A postpartum client who is breastfeeding her 2-week-old newborn reports sore and cracked nipples. Which nursing intervention should the nurse implement first?

The first and most critical nursing action is to directly observe a complete breastfeeding session. Position yourself to clearly see the infant's mouth and the mother's breast. Assess for the following signs of an effective, deep latch:

• The infant's mouth is wide open, with lips flanged outward like a fish.
• The chin is deeply touching the breast, and the nose is lightly touching or slightly away.
• More areola is visible above the infant's top lip than below the bottom lip (asymmetrical latch).
• The infant's cheeks appear full and rounded during sucking, without dimpling or clicking sounds.
• The mother reports a strong tugging sensation but no persistent pinching or pain throughout the feed.

Simultaneously, evaluate the infant's body alignment. The infant should be in a straight line from ear to shoulder to hip, turned fully toward the mother ("tummy-to-mummy"), with the neck slightly extended. Common positioning pitfalls include the infant's body twisted away or the mother leaning her breast into the infant's mouth, which can lead to a shallow, painful latch.

If a shallow latch is identified, guide the mother to gently break the suction by inserting a clean finger into the corner of the infant's mouth before re-latching. Teach her to wait for a wide-open gape, as if on a yawn, and then bring the infant to the breast quickly, chin first. The "asymmetrical latch" technique, where the infant's lower jaw covers more areola, is key. For positioning, demonstrate the cross-cradle or football hold, which offer more head control for mothers learning to latch.

Once the mechanical cause is addressed, provide comfort and promote healing. Express a few drops of breast milk onto the nipples after feeding and allow them to air-dry; breast milk has anti-infective and emollient properties. If needed, medical-grade lanolin can be applied sparingly, but it is not a substitute for latch correction. Avoid soap on the nipples and change breast pads frequently to keep the area dry. Assess for signs of infection, such as persistent pain, erythema, or purulent discharge, which may indicate mastitis or candidiasis requiring further evaluation.

Schedule a follow-up visit or phone call within 24-48 hours to reassess nipple integrity and feeding effectiveness. Reinforce that breastfeeding should not be painful and encourage the mother to seek immediate help if pain persists. Provide resources for lactation consultant referral if problems are complex or not resolving with basic interventions. Document the latch assessment, interventions taught, and the mother's understanding and return demonstration.