Use of tobacco, alcohol and other substances during pregnancy = 5.
34
Community Health Interventions
Ascertain reason for beginning abstinence,
involvement in therapy.
Discuss the concept of substance abuse and the
different types of symptoms (patterns of use,
impairment caused by use, tolerance to
substance).
Explore community resources as appropriate.
Emphasize and encourage prevention strategies
(e.g., abstinence from drugs, alcohol and tobacco
for pregnant women)
Encourage cessation of tobacco, especially
smokeless, and enrollment in smoking-cessation
classes.
Note use of alcohol/other drugs and nicotine.
Advise the patient who uses tobacco or nicotine
to stop.
Assess the patient’s willingness to attempt to quit
using tobacco or nicotine at the time.
Assist the patient who is interested in quitting by
providing pregnancy-specific, self-help tobacco
and nicotine cessation materials.
Arrange follow-up visits to track the progress of
the patient’s attempt to quit using tobacco and
nicotine.
Rationale
To provide insight into a patient's willingness to
commit to long-term behavioral change, and
whether the patient even believes that she can
change.
To provide the knowledge and information
necessary to prevent dangerous situations and to
create healthy personal choices, as well as
acceptance of problem and treatment options.
Additional assistance such as day programs,
individual/family counseling, drug/alcohol
cessation programs can strengthen client’s coping
abilities and sense of control.
Promoting wellness starts with preventing
complications and/or limiting severity of
anticipated problems. Such strategies can often
be initiated by nurses where the potential is first
identified, in the community setting.
To reduce incidence of gum disorders, oral
cancer, and other health problems.
Maternal pregnancy complications and negative
effects on the developing fetus are increased with
the use of tobacco, alcohol, and illicit drugs.
Providing advice about quitting with information
about the risks of continued tobacco and nicotine
use to the woman, fetus, and newborn
Quitting advice, assessment, and motivational
assistance should be offered at subsequent
prenatal care visits.
Support the importance of having tobacco and
nicotine-free space at home and seeking out a
quitting buddy such as a former tobacco or
nicotine user. Encourage the patient to talk about
the process of quitting.
For current and former tobacco and nicotine
users, use status should be monitored and
recorded throughout pregnancy, providing
opportunities to congratulate and support
 success, reinforce steps taken towards quitting,
and encourage those still considering a cessation
attempt.

References:

Tobacco and nicotine cessation during pregnancy. ACOG. (n.d.). Retrieved May 5, 2022, from
https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2020/05/tobacco-and-nicotine-
cessation-during-pregnancy

Vera, M. B. (2022, March 18). 8 Substance Abuse Nursing Care Plans. Nurseslabs.
https://nurseslabs.com/substance-abuse-nursing-diagnosis-care-plan/

Shaken Baby Syndrome, sometimes called abusive head trauma - 4.67

Community Health Interventions Rationale

Assess the severity and pervasiveness of the
situation (e.g., potential for long-term stress
leading to abuse or neglect,and delayed
development).
Assessing the risk of potential hazards aids in
determining the appropriate interventions in terms
of intensity, as well as the likelihood of harm, such
as an accident or illness, and the severity to
which assistance and support may be required by
the parent/caregiver.

Evaluate the environment in which long-standing To determine the part of planning that analyzes
care will be provided. and evaluates the potential effects of alternative
resource solutions on ongoing services/other
needs of child and care provider(s).

Note chronological age and review expectations
for “normal” development at this age
To assist in the assessment of developmental
expectations and to simulate the equivalency of
components such as physiological response,
social interaction, learning, and cultural
assimilation.

Instruct the patient’s family on how to take The knowledge of safety precautions minimizes
precautions to avoid tissue trauma or disruption of the incidence of bleeding that can lead to
standard clotting mechanisms. permanent brain injury or death of the baby.

Emphasize importance of follow-up screening To promote ongoing evaluation, support, or

appointments and encourage attendance at management of situations to maintain patient
appropriate educational programs (e.g., parenting health and enhance care outcomes.
classes, infant stimulation sessions, seminars on
life stresses and the aging process)

Identify available community resources, as Provides additional assistance to support family

 appropriate (e.g., early intervention programs, efforts and coping if interventions are required.
seniors’ activity/support groups, gifted and
talented programs, sheltered workshops,
children’s services, and medical
equipment/supplier).

Identify possible signs and symptoms of a Shaken Studies have suggested that 80% of deaths
Baby Syndrome for early detection of the disease. associated with abusive head trauma might have
survived with earlier intervention.

Educate the parents or caregivers of children’s
behavior.
Parent education cards on such topics as
constant crying, feeding problems, temper
tantrums and toilet training, developed to contain
information on appropriate expectations of
children and nonviolent approaches to behavior
management have demonstrated effectiveness in
changing parents’ knowledge and reported
behavior

Home visitation by nurses in the perinatal and Extended home visitation programs can prevent
early childhood periods child physical abuse and neglect among poor,
adolescent or single parents.

Evaluate client’s progress on a continual basis. To make referrals in a timely manner and/or to
Identify target symptoms requiring intervention. make adjustments in plan of care, as indicated.

References:

Head injury nursing diagnosis and nursing care plan. NurseStudy.Net. (2022, March 21). Retrieved May
5, 2022, from https://nursestudy.net/head-injury-nursing-diagnosis/

Ward, M. G., Bennett, S., & King, W. J. (2004). Prevention of shaken baby syndrome:
Never shake a baby. Paediatrics & child health, 9(5), 319–321.
Joyce T, Gossman W, Huecker MR. Pediatric Abusive Head Trauma. [Updated 2022 Jan 11]. In:
StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK499836/

Doenges, M., Moorhouse, M., & Murr, A. (2013). Nurse’s Pocket Guide (Diagnosis, Prioritized
Interventions, and Rationales (13th ed.) [E-book]. F. A. DAVIS COMPANY.

Ineffective Breastfeeding - 4.67

 Community Health Interventions
Assess psychosocial factors that may contribute
to ineffective breastfeeding (e.g., anxiety, goals
and values/lifestyle that contribute to ambivalence
about breastfeeding).
Assess for presence/absence of related factors or
conditions that would preclude breastfeeding.
Assess breast and nipple structure.
Provide instruction in correct positioning.
Provide support by actively helping the mothers to
correctly position the baby to attain a good latch
on the nipple and encouraging her to continue
trying.
Enhance the flow of milk. Teach the mother to
massage breast or burp infant and switch to other
breast when infant's swallowing slows down.
Identify where women lack support from partners
and/or family members and explore alternatives
such as mother-to mother support groups
Link new mothers to peers who have
breastfeeding experience through trained peer
outreach workers, volunteer mother-to-mother
support groups, home visits and telephone
contacts
If unsuccessful in achieving effective
breastfeeding, help clients accept and learn an
alternate method of infant feeding.
Rationale
The attitude of the mother toward breastfeeding is
critical in achieving successful lactation,
influencing milk production, and facilitating the art
of breastfeeding (Brandt, Andrews, Kvale, 1998).
Some conditions (e.g. certain maternal drugs,
maternal HIV-positive status, infant galactosemia)
may preclude breastfeeding, in which case the
infant needs to be started on a safe alternative
method of feeding (Riordan, Auerbach, 2000;
Lawrence, 2000).
Normal nipple and breast structure or early
detection and treatment of abnormalities with
continuing support are important for successful
breastfeeding (Vogel, Hutchison, Mitchell, 1999).
"Correct positioning is perhaps the most critical
single measure for getting breastfeeding off to a
good start. Many problems can be attributed to
carelessness or inattention to this simple aspect
of breastfeeding" (Righard, 1998).
Many problems that can lead to discontinuing
breastfeeding can be prevented by giving a high
level of practical and emotional support to the
mother (Janken et al, 1999).
The perception of inadequate milk supply can
lead to early weaning. Infants should breastfeed
from both breasts at each feeding. Breast
massage can enhance the flow of milk and
stimulate production (Riordan, Auerbach, 2000)
A supportive partner, family member, or friend
plays a key role in the success of breastfeeding.
When a mother feels supported she is more likely
to feel confident and empowered with her choice
to breastfeed.
Peer counselors reinforce breastfeeding
recommendations in a socially and culturally
relevant context, since they understand the
cultural and environmental barriers to
breastfeeding and often speak the native
language of their clients.
Once the decision has been made to provide an
alternate method of infant feeding, the mother
needs support and education (Brandt, Andrews,
Kvale, 1998; Mozingo et al, 2000).
 Reinforce and add to the knowledge base
regarding underlying problems and specific
treatment measures.
If a mother understands the rationale for
recommended treatment, she may be more likely
to comply with recommendations and less likely to
perceive the problem as insurmountable (Cox,
Turnbull, 1998; Susin et al, 1999).

References:

Ineffective Breastfeeding. (2013, July 27). Nursing Interventions and Rationales.

http://nursinginterventionsrationales.blogspot.com/2013/07/ineffective-breastfeeding.html

Public Health Agency of Canada. (2019, December 4). Protecting, Promoting And Supporting
Breastfeeding: A Practical Workbook For Community-based Programs - 2nd Edition -
Canada.ca. Protecting, Promoting And Supporting Breastfeeding: A Practical Workbook For
Community-Based Programs - 2nd Edition.
https://www.canada.ca/en/public-health/services/health-promotion/childhood-adolescence/
publications/protecting-promoting-supporting-breastfeeding.html#c4a

Chapman, D. J., Morel, K., Anderson, A. K., Damio, G., & Pérez-Escamilla, R. (2010). Breastfeeding peer
counseling: from efficacy through scale-up. Journal of human lactation : official journal of International
Lactation Consultant Association, 26(3), 314–326. https://doi.org/10.1177/0890334410369481