Question

Essentials of Maternity, Newborn, and Women's Health Nursing

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.

2. You are the newborn nursery nurse and have been called to the labor and delivery suite to attend the delivery of a G5P4 mother whose pregnancy was complicated by gestational diabetes. At 2032 a male infant weighing 8 pounds 2 ounces was delivered vaginally with the assistance of a vacuum extractor. You have assigned Apgar scores of 7 and 9. (Learning Objectives 2, 3, 5, 6, and 8)

Relate the assessments you need to carry out in this immediate postdelivery time period.

Describe the nursing interventions you will perform before the baby is taken to the newborn nursery.

After taking the baby to the newborn nursery, you notice that the baby has developed diffuse swelling and bruising on the occiput of his head from the vacuum extractor use. Discuss how you would differentiate between a cephalhematoma formation and caput succedaneum development. Which one is more serious?

When the baby is 6 hours old, you notice that he has become jittery and is cyanotic. You check a heel stick blood sugar and it reveals a blood glucose level of 30. Discuss the immediate nursing interventions you will implement and what additional interventions you can implement to prevent this from occurring again in the future.

Answer 1

1The head to foot assessment of newborn are

• Head-Head circumference of the baby is assessed which is 33 to 35 cm.
• Eyes-Observe the eyes and check whether the pupils are equal,round,react to light and by accomodation.check whether blink reflex is present.
• Ears are assessed to see whether they are symmetrical.Low-set ears are associated with Down Syndrome.
• Nose-flat,broad ,in ce ntr e of face,obligatory nose breathing,occasional sneezing to remove obstructions
• Mouth-Pink ,moist gums,Epstein pearls maybe present on hard palate,uvula in midline.
• Neck-Short and thick,trachea on midline and good range of motion and ability to flex and attend.
• Chest-Circular appearance because anteroposterior and lateral diameters are about equal.
• Skin- Pinkish red to pinkish yellow.,presence of vernix caseosa,lanugo and milia is present.
• Abdomen-Assess for intact umbilical cord and ensure thayt the cord is clamped
• Gastrointestinal- Assess for umbi;ical hernia,monitor cord for meconium staining,monitor bowel sounds
• Anus- Ensure that anal opening is present.
• Extremities-flexed and full range of motion.

Apgar scoring system is used to determine the Apgar score.An Apgar score of 8 to 10 indicate intervention is required except to support newborns spontaneous effects.4-7 indicates gentle stimulation,rub newborns back,administer oxygen to newborn,0-3 newborns require resuscitation.The babys Apgar score is normal.

Auditory Brain stem response (ABR)and the transitory evoked otoacoustic emissions(TEOAE) test.In the ABR the emits sound waves and then evaluates for brainstem response in baby by priting out a brain waveform picture which can be matched to normal brain waveform responses.TEOAE assess cochlear function by testing the echoes that are formed by cochlear hair cells as they transmit sound waves .

Teaching is given on formula feeding such as about sterilization techniques and informing the client that formula is a sufficient diet for the first 4 to 6 months.Teach the client about breast engorgement as well as how to pump her breasts and how to store breast milk properly.Advise about bathing the newborn in a warm room before feeding and use a mild soap.Assess diaper and clothing needs for the newborn with the client.Instruct the client that the newborns head should be covered in cold weather to prevent heat loss.

2 The initial care of the newborn include

• Observe or assist with initiation of respirations.
• Assess Apgar score
• Note characteristics of cry.
• Monitor for nasal flaring ,grunting,retractions,and abnormal respirations,such as a see saw respiratory pattern.
• Assess for cyanosis.
• Assess for gross anomalies

Nursing interventions

• Obtain vital signs.
• Observe the newborn for signs of hypothermia.
• Suction the mouth first and then the nares with a bulb syringe.
• Dry the newborn and stimulate crying by rubbing.
• Maintain temperature stability.
• Keep the newborn with the mother to facilitate bonding.
• Place the newborn at mothers breast if breast feeding is planned
• Place the newborn in radiant warmer.
• Ensure the newborns proper identification.

Caput succedaneum is the area of edema over the presenting part of the fetus or newborn resulting from pressure against the cervix. Caput succedaneum needs no treatment he swelling with cephalhematoma is not present at birth rather it develops within the first 24 to 48 hours after birth. Cephalhematoma is the bleeding between the periosteum and skull from pressure during birth ,does not cross suture lines.This is a more serious condition and requires observation and support of the affected part.Transfusion and phototherapy maybe necessary if blood accumulation is significant.

Nursing Interventions for hypoglycaemia are

• Prevent low blood glucose level through early feedings.
• Administer glucose orally
• Monitor blood glucose levels as prescribed.
• Monitor for feeding problems.
• Monitor for apneic periods.
• Assess for shrill cries.
• Evaluate lethargy and poor muscle tone.