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.

a. What data will you report to the RN?

b. What is causing these symptoms in this infant?

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

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

Answer 1

1) hypogycemia,blood sugar is 32

Moderate hypothermia ,97degree

Breathing difficulties,rr 70 with flaring of nose and occasional grunting

Pale appearance

Lethargic

Not interested in taking feed

Membranes ruptured for 28 hours prior to delivery

2) hypoglycemia

Hypoglycemia is when the level of sugar (glucose) in the blood is too low.

Rationale:

Let us see some of the etiological factors,

Hypoglycemia can be caused by conditions such as:

Poor nutrition for the mother during pregnancy

Making too much insulin because the mother has poorly controlled diabetes

Incompatible blood types of mother and baby (severe hemolytic disease of the newborn)

More insulin in the baby's stool for other reasons, such as a tumor of the pancreas

Birth defects

Congenital metabolic diseases or hormone deficiencies. Some of these run in families.

Not enough oxygen at birth (birth asphyxia)

Liver disease and,

Infection (which is most important in this case, because;

We have seen that the mothers membrane ruptured for 28 hours, which can cause   infection to the new born, it can be the reason for hypoglycemia.

Now let us see the signs and symptoms, (also mentioned the symptoms present in the new born)

The most common signs include:

Shakiness

Blue tint to skin and lips (cyanosis)

Stopping breathing (apnea)/difficulties in breathing

( present in the newborn)

Low body temperature (hypothermia)(present in the new born)

Floppy muscles (poor muscle tone)

Not interested in feeding(present in the new born)

Lack of movement and energy (lethargy)(present in the new born)

Seizures

3) the nurse can aticipate orders such as, (treatment)

. Glucose supplements:to maintain Normal glucose level in the blood

. Oxygenation:since breathing difficulties are there

. SpO2 level monitoring

. Continues sugar monitoring:to know any changes and to act accordingly

. Test for CRP(c reactive protein) :since there are chances of infection.

(The immediate treatment for hypoglycemia is giving the baby a rapid-acting source of glucose such as mixture of glucose/water or formula as an early feeding if baby is able to take by mouth.

If baby is not responding and has seizures IV fluids containing glucose is the best choice to raise the blood glucose quickly.

Any neonate whose glucose falls to ≤ 50 mg/dL should begin prompt treatment with enteral feeding or with an IV infusion of up to 12.5% D/W, 2 mL/kg over 10 min; higher concentrations of dextrose can be infused if necessary through a central catheter. The infusion should then continue at a rate that provides 4 to 8 mg/kg/min of glucose (ie, 10% D/W at about 2.5 to 5 mL/kg/h). Serum glucose levels must be monitored to guide adjustments in the infusion rate. Once the neonate’s condition has improved, enteral feedings can gradually replace the IV infusion while the glucose concentration continues to be monitored. IV dextrose infusion should always be tapered, because sudden discontinuation can cause hypoglycemia.)

4) nursing interventions

. Assess the general condition of the newborn, including appearance, sugar level and vital signs

. Keep the baby in the warmer, to prevent further hypothermia, and to provide warmth

. Provide oxygenation to aid in breathing

. Continuously monitor the blood sugar level to avoid any complications and take immediate measures

. Check SpO2 levels in the blood

. Encourage mother to feed the child more frequently, make sure that the nutritional needs are met.

. Trace and inform lab values as fast as possible