Chapter 17, Newborn Transitioning
1. Sarah works in the labor and delivery unit as a transition nurse. Her department has instituted a new bedside transition period where newborns make the transition to extrauterine life in their mother’s recovery room about an hour after birth. Sarah’s next assignment is a new baby boy with Apgar scores of 8 and 9, born by cesarean about 1 hour ago to Lindsay, a 28-year-old G1. Sarah’s assessment findings of the new baby boy are:
- Vital signs: axillary temperature 37.0° C, heart rate 145, respiratory rate 75
- Observations: color pink, respirations rapid and unlabored, good muscle tone, good arm and leg movement
- Auscultation: breath sounds clear and equal bilaterally, strong heart sounds with a soft murmur, active bowel sounds in all four quadrants
- Physical assessment: fontanels soft and flat, eyes clear with red reflex in both, ears normal shape and placement, soft and hard palate intact, strong suck, both nares patent, capillary refill less than 2 seconds, both testes descended
- Measurements: weight 8 lb 6 oz, length 20 in, head circumference 36.2 cm, chest circumference 36.0 cm
As Sarah is charting her findings, Lindsay asks Sarah if everything is OK with her baby. (Learning Objectives 1, 2, 3, and 4)
- Which assessment findings for this newborn are abnormal? What is the most likely cause of these abnormal findings?
- How would Sarah explain these abnormal findings to Lindsay?
- What are the nursing interventions that Sarah would implement based on these findings?
2. Baby girl Destiny was born by cesarean delivery 2 days ago. Destiny weighed 7 lb 3 oz, length 19 in, head circumference 34 cm, and 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 Objectives 7 and 8)
- 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 3, 6,7, and 9)
- 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 lb 2 oz was delivered vaginally with the assistance of a vacuum extractor. You have assigned Apgar scores of 7 and 9. (Learning Objectives 1, 2, 4, 5, and 7)
- What are the assessments you need to carry out in this immediate postdelivery time period?
- What are 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. What are the differences 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. What are the immediate nursing interventions you will implement and what additional interventions you can implement to prevent this from occurring again in the future?
Chapter 23, Nursing Care of the Newborn With Special Needs
1. Brenda is a nurse in a special care nursery. A 16-year-old girl had been admitted to the emergency department earlier that morning with complaints of excruciating back pain and nausea. She was diagnosed as being in labor and transferred to the labor and delivery unit. She was apparently unaware of the pregnancy. She received no prenatal care and cannot remember the exact date of her last menstrual period. An ultrasound determined the infant to be approximately 5 lb. All attempts to stop labor are unsuccessful, and a baby girl is delivered. The newborn is placed on the open bed warmer for the team to assess.
They observe decreased muscle tone, spontaneous respirations, and heart rate 120. The infant is crying softly. The infant receives stimulation by drying with a warm blanket and oxygen blow-by via bag and mask by the respiratory therapist at just prior to 1 minute of age. The infant’s color is blue at 1 minute of age and her Apgar score is 7. The infant’s tone improves, and she begins to pull her arms and legs to midline. Her color improves quickly with blow-by oxygen and the respiratory therapist slowly backs off the oxygen. The infant receives an Apgar score of 9 at 5 minutes of age.
The baby’s physical appearance includes the following: head a little larger than body size, numerous veins visible under skin, plantar creases on half of foot sole, ears are formed and soft with little cartilage, nipples aren’t well defined, labia majora smaller than labia minora. (Learning Objectives 1, 2, 3, and 4)
- What equipment would Brenda check to ensure that it was present and working properly for the delivery? Why might she need this equipment?
- Based on the physical assessment and response to resuscitation, what would you determine this infant to be: preterm, term, or postterm? Why?
- Once the infant is stable, what course of action should Brenda take next? Why? What problems should she anticipate?
2. Paula gave birth to a premature baby boy at 27 weeks’ gestation. Baby boy Matthew is 10 days old, weighs 2 lb 1 oz and has just been diagnosed with a grade IV cerebral bleed. He is intubated and on a ventilator. He has an oral gastric tube in his mouth and has an umbilical IV access. Paula has just been informed that the probability of Matthew surviving is very low. (Learning Objectives 2, 3, 4, and 5)
A. Discuss the effect of Matthew’s death on his parents. What can the nurse do to assist them during this time?
Chapter 24, Nursing Management of the Newborn at Risk: Acquired and Congenital Newborn Conditions
1. On the evening shift in the special care nursery, you are paged to delivery room 5. When you arrive, the labor nurse says the baby has been stuck in the birth canal for a while, and the fetal heart tones are down. They use the vacuum suction to assist delivery. The doctor gets the baby out and places the infant on the radiant warmer. You are the resuscitating nurse for the infant, and you observe the following: the infant is limp, pale, gasping, has poor tone, and the heart rate is 101. (Learning Objective 1)
- What are your first actions to aid in this infant’s recovery?
- What Apgar score would you assign at 1 minute with these results? Explain the score for each category.
2. Tammi is an 18-year-old single mother who delivered a full-term infant 3 days ago. The father is not involved, and Tammi’s aunt is her support person. The infant is very fussy in the nursery, with mild tremors noted. Tammi is having a hard time feeding her baby, the baby spits up a lot and he does not console easily. The physician has been called to assess the infant. (Learning Objective 6)
- What is the probable cause of the infant’s symptoms, and what questions do you need to ask the mother?
- What is the acronym of the tool used in assessing the infant’s condition, and what are the top three substances used that can cause this condition?
- What measures are used to test for this condition and on whom you perform the test?
Please write the answers underneath each question. Please also take your time and do a good job.