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    Case Study 116

    Uploaded by

    Jonah Maasin
    The document describes the care of a newborn, Baby H, over their first day after birth. It provides details of the initial physical assessment and monitoring during the transitional period, including tasks like measuring vitals and checking for jaundice. It also outlines teaching points for the mother on breastfeeding, cord and circumcision care, safety, and the importance of follow-up visits for growth monitoring. Key tasks for the nurse include assessment, teaching, and ensuring the mother is prepared before discharge.

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    Case Study 116

    Uploaded by

    Jonah Maasin
    122 views4 pages
    The document describes the care of a newborn, Baby H, over their first day after birth. It provides details of the initial physical assessment and monitoring during the transitional period, including tasks like measuring vitals and checking for jaundice. It also outlines teaching points for the mother on breastfeeding, cord and circumcision care, safety, and the importance of follow-up visits for growth monitoring. Key tasks for the nurse include assessment, teaching, and ensuring the mother is prepared before discharge.

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    The document describes the care of a newborn, Baby H, over their first day after birth. It provides details of the initial physical assessment and monitoring during the transitional period, including tasks like measuring vitals and checking for jaundice. It also outlines teaching points for the mother on breastfeeding, cord and circumcision care, safety, and the importance of follow-up visits for growth monitoring. Key tasks for the nurse include assessment, teaching, and ensuring the mother is prepared before discharge.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    122 views4 pages

    Case Study 116

    Uploaded by

    Jonah Maasin
    The document describes the care of a newborn, Baby H, over their first day after birth. It provides details of the initial physical assessment and monitoring during the transitional period, including tasks like measuring vitals and checking for jaundice. It also outlines teaching points for the mother on breastfeeding, cord and circumcision care, safety, and the importance of follow-up visits for growth monitoring. Key tasks for the nurse include assessment, teaching, and ensuring the mother is prepared before discharge.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
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    Maasin, Jonah Rosalie A. BSN2A GRP3.

    SCENARIO:

    ❑ Baby H was just born in a hospital that provides single-room maternity care (SRMC).
    ❑ SRMC allows the infant to remain with the parents after birth.
    ❑ The nurse will complete the physical assessment and observe for physiologic changes in the
    infant’s transition from intrauterine to extrauterine life.
    ❑ The textbooks will tell you that the infant goes through an initial phase of reactivity 30 to 60
    minutes after birth, then a sleep phase for 4 to 6 hours, the q second period of reactivity. You
    will see variations of the timing in actual practice.

    QUESTIONS:

    1. What care is specific to the first period of reactivity?

    The first reactivity period generally lasts six to eight hours. In the first 30 minutes after birth, the
    newborn is usually very alert and active. The baby will generally have a strong sucking reflex during this
    time, and this is generally an excellent time to start breastfeeding. Your baby will have his eyes open and
    look around. Physiologically, the baby's breathing rate may increase and the lungs will sound quite
    moist. The heart rate can increase, the bowel sounds are active, the production of mucus increases and
    the body temperature can drop slightly.

    2. Identify 8 assessment or tasks that the nurse needs to do during the transitional care period of
    reactivity:

    • General Measurement such as weight, length, chest and head circumference.


    • Gestational age assessment, for maximum reliability gestational age needs to be assessed in the
    initial four (4) hours of birth.
    • General appearance, abnormal findings might be seen such as jaundice, lack of interest in
    environment, cyanosis, heart rate over 160 beats per minute or less than 100 beats per min, lack
    of responsiveness, and hypertonic or hypotonic position.
    • Neurological assessment includes an evaluation of a neonate's level of alertness, cranial nerve
    function, motor and sensory system function, and the presence of primitive reflexes.
    • Head to toe assessment includes eye, ear, nose, mouth, neck, shape and size of head, cranial
    nerves and lower extremities.
    • Genitourinary system assessment, abnormalities and malformations described include
    abdominal distention, abdominal wall defects, exstrophy of the bladder, umbilical cord
    anomalies, and abnormalities of the male and female genitalia.
    • Respiratory system assessment
    • Cardiovascular system assessment

    3. You are preparing to give the injection of vitamin K ( aquaMephyton). The order is to give 0.5 mg
    subcutaneously upon arrival to the nursery. The medication comes in a solution of 1mg/0.5ml.
    Calculate how much medication you will draw up into the syringe.

    0.5ml/1mg x0.5mg= 0.25ml


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    4. Once the transitional care and documentation are completed, the infant might be transferred to
    normal newborn nursery. What ongoing care of newborn is this nurse responsibility for?

    • Assessing vital signs every 4 hrs.


    • Assess decrease in profusion
    • Assess and maintain cleanliness
    • Assess for any skin color changes

    5. The laboratory also performs a Coomb’s test on baby H. What is the purpose of coomb’s test?

    It is done to identify the infant’s blood type and used to detect antibodies that are stuck to the
    surface of red blood cells. Many diseases and drugs can cause this to happen. These antibodies
    sometimes destroy red blood cells and cause anemia.

    6. True or false. A phenylketonuria blood test can be done any time before an infant is discharge to
    home. If false explain your rationale.

    FALSE. PKU must be done after the infant turned 24 hrs. old, If PKU isn’t diagnosed and treated right
    away, it can cause lasting problems, including developmental delays, Mood disorders, Hyperactivity and
    severe intellectual disability.

    CASE STUDY PROGRESS

    ❑ Baby H.’s mother has decided to breastfeed her infant. She asks for assistance.

    7. Identify six important points to include in your teaching plan for breastfeeding.

    • Always place newborn on his back after breastfeeding.


    • Explain to the mother that when her newborn is properly latched on, his nose, cheeks, and chin
    will be in contact with her breast.
    • Demonstrate the four basic breastfeeding positions; football -hold, cradle or modified cradle
    and side lying.
    • Place newborn skin to skin on the mother’s chest immediately after birth.
    • Express few drops of colostrum or milk and spread it over the nipple to lubricate the nipple and
    entice the newborn.
    • Reassure the mother that uterine cramps are normal during breastfeeding, resulting from
    oxytocin, which also promote uterine involution.

    8. Baby H.’ mother calls you to tell you that her baby seems too sleepy and not feeding well. What will
    your next action be?

    Most babies are tired from the birthing process and may sleep more frequently. The nurse should assess
    whether the infant has eaten enough, whether he or she should be awakened to feed longer, or
    whether the infant should be fed again sooner than usual. It is important to emphasize that the wake-up
    techniques used should be gentle.

    • Mother can undress the baby and place the infant against the skin.
    • Change the diaper

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    3 of 4

    • Wipe the infants face with lukewarm washcloths to help infants wake up

    CASE STUDY PREGRESS

    ❑ You are meeting with Baby H.’s mother to review discharge instructions. She has many
    questions.

    9. Baby H’s mother asks you about cord care and circumcision care for her infant. What will you tell
    her?

    ✓ It is critical that the umbilical cord stump and surrounding skin remain clean and dry. This basic
    care aids in the prevention of infection.
    • clean cord with water (using cleanser sparingly if needed to remove debris) during the initial
    bath of the newborn.
    • Assess stump and base of cord for erythema, edema, and drainage with each diaper change.
    • The newborn diaper should be folded don and away from the umbilical stump.
    • Most cords fall off within the 10 to 14 days.
    • Bathing infants by submerging in water should not occur until the cord has fallen off.
    ✓ Parents circumcise their newborn sons for a variety of reasons, including health benefits such as
    a lower risk of urinary tract infection during the first year of life and a lower risk of sexually
    transmitted infections (STIs) later in life.
    • Fanfold diapers to prevent pressure on the circumcised area.
    • Swaddle with comfort
    • Keep area clean
    • Avoid wrapping the penis in tight gauze which can impair circulation.
    • Avoid tub bath until circumcision is healed.
    • Avoid premoistened towelettes to clean penis
    • Expect fuzziness from newborn

    10. Baby H’s mother asks you how she can keep her infant from catching colds or some other type of
    infection. What is the most important measure to teach her?

    • Proper hand hygiene helps prevent infections


    • Keep sick family members away from infants
    • Attend follow up appointment to prevent or identify early infections.
    • Disinfect surfaces around infant

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    11. After discharge, it is important for Baby H. to receive follow up care. What should you teach the
    mother to help her understand the importance of regular visits?

    Every month of your baby's first year brings new developments: tiny smiles, emerging teeth,
    and, eventually, crawling and walking. Your pediatrician will check for proper growth and development
    and answer your questions about eating, sleeping, and vaccinations during well-baby visits. Follow ups
    also help determine early developmental problems not detected at childbirth. Early detection can
    improve or resolve complication. General idea is to check the well being of the infant in every stage of
    growth.

    12. You realize that Baby H.'s mother needs information about safety issues before being discharged.
    After a review of safety issues, which statement by Baby H.'s mother indicates that she needs further
    Instruction?

    a. "I have a car seat and will use it for my baby every time we use the car."

    b. "I can leave him on the infant table for just a few moments while he is a newborn."

    c. "I will not drink hot coffee while holding my baby."

    d. "I will check the bath water temperature before bathing him”

    CASE STUDY OUTCOME

    ❑ Baby H. is discharge to home with his parents

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