Question

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

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 pounds 6 ounces, length 20 inches, 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 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?

Describe 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 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?

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Answer 1

1. In the present scenario, the baby of Lindsay (newborn)

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 pounds 6 ounces, length 20 inches, head circumference 36.2 cm, chest circumference 36.0 cm.

*Which assessment findings for this newborn are abnormal? What is the most likely cause of these abnormal findings?

Here for your baby, there is slight respiratory distress is present due to the cesarean delivery/premature delivery or sudden transition to the extrauterine life,and also a slight asymmetry between the head and chest present why because normally the chest circumference is less than the head circumference for the newborn baby may be due to labored breathing. I am suspecting that the baby is having Respiratory Distress Syndrome.

*How would Sarah explain these abnormal findings to Lindsay?

There is nothing to worry about the findings, There is some labored breathing and increased respiratory is there, most of the newborn show these findings due to a rapid transition to the external environment. With proper management, we can treat hypoxia. The baby needs immediate care to prevent complications

*Describe the nursing interventions that Sarah would implement based on these findings.

-Administration of intratracheal surfactant has been shown to improve oxygenation as per doctors order and decrease ventilatory requirements

-Check the vital signs frequently

-Properly mummify the baby to prevent hypothermia

-If something abnormal immediately notifies it to the physician

-Encourage the mother to feed her baby if not possible encourage her to express the breast milk for feeding

-Adequately feed the baby and administer IV fluids if needed

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. 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

*Based on your observations of Destiny, are her behaviors normal? Which of the five typical behavioral responses were observed?

In my observations, the behavior shown by the baby girl destiny is not normal. Normally the Newborn are even able to hear when they are inside the womb of their mothers, they can hear each and every sound produced by mother like belching, gargling, the sound of food digestion, and as well as the baby may respond to the external voices of the womb etc. Baby's ear is well developed at the time of birth and the baby may respond to all the voices hear to her.

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.

*Does not soothe by soft sounds

*The baby dost not make sounds other than hungry or diaper change

*Doesn't move or wake up at the sound of voices or nearby noises when sleeping

*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?

Moro reflex. The Moro reflex is often called a startle reflex because it usually occurs when a baby is startled by a loud sound or movement. In response to the sound, the baby throws back his or her head, extends out the arms and legs, cries, then pulls the arms and legs back in. A baby's own cry can startle him or her and trigger this reflex. This reflex lasts about 5 to 6 months.

The Mrorefelx is absent to the baby, the baby did not respond to any type of sounds that may be either soft or hard sounds.

We have to encourage the parents of the baby regarding this concern and inform to the pediatrician

Encourage the baby to consult the bay to hearing and speech specialist if needed.