Question

1. scenario: A neonatal nurse is in attendance for a high-risk delivery and is told the mother received morphine sulfate IV 30 minutes ago.

Describe what interventions you would be prepared for immediately after the delivery of the infant.

2. scenario: An infant of a diabetic mother is admitted to the newborn nursery.

Describe all of the pharmacological interventions that accompany newborn care and which intervention has the highest priority for this infant.

Answer 1

1. NAS is a syndrome of drug withdrawal observed in babies of women who are physically dependent on the drug during pregnancy; manifested by non- specific signs and symptoms including neurological excitability, gastrointestinal dysfunction, autonomic signs, poor weight gain, neuromuscular abnormalities and occasionally seizures.

So, the interventions that would be prepared for immediately after the delivery of the infant are :-

Maintaining thermoregulation & cardiorespiratory function, observing for urination/passage of meconium, identifying mother/father/newborn, assessing for major anomalies, encouraging bonding/breastfeeding and a thorough Neurological examination, Respiratory function assessment.

2) Nursing assessment for IDM

- big baby doesn't mean mature baby.

- nurse must consider gestational age and whether the baby is AGA or LGA in planning safe care

- assess for respiratory distress, hyperbilirubinemia, birth trauma, congenital anomalies

#. Ndx for IDM

- altered nutrition (< than body req) r/t increased glucose metabolism and hyperinsulinemia

- impaired gas exchange r/t respiratory distress secondary to impaired production of surfactant

- increased incidence of congenital anomalies r/t poor maternal metabolic control

- ineffective family coping r/t illness of the baby

#. Planning and implementation for IDM

- nursing care is directed toward early detection and ongoing monitoring of hypoglycemia and polycythemia and hyperbilirubinemia

- assess for signs of birth trauma and congenital anomalies

- parent teaching about preventing macrosomia and resulting fetal problems by instituting early and ongoing diabetic control

- advise parents that with early detection and care, most IDMs have no significant sequelae

#. Outcomes for IDM

- IDM respiratory distress and metabolic problems are minimized

- parents understand the effects of maternal diabetes on baby's health and preventive steps they can initiate to decrease its impact on subsequent pregnancies

- parents verbalize their concerns about their baby's health problems and understand the rationale behind management of the newborn