Question

Newborn Care Case Study

Scenario: Baby H was just born in a hospital that provides single-room maternity care. This room allows the infant to remain with the parents after birth. H’s mother was in labor for 12 hours and gave birth vaginally. Baby H is the first baby born to these parents. The nurse will complete the physical assessment and observe for physiologic changes in the infant’s transition from intrauterine to extrauterine life.

1. Name the three phases that occur during this transition period and state an approximate time frame for each.
2. What care is specific to the first period of reactivity?
3. The sleep phase and second reactive phase might occur in the room or in the nursery. Identify 8 assessments or tasks that the nurse needs to do during the transitional care period.
4. You are preparing to give the injection of vitamin K. The order is to give 0.5 mg subcutaneously on arrival in the nursery. The medication comes in a solution of 1 mg/0.5 mL. Calculate how much medication you will draw up into the syringe.
5. Erythromycin ointment is instilled in both eyes to prevent which infection?
6. Once the transitional care and documentation are completed, the infant might be transferred to the normal newborn nursery if the hospital does not use single-room care. The newborn nursery nurse is responsible for what ongoing care of the newborn infant?
7. The laboratory performs a Coombs test on Baby H. What is the purpose of the Coombs test?
8. True or false: a phenylketonuria (PKU) blood test can be done any time before an infant is discharged home. If false, explain your rationale.

Baby H’s mother has decided to breastfeed her infant. She asks for assistance.

9. Identify 6 important points to include in your teaching plan.
10. H’s mother calls you to tell you that her baby seems too sleepy and is not feeding well. What will your next action be?

You are meeting with Baby H’s mother to review discharge instructions. She has many questions.

11. Baby H’s mother asks you about cord care and circumcision care for her infant. What will you tell her?
12. Baby H’s mother asks you how she can keep her infant from catching a cold or some other type of infection. What is the most important measure to teach her?
13. After discharge, it is important for Baby H to receive follow-up care. What should you teach the mother to help her understand the importance of regular visits?
14. What are some safety issues that should be addressed before Baby H is discharged?

Baby H is discharged home with his parents.

Answer 1

physiologic changes in the infant’s transition from intrauterine to extrauterine life.

The successful transition from intrauterine to extrauterine life is dependent upon significant physiologic changes that occur at birth. In almost all infants, these changes are successfully completed at delivery without requiring any special assistance.

• The first period of reactivity (0-30 minutes) characterized by an increase in heart rate, irregular respirations and fine crackles in the chest with grunting and nasal flaring
• A period of decreased responsiveness (30 minutes to 3 hours) with rapid shallow respirations, lower heart rate, decreased muscle activity interspersed with jerks and twitches and sleep
• A second period of reactivity (2-8 hours) in which exaggerated responsiveness, tachycardia, labile heart rate, abrupt changes in tone and color, and gagging and vomiting are commonly seen

Residual symptoms of transition such as crackles in the lungs, a soft cardiac murmur and acrocyanosis may persist for periods of up to 24 hours in otherwise healthy infants.

2.care in first period of reactivity-Assess and monitor heart rate and respiration and color every 15 to 30 minutes for the first hour. infant directly on mother's abdomen and covering with warm blankets. If infant is not with mother, place infant under a radiant warmer until body temperature stabilizes

3. The 8 assessments or tasks that the nurse needs to do during the transitional care period.

The 8 assessment task which the nurse must do in the transitional care period are follows;

1- General measurements such as weight,length, chest, and head circumferance

2-Gestational age assessment

3- General appearance assessment.

4-Skin assessment

5-Head assessment including size and shape of head and cranial suiture.

6-Eye,ear,nose,mouth and neck assessment

7-asessment af respiratory and cardiovascular system.

8-Neurological assessment.