Question

A 16-year-old primigravida delivers a baby girl at 35 weeks. The baby was born by cesarean section due to placenta abruption. Upon assessment of the newborn, the nurse notices that the baby appears irritable and tachypneic with a shrill cry, decreased Moro reflex, and frequent sneezing.

The nurse is concerned about the newborn. No prenatal care was documented. The adolescent mother denies taking illicit drugs, alcohol, and smoking cigarettes. (Learning Objectives 12, 14)

Answer the following questions based upon the information above:

1. What assessment criteria signals a red flag and why?
2. What nursing interventions, if any, do the newborn and the new mother need?

Answer 1

1. What assessment criteria signals a red flag and why?

• In this case a adolescent becomes a mother and delivers a pre mature baby.
• 99% of all babies born at 35 weeks survive but this is a case of adolescent mother . Although a baby born at 35 weeks resembles a full-term one, he's still premature and needs the right support to grow.
• Along with that patient have undergone cesarean due to placenta abruption i.e. serious pregnancy complication in which the placenta detaches from the womb (uterus).
• In this condition the mother needs adequate care and bed rest. The cesarean is undergone due to placental abruption.
• In this case  baby becomes very irritable which means baby  may be ill or in pain.
• The newborn is appeared with Transient tachypnea i.e. a breathing disorder seen shortly after delivery in early term babies. Transient means it is short-lived (most often less than 48 hours). As this is along with shrill cry there may be a chance of  kernicterus.
• Absence of the Moro reflex in an infant is abnormal. Absence on both sides suggests damage to the brain or spinal cord. In this case of decreasing moro reflex adequate rest and some points should be remembered :   

1. moving the baby’s outstretched arms and legs gently toward their body
2. holding the baby close until they calm down
3. supporting the baby’s head and neck when moving or holding them
4. swaddling the baby in a lightweight cloth

• It is normal for your newborn babies to sneeze frequently. It is her way of clearing airborne fluff, dust and mucous from her nose as well as milk, which can go up into her nose when she vomits. It is very common and nothing to worry about.
• No prenatal care was documented which means ,there are three times more likely to have a low birth weight and five times more likely to die than those born to mothers who do get care. Doctors can spot health problems early when they see mothers regularly.

2.What nursing interventions, if any, do the newborn and the new mother need?

• Nurses should provide around-the-clock care for preterm babies who need extra support to keep warm, to breathe and to be fed, or who are very sick.
• Essential newborn care:
  • All babies need to be protected from infections: everyone who touches the mother or the baby should have clean hands. Medical examinations and procedures should only be done if necessary. Sterile gloves and cutting devices should be used for clamping and cutting the umbilical cord.
  • All babies need to be kept warm.
  • Those who do not start breathing on their own need help: ventilation with a bag and mask will usually put them back on track.
  • Breast is best: just like full-term babies, breast milk is the best nutrition for preterm babies. Babies should be breastfed as soon as possible after birth. Most premature babies who are unable to coordinate the suck and swallow reflex can be fed their mother’s expressed breast milk by cup, spoon or nasogastric tube.
• Care for preterm babies with complications:
  • Babies who have infections need treatment with antibiotics.
  • Babies who do not breathe when they are born need basic newborn resuscitation; if breathing problems persist, they may need additional support from a machine (ventilator) and extra oxygen.

• Care for postpartum adolescents

Develop a relationship with the younger mother, it is important to remain nonjudgmental. This may mean that the nurse needs to move beyond her own feelings about teen pregnancy and to get to know the young woman individual. As many teenagers find it difficult to talk spontaneously, they need help from a sensitive nurse to express their feelings. In addition to questioning the young mother about her labor, delivery, and postpartum experiences, the nurse should learn about the young mother's life at home and the father of the baby. As the latter may be a particularly sensitive area, it should be approached with care. The nurse must assess the adolescent and her infant and observe the young mother interacting with her child. The intellectual and cognitive limitations of the adolescent must be considered if patient teaching is to be effective. A young mother who does not have the self control or attention span necessary to sit through an hour-long class on infant care may benefit from a hands-on, 1-to-1 teaching session with her nurse. Such teaching with a live infant is particularly effective with young mothers as is a small group class. To deliver both effective teaching and nursing care, it is essential to know how far the adolescent has progressed in her own development. The late adolescent often can be treated like an adult in terms of how she is expected to care for her infant and respond to patient teaching.

• New mothers should be careful not to eat food items that cause gas and constipation. During the period after the C-section, you should avoid consumption of junk food and carbonated drinks and consume food items such as soup, cottage cheese, broth, yoghurt and other items which are easily digested by the body.All this care has to be given .
• Nursing interventions for a child who is irritable is to provide rest periods to promote relief, sleep, and relaxation; place infant on a position of comfort to reduce pain.

• There are many ways to elicit Moro reflex. However, the most common method used is the “drop method” wherein the nurse lifts the baby completely off the bed while supporting the head and the neck, and then the nurse lowers the baby rapidly till there is only 4-8 inches between the baby and the bed. It is important to note that while doing this, the baby is kept in supine position. Complete Moro reflex involves bilateral abduction of arms, extension of forearms, and full opening of hands. This is then followed by slow return of hands towards the midline and then followed by curling of the fingers.