My baby fusses or cries during nursing – what’s the problem?

My baby fusses or cries during nursing – what’s the problem?

Some babies will fuss, cry or pull off the breast during nursing. There are a number of reasons why this might be happening. It’s pretty common to see this type of behavior at around 6-8 weeks, though it can occur at any time. If your baby is generally fussy (not just when nursing) see My baby is fussy! Is something wrong?

Determining the problem
Here are some of the problem-solving steps I go through when my baby is fussy at the breast or a mother asks me why her baby is fussing during nursing:
How old is baby? Most babies go through growth spurts during the first few days at home and around 7-10 days, 2-3 weeks, 4-6 weeks, 3 months, 4 months, 6 months, 9 months, etc. Many babies are fussy during growth spurts.
Is baby working on anything new developmentally? Babies who are starting to notice the world around them can be notoriously distractible. Any kind of new developmental step that baby is working on can affect nursing temporarily, whether it be fussy nursing behavior or simply more frequent nursing.
When is baby fussing? To figure out the cause it’s helpful to pay attention to when the fussy behavior happens, both during the nursing session and during the day.
If baby is fussy right when your milk is letting down (or immediately after), there’s a good chance that the fussy nursing is related to a fast let-down. If baby is fussy before let-down, or a few minutes into nursing (and a while after let-down), then baby may be impatient for the fast flow of milk that comes with let-down. Fussing at the end of a nursing session (or what seems to be the end) may mean that baby needs to burp, or is ready to finish nursing, or just wants to suck (and doesn’t want to deal with a new let-down at this point), or wants to continue nursing on the other side or with a faster flow of milk.
If the fussy behavior is mainly in the mornings, it might be due to a faster than usual let-down if baby has just had a longer sleep period and mom’s breasts are fuller than usual. If baby is fussier during evening nursings, it may be due to the normal fussy time that most babies have during the evening. Although most babies don’t react to foods that mom eats, some do. If you eat a particular food at about the same time each day (or most days) and baby has a regular time where she fusses during nursing, try not eating that food for a week or two to see if things improve.
Does fussing occur on both sides equally or only on one side? Most moms have a faster let-down and/or a more abundant milk supply on one side than the other, so if your baby fusses more on one side, it may be due to these differences.

What else is going on with baby? Is she sick or teething? Is something new or different going on in her environment? Has she started solids or is she trying a new food? Is she exhibiting other symptoms besides the fussy nursing?
Below are discussions of some of the different things that can lead to fussy nursing behavior. Keep in mind that the problem may also be a combination of several things.

Does baby need to burp?
Many babies will cry, fuss, pull off the breast, etc. if they need to burp. Try to burp between breasts and after a feeding, but don’t worry if baby does not burp and is content. Breastfed babies overall don’t take in as much air during a feeding as bottle-fed babies do, so usually don’t need to burp as often. If baby has been crying before she nurses, or is so hungry that she nurses “frantically” or if mom has a fast let-down, baby could be taking in more air and may need to be burped more often.
Burping is usually only necessary during the first few months, though it may extend longer. Once your baby is moving more freely, she will be able to relieve the gastric gas herself. This usually will occur between the 4th and 6th month, but may be shorter in some children and longer in others.
If baby has a hard time burping, try burping more often during a feeding. The best burping position is one that applies firm pressure to the baby’s tummy. Placing baby over the shoulder way up so that there is pressure on baby’s abdomen often works well. Walking around while doing this might distract her long enough to get a good burp. You may even want to lie baby down on her stomach and burp her that way.

Growth spurt
Babies often pull off and fuss during growth spurts. Most babies go through growth spurts, sometimes called frequency days, during the first few days at home and around 7-10 days, 2-3 weeks, 4-6 weeks, 3 months, 4 months, 6 months and 9 months (more or less). More growth spurt information in this link.

Distractible baby
If baby seems to be pulling off the breast at any distraction (real or imaginary), then see The Distractible Baby.

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Nursing Care Plan for HNP Herniated Nucleus Pulposus

Nursing Care Plan for HNP Herniated Nucleus Pulposus

Herniated Nucleus Pulposus
Intervertebral Discs are the cartilage plates that form a cushion between the vertebral bodies. Hard and fibrous material is combined in one capsule. Such as ball bearings in the middle of the disc called the nucleus pulposus. Herniated nucleus pulposus is a rupture of the nucleus pulposus.

Herniated nucleus pulposus into the vertebral bodies can be above or below it, can also directly into the vertebral canal.

Pain can occur in any part such as cervical spine, thoracic (rarely) or lumbar. Clinical manifestations depend on the location, speed of development (acute or chronic) and the effect on surrounding structures. Lower back pain is severe, chronic and recurring (relapse).

Diagnostic Examination
1. Spinal RO: Shows the degenerative changes in the spine
2. MRI: to localize even small disc protrusion, especially for lumbar spinal disease.
3. CT Scan and Myelogram if the clinical and pathological symptoms are not visible on MRI
4. Electromyography (EMG): to localize the specific spinal nerve roots are exposed.

Assessment Nursing Care Plan for HNP Herniated Nucleus Pulposus

1. Anamnesa
   The main complaint, history of present treatments, medical history past, family health history.

2. Physical examination
Assessment of the patient's problem consists of onset, location and spread of pain, paresthesias, limited mobility and limited function of the neck, shoulders and upper extremities.Assessment in the area include palpation of the cervical spine which aims to assess muscle tone and rigidity.

3. Examination Support

Diagnosis Nursing Care Plan for HNP Herniated Nucleus Pulposus

1. Acute Pain
2. Impaired physical mobility
3. Anxiety
4. Knowledge deficient

Intervention Nursing Care Plan for HNP Herniated Nucleus Pulposus

1. Acute pain related to nerve compression, muscle spasm
 a. Assess complaints of pain, location, duration of attacks, precipitating factors / which aggravate. Set scale of 0-10
 b. Maintain bed rest, semi-Fowler position to the spinal bones, hips and knees in a state of flexion, supine position
 c. Use logroll (board) during a change of position
 d. Auxiliary mounting brace / corset
 e. Limit your activity during the acute phase according to the needs
 f. Teach relaxation techniques
 g. Collaboration: analgesics, traction, physiotherapy

2. Impaired physical mobility related to pain, muscle spasms, and damage neuromuskulus restrictive therapy
 a. Give / aids patients to perform passive range of motion exercises and active
 b. Assist patients in ambulation activity progressively
 c. Provide good skin care, massage point pressure after rehap change of position. Check the state of the skin under the brace with a specific time period.
 d. Note the emotional responses / behaviors in immobilizing
 e. Demonstrate the use of auxiliary equipment such as a cane.
 f. Collaboration: analgesic

3. Anxiety related to ineffective individual coping
 a. Assess the patient's anxiety level
 b. Provide accurate information
 c. Give the patient the opportunity to reveal problems such as the possibility of paralysis, the effect on sexual function, changes in roles and responsibilities.
 d. Review of secondary problems that may impede the desire to heal and may hinder the healing process.
 e. Involve the family

4. Knowledge deficient related to the lack of information about the condition, prognosis
 a. Explain the process of disease and prognosis, and restrictions on activities
 b. Give information about your own body mechanics to stand, lift and use the shoes backer
 c. Discuss about treatment and side effects.
 d. Suggest to use the board / mat is strong, a small pillow under your neck a little flat, bed side with knees flexed, avoid the tummy.
 e. Avoid the use of heaters in a long time
 f. Give information about the signs that need attention such as puncture pain, loss of sensation /  ability to walk.

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Nursing Care Plan for Hypospadias with Assessment and Diagnosis

Nursing Care Plan for Hypospadias with Assessment and Diagnosis

Hypospadias
A. Definition of Hypospadias
   Hypospadias is a congenital abnormality, the location of the external urethral meatus is located more towards the proximal ventral surface of the penis. In normal circumstances the external urethral meatus is located on the tip of the glans penis (the most distal).

B. Etiology of Hypospadias
   Is one of the bases of congenital anomalies, most often in male genitalia, occurring in one in 350 male births, can be associated with other congenital abnormalities such as renal and genetic anomalies such as Klinefelter syndrome.

C. Signs and symptoms of Hypospadias
   Signs and symptoms of hypospadias may include:
    The opening of the urethra at a location other than the tip of the penis.
    Spray urine to exit abnormally.
    Hole penis that does not exist at the tip of the penis, but is below or at the base of the penis.
    The penis curved downward.
    The penis looks like a hooded due to abnormalities in the skin of the penis forward.
    If urination, the child should be seated.

D. Management of Hypospadias
   Corrective surgery should be done at pre-school age. In infants cordectomy performed to straighten the penis at the age of 2-4 years of reconstruction of the second stage consists of urethral reconstruction.

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What is Nursing Diagnosis

What is Nursing Diagnosis - And Why Should I Care?
One of the most frequent questions we get goes something like this….”My patient has Congestive Heart Failure. What is the highest priority/most likely nursing diagnosis?”
There is no right answer, because it’s the wrong question! Assigning a nursing diagnosis based on a medical diagnosis skips several steps essential to optimal and safe patient care. A medical diagnosis is only one piece of the puzzle; it does not by itself, provide the depth of information necessary to make an accurate nursing diagnosis.

There is no right answer, because it’s the wrong question! Assigning a nursing diagnosis based on a medical diagnosis skips several steps essential to optimal and safe patient care. A medical diagnosis is only one piece of the puzzle; it does not by itself, provide the depth of information necessary to make an accurate nursing diagnosis.

WHAT IS A NURSING DIAGNOSIS?
Maybe the easiest thing is to start with what a nursing diagnosis is NOT.

A nursing diagnosis is NOT:
    > Merely a label that you make up that “sounds like” it explains what you are seeing in your patient.
    > Another way of explaining the medical diagnosis, or of renaming a medical condition.
    > Something that “goes with a particular medical diagnosis”.

Nursing diagnosis is defined as “a clinical judgment about individual, family, or community experiences/responses to actual or potential health problems/life processes. A nursing diagnosis provides the basis for selection of nursing interventions to achieve outcomes for which the nurse has accountability.” (Herdman, 2012, p. 515). 

In other words, a nursing diagnosis is a judgment based on a comprehensive nursing assessment. The medical diagnosis provides one important piece of data, but it does not provide anywhere near the depth of information necessary for making an accurate nursing diagnosis.

WHY SHOULD YOU CARE?
Because an accurate nursing diagnosis based on a thorough assessment results in more effective and safer patient care. Period.

Let’s take a look at an example:

A man is admitted through the Emergency Department with a medical diagnosis of Viral Pneumonia with the following profile:

    > Age 78;
    > Dyspneic and demonstrating very shallow breathing;
    > Pulse oximeter is showing 90% on 4L of O2;
    > History of COPD.

What is the primary nursing diagnosis? 

Did you think of impaired gas exchange? Seems obvious, doesn’t it, considering the data and medical diagnosis? However, the question the nurse should ask is this: “What is causing the low SpO2?”

After completing a thorough assessment, the nurse discusses her findings with the patient, including the very shallow breathing. She learns the patient is breathing shallowly because he’s in pain. He’s suffering from posthepatic neuralgia as a result of a very painful course of shingles. In this example, the assessment-based, primary nursing diagnosis is chronic pain.

Consider these two scenarios:
Nursing Diagnosis Linked to the Medical Diagnosis
A care plan is developed to address the nursing diagnosis of impaired gas exchange, based on the medical diagnosis of Viral Pneumonia. The posthepatic neuralgia as a cause for shallow breathing is not identified and overlooked in treatment.

OR

Nursing Diagnosis Linked to Nursing Assessment and Critical Thinking
A care plan is developed to address the nursing diagnosis of chronic pain, with treatment designed to resolve this as the primary cause of the shallow breathing, and to prevent recurrence.
Which scenario provides the best patient care and outcome? What do you think the relationship is – or is not – between medical diagnosis and nursing diagnosis?

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