Question

2. Baby girl Destiny was born by cesarean delivery 2 days ago. Destiny weighed 7 pounds 3 ounces, length 19 inches, head circumference 34 cm, 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 Objective 5)

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 4, 7, 8, and 10)

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.

Answer 1

1.The warning signs of newborn babies include-

Doesn't respond to sounds, music or voices

Doesn't startle in response to a sudden loud sound.

Isn't soothed by soft sounds.

Doesn't move or wake up at the sound of voices or nearby noises when sleeping in quite room.

Destiny doesn't respond to loud sound of telephone is warning sign. She might have hearing problem.

There are two types of baby hearing screening-

AABR- Automated Auditory Brainstem Response

OAE- Otoacoustic emissions

Destiny must undergo these two tests.

2. Assessment for an infant born at 37 weeks gestation includes-

Apgar scoring

Birth Weight

Measurements of head circumference, abdominal circumference, length from top of head to feet of baby

Temperature, pulse and breathing rate measurement.

Physical examination include general appearance, skin,head and neck, face, mouth, lungs, heart sounds, genitals and anus, arms and legs

In Apgar test , 5 things are used to check baby's health. Each is scored on the scale of 0 to 2 , with 2 being the best score.

Apgar score 8 or 9 indicates that baby is looks well, and doesn't need medical attention. This is ideal score.

There are 3 screenings important within 24-48 hrs-

Blood test

Hearing test

Pulse oximetry testing.

Generally 3 vaccinations are very crucial at time of birth-

BCG vaccine

Hepatitis B vaccine

Polio vaccine.