patient will display surgical site healing following c-section or episiotomy without signs of redness, warmth, or drainage 

Risk For Infection Assessment

1. Identify risk factors.
Gestational diabetes, intrapartum infections, PROM, preeclampsia/eclampsia, and prolonged labor increase the incidence of infection.

2. Assess signs and symptoms.
Fever, uterine tenderness, bleeding, and foul-smelling lochia are signs of endometritis. Localized infections to surgical incisions include pain, erythema, and purulent drainage without approximation of wound borders.

3. Monitor lab work.
The white blood count will be elevated along with neutrophils and lactic acid. Blood cultures can also be obtained prior to starting antibiotics.

Risk For Infection Interventions

1. Administer antibiotics.
Broad-spectrum antibiotics should be administered until cultures or pathogens are identified. Very ill patients or serious infections require IV antibiotics. Less severe infections can be treated outpatient with oral antibiotics.

2. Decrease the risk prior to delivery.
It’s vital for the healthcare team to reduce the risk of infection through proper handwashing, NOT shaving before delivery, preoperative showering before cesarean section, maintaining glycemic control <200 mg/dL, limiting vaginal examinations, and avoiding internal fetal monitoring.

3. Provide education on symptoms.
Nurses should educate patients at discharge on signs and symptoms of infection and when to seek prompt treatment (fever, persistent pain, changes in lochia).

4. Demonstrate wound care.
Teach the patient to care for their episiotomy incision by not bearing when defecating (may need to take stool softeners), use ice packs to decrease the swelling, begin warm sitz baths 24 hours after birth, change postpartum pads every 2-4 hours, and always wipe front to back after using the bathroom and clean the area by spraying warm water over the area and patting dry with a clean towel. For a C-section incision, keep the dressing clean and dry until instructed to remove. Wash with soap and water as instructed and do not scrub.

References and Sources

1. Berens, P. (2022, January). Overview of the postpartum period: Normal physiology and routine maternal care. UpToDate. https://www.uptodate.com/contents/overview-of-the-postpartum-period-normal-physiology-and-routine-maternal-care
2. Boushra M, Rahman O. Postpartum Infection. [Updated 2021 Jul 15]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560804/
3. Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2008). Nurse’s Pocket Guide Diagnoses, Prioritized Interventions, and Rationales (11th ed.). F. A. Davis Company.
4. Episiotomy – aftercare. (2020, March 31). MedlinePlus. Retrieved May 11, 2022, from https://medlineplus.gov/ency/patientinstructions/000483.htm
5. Going home after a C-section Information. (202, October 5). Mount Sinai. Retrieved May 11, 2022, from https://www.mountsinai.org/health-library/discharge-instructions/going-home-after-a-c-section
6. Lactation Consultant: When To See One & What To Expect. (2021, November 30). Cleveland Clinic. Retrieved May 11, 2022, from https://my.clevelandclinic.org/health/articles/22106-lactation-consultant
7. Missler, M., van Straten, A., Denissen, J. et al. Effectiveness of a psycho-educational intervention for expecting parents to prevent postpartum parenting stress, depression and anxiety: a randomized controlled trial. BMC Pregnancy Childbirth 20, 658 (2020). https://doi.org/10.1186/s12884-020-03341-9
8. Rayce, S. B., Rasmussen, I. S., Væver, M. S., & Pontoppidan, M. (2020). Effects of parenting interventions for mothers with depressive symptoms and an infant: systematic review and meta-analysis. BJPsych open, 6(1), e9. https://doi.org/10.1192/bjo.2019.89
9. Vismara, L., Rolle, L., Agostini, F., et al. Perinatal Parenting Stress, Anxiety, and Depression Outcomes in First-Time Mothers and Fathers: A 3- to 6-Months Postpartum Follow-Up Study. (2016, June 24). Frontiers. Retrieved May 11, 2022, from https://www.frontiersin.org/articles/10.3389/fpsyg.2016.00938/full