R Case studies
R Case studies
Chapter 17, Newborn Transitioning
1. Sarah works in the labor and delivery unit as a transition nurse. Her department has instituted a new bedside transition period where newborns make the transition to extrauterine life in their mother’s recovery room about an hour after birth. Sarah’s next assignment is a new baby boy with Apgar scores of 8 and 9, born by cesarean about 1 hour ago to Lindsay, a 28-year-old G1. Sarah’s assessment findings of the new baby boy are:
- Vital signs: axillary temperature 37.0° C, heart rate 145, respiratory rate 75
- Observations: color pink, respirations rapid and unlabored, good muscle tone, good arm and leg movement
- Auscultation: breath sounds clear and equal bilaterally, strong heart sounds with a soft murmur, active bowel sounds in all four quadrants
- Physical assessment: fontanels soft and flat, eyes clear with red reflex in both, ears normal shape and placement, soft and hard palate intact, strong suck, both nares patent, capillary refill less than 2 seconds, both testes descended
- Measurements: weight 8 lb 6 oz, length 20 in, head circumference 36.2 cm, chest circumference 36.0 cm
As Sarah is charting her findings, Lindsay asks Sarah if everything is OK with her baby. (Learning Objectives 1, 2, 3, and 4)
- Which assessment findings for this newborn are abnormal? What is the most likely cause of these abnormal findings?
- How would Sarah explain these abnormal findings to Lindsay?
- What are the nursing interventions that Sarah would implement based on these findings?
2. Baby girl Destiny was born by cesarean delivery 2 days ago. Destiny weighed 7 lb 3 oz, length 19 in, head circumference 34 cm, and chest circumference 34 cm. Her newborn course has been unremarkable. You observe that when held, Destiny appears alert and stares into her caregiver’s face. Destiny appears to be a content baby and cries only when she is hungry or when she needs a diaper change. When hungry, you observe that she brings her hand to her mouth and starts sucking on her fist and then begins to cry. Destiny falls asleep immediately after the feeding. The telephone, which is next to Destiny on her mother’s bed, rings loudly and Destiny does not appear to respond to the loud sound by moving her extremities or awakening briefly. (Learning Objectives 7 and 8)
- Based on your observations of Destiny, are her behaviors normal? Which of the five typical behavioral responses were observed?
- Does Destiny exhibit any behaviors that may be cause for concern? What is the concern and what might you as the nurse do to assess further?
Chapter 18, Nursing Management of the Newborn
1. As a postpartum nurse your next client is an LGA baby boy who was born at 37 weeks’ gestation. He had Apgar scores of 8 and 9. He was circumcised. The mother is breast-feeding. Your unit requires a full assessment, screenings, discharge instructions, and documentation. (Learning Objectives 3, 6,7, and 9)
- Describe what a normal head-to-toe assessment would be for an infant born at 37 weeks’ gestation. What test is used to determine this gestational age? What is the scale used to determine the Apgar score, and are this baby’s scores normal?
- As the discharging nurse, you are responsible for what screenings in an infant in the first 24 to 48 hours? What immunizations would be required?
- What discharge instructions would be pertinent to this mother? How would you educate her or the family?
- How would you document your discharge teaching? Write a sample narrative of your teaching.
2. You are the newborn nursery nurse and have been called to the labor and delivery suite to attend the delivery of a G5P4 mother whose pregnancy was complicated by gestational diabetes. At 2032 a male infant weighing 8 lb 2 oz was delivered vaginally with the assistance of a vacuum extractor. You have assigned Apgar scores of 7 and 9. (Learning Objectives 1, 2, 4, 5, and 7)
- What are the assessments you need to carry out in this immediate postdelivery time period?
- What are the nursing interventions you will perform before the baby is taken to the newborn nursery?
- After taking the baby to the newborn nursery, you notice that the baby has developed diffuse swelling and bruising on the occiput of his head from the vacuum extractor use. What are the differences between a cephalhematoma formation and caput succedaneum development? Which one is more serious?
- When the baby is 6 hours old, you notice that he has become jittery and is cyanotic. You check a heel stick blood sugar and it reveals a blood glucose level of 30. What are the immediate nursing interventions you will implement and what additional interventions you can implement to prevent this from occurring again
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