Question

The nurse is caring for a 37 5/7 week baby born to a G4 P2 mother via vaginal delivery. Her membranes were ruptured for 28 hours prior to delivery and the mother received two doses of antibiotics prior to delivery. The baby is now 20 hours old and has been bonding well with mom. Upon assessment of the baby you obtain the following data:

   HR 156, RR 70, Temp 97 degrees F, Blood sugar 32

   The baby appears pale with pink undertones. The mother states that the baby is so sleepy she is having trouble getting him to latch while breastfeeding.

   Lung sounds are clear & equal. There are moderate subcostal and intercostal retractions, nasal flaring and occasional grunting.

   1. What data will you report to the RN?

   2. What is causing these symptoms in this infant?

   3. What will the nurse anticipate the physician will order? Include rationales.

   4. What will your nursing interventions be? Include rationales.

Answer 1

1.Hypothermia, hypoglycemia blood sugar level 32,

breathing difficulties respiratory rate is 70.

.moderate subcostal and intercostal retractions, nasal flaring and occasional grunting.

baby skin is pale and pink.

problem of latch while breastfeeding.

2.neonatal hypoglycemia.

Neonatal hypoglycemia most commonly affects the following groups.

Intrauterine growth restriction or small compared to gestational age infants

Infants of diabetic mothers or large for gestational age infants

Late-preterm infants (34 to 36.6 weeks gestational age) .

Infants experiencing perinatal stress (e.g., fetal distress, perinatal ischemia, maternal preeclampsia/eclampsia, sepsis, hypothermia) or those with congenital heart disease have increased metabolic energy requirements, which puts them at risk for hypoglycemia.

Symptoms of neonatal hypoglycemia include

Sweating

Feeding difficulties, poor suck  

Weak or high-pitched cry

Tremors

Hypothermia

Irritability

Lethargy/stupor

Hypotonia

Seizures

Coma

Apnea, grunting or tachypnea

Cyanosis .

3., a blood glucose test must be done immediately.The normal concentration of glucose in the blood of newborn infants is 2.5 mmol/l (45 mg/dl) to 7.0 mmol/l (126 mg/dl).

if the baby has low blood sugar, then their glucose concentration should be retested every three to six hours within the first 24 to 48 hours of life .

Because NH can result in brain injury.

low blood glucose levels will only last for a few hours, but can last up to 24-72 hours. Once your baby's levels become normal, he shouldn't have further problems with hypoglycemia (another name for low blood glucose). In very rare cases, low blood sugar can be severe or last a long time.

Dextrose is typically administered through an IV and the levels are monitored and adjusted until the blood glucose level in the baby is at an acceptable concentration. If needed, treatment will be continued for a few hours or days to a week, or until the baby can maintain normal glucose levels. Babies who were born early, have an infection, or were born at a low weight may need to be treated for a longer period of time.

Conventionally, a 2 mL/kg to 3 mL/kg (200−300 mg/kg) intravenous bolus of 10% dextrose is given, followed by a continuous infusion. Initial glucose infusion rates generally used for full-term infants are 4 to 6 mg/kg/min, while rates for premature infants may be 6 to 8 mg/kg/min.

4.Assess for signs of hypoglycemia.

Assess feet for temperature, pulses, color, and sensation.

check vital signs temp,heart rate, respiratory rate.

check blood glucose levels .Blood glucose levels usually get back to normal within 12 hours to 72 hours (3 days) of birth, especially once your baby is feeding regularly.

Breast feeding the baby during 2hrs interval.

The most natural way to feed your baby and to keep a normal blood glucose level is early and frequent breastfeeding. Talk to your health care provider before you start using breast milk substitutes (formula).

Assist and educate the mother about latch problem while breastfeeding.

Your baby does not wake up and latch on to your breast for most feedings. call the doctor right way.

Take measurements weight, length,head circumference, chest circumference.