Newborn Case Study 2

Newborn Case Study Baby H. is admitted to the transitional nursery, where 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 the infant goes through an initial phase of reactivity 30 to 60 minutes after birth, then a sleep phase for 4 to 6 hours, then a second period of reactivity. You will see variations of the timing in actual practice. Part 1 1. What care is specific to the first period of reactivity? - Keep newborn dry and warm, vital signs, encourage bonding and breastfeeding, APGAR scores, assessment of umbilical cord, airway clearance 2. The sleep phase and second reactive phase may occur in the nursery, what are they and when do they occur? - The sleep phase is the period when the baby will be difficult awaken and show no interest in sucking, the bowel sounds are now heard, and heart and respiratory rates return to baseline. This phase occurs about half an hour after the activity phase ends. - The second reactive phase the baby is now awake and alert again, GI tract is more active – they may pass first meconium, initial voiding; shows readiness for feeding – sucking, rooting, swallowing; heart and respiratory rates increase; respiratory and gastric mucus increases – baby response is gagging, choking, and regurgitating; may have rapid color changes – cyanotic or mottled – in apneic periods. 3. Identify eight assessments or tasks that the nurse needs to do during the transitional care period. - Assess vital signs q30min until stable for 2 hours - Measurements: head circumference, body length, weight - Assess airway clearance & skin color - Neuro status: muscle tone, reflexes, LOC, response to handling - Maintain thermoregulation - Assess ability to feed - Vitamin K injection - Erythromycin eye ointment Once the transitional care and documentation are completed, the infant is transferred to the normal newborn nursery. Part 2 4. What ongoing care of newborn is this nurse responsible for? - Assess vital signs q6-8h, place supine for sleeping, oral-nasal suctioning if needed to maintain a clear airway, maintain temp w/in normal range – dried after bath, dressed, and exposed to air minimally, head covering; record intake; record voiding and stooling; weigh at same time each day; assessment of umbilical cord and care; assessment and care for circumcised/uncircumcised newborn 5. What is the significance of the Coombs’ test? - The test will identify if the newborn has antibody-coated Rh-positive RBCs, they have been coated with maternal antibodies. 6. The baby is lethargic and not feeding well. What should your next action be? - Stimulate newborn by unwrapping, diaper change, stroke cheek with finger or mom’s nipple, hold baby upright, talk to baby, gently rub hands and feet. 7. Baby H.’s mother has decided to breast feed her infant. She asks for assistance. Identify six important points to include your teaching plan. - Position self in comfortable position – well supported pillows - Bring baby to her breast rather than leaning forward to the baby - Baby needs to attach lips onto breast, far back onto the areola, not on the nipple – stroke baby’s lips w/ nipple to get a wide open mouth - First breast feeding session lasting 10-20 min - Do not watch clock to determine when to switch breasts but watch newborns feeding pattern - Baby should be nursing at least 8x in 24 hours 8. Baby H.’s mother asks you about cord care and circumcision care for her infant. What should you tell her? - Cord care: wash hands with soap and water before/after care, keep cord dry and exposed to air or loosely covered w/ clean clothes, clean cord and skin around w/ cotton swab/ball, clean 2-3x/day or w/ each diaper change, do not touch or apply dirty things to it, bandages should be avoided, no tub baths until cord falls off, fold diapers under cord, check for odor, oozing, or redness around cord – signs of infection, never pull or try to loosen. - Circumcision care: use new, clean washcloth to squeeze warm water over site once a day, rinse w/ warm water and pat dry, apply small amount of petroleum jelly w/ diaper change, put diaper snugly so it does not move or rub tender glans, check for foul-smelling drainage or blood, plastibell – let fall off alone, do not pull off; light sticky yellow drainage may form over head – normal healing process. 9. You realize the baby needs follow-up (F/U) care after discharge. What should you teach the mother to help her understand the importance of regular visits? - Follow-up care examination should be w/in 48hr after discharge, its focused on normal newborn care, assessment for hyperbilirubinemia, any extreme weight loss, presence feeding problems, and knowledge deficits on newborn care 10. You realize that Baby H.’s mother needs information about safety issues before being discharged. What should you teach her? - Proper positioning of the newborn on the back to sleep - Correct use of the bulb-syringe - Prevent infection – wash hands w/ soap and water - Baby should never be left alone - Never lift newborn if feeling weak, faint, or unsteady - Car seat safety – safest spot in car is middle of the back seat, seat should be positioned to face the rear until child reaches appropriate age - Always keep and eye or hand on baby when out of crib – they can easily roll off bed