Question

Chapter 1 Obstetrical Cases 33 % CASE 9 MOTHER-BABY COUPLETS A, B, AND C Learning Objectives 1. Analyze assessment data for 3 different infants and their mothers. 2. Discuss routine mother-baby nursing interventions (circumcision care, breastfeeding, and normal assessments). 3. Identify interventions for mother-baby couplets with common complications, such as diabetes, substance abuse, infection. 4. Describe delegation principles in mother-baby care assignments. A Today you are the nurse in charge of 3 mother baby couplets. Baby A is a male infant born at 37 weeks gestation to a diabetic mother. He weighed 10 lbs. 2 oz. and was a spontaneous vaginal birth. He is now 1 hour old. Baby A has a large caput, facial bruising, positive moro reflex, and Apgars of 6 and 8. Mom plans to bottle-feed. Baby A's vitals are T. 98, P.130, R. 48. Baby B is 3 hours old. Your assessment shows in SGA female infant of 42 weels who weighs 5 lbs. and has small eye openings and a thin upper lip. Mom has a known history of alcohol and cocaine addiction. She also has a history of having hepatitis B. She is a chronic car rier. You note there are only two vessels on the umbilical cord. T. 96.8-, P.120, R. 62. The baby is jittery and has a positive clonus and a poor suck reflex. Apgars were 5 and 7. Baby Cis a 7 lb. 8 oz. male of 40 weeks gestation from a spontaneous vaginal delivery. He is scheduled for circumcision tomorrow morning. Tis 98.2", P.130, R.40. Mother plans to breast- feed. Apgars were 8 and 10. Focus Questions 1. There are several routine procedures, lab tests, and treatments necessary for all newborns from birth to discharge. Discuss this plan of care, giving the rationale for all procedures and the treatments.

Answer 1

lab tests on newborn

• maple syrup urine disease (MSUD), homocystinuria, biotinidase deficiency, congenital adrenal hyperplasia, MCAD, tyrosinemia, cystic fibrosis, and toxoplasmosis.

routine procedure:

1. Infant security : Babies are given wrist and ankle bands at birth that match their mothers.
2. vital signs: To assess baby’s vital signs (temperature, heart rate and respiration) to be sure your baby is adjusting to life as a newborn and to detect any problems with her heart, lungs, or need for warming.
3. Test for jaundice : Blood taken by pricking the baby’s heel is sent to a lab- oratory, where the bilirubin level is determined. If high, the baby has significant jaundice. Sometimes a special instru- ment, called a jaundice meter, is used first as a screening tool to estimate the blood levels of bilirubin by flashing a light over the skin of the baby’s sternum or forehead.
4. Heel stick: All babies are required by their state to get tested for metabolic disorders before they leave the hospital. This is done by drawing a few drops of blood from the baby’s heel. The blood is sent to a laboratory for testing that can identify babies who need medical care, sometimes before they show signs of a problem.
5. Septic workup in case baby has fever or other sign of infection: Blood is drawn and cerebro- spinal fluid may be obtained by spinal tap; samples are sent to the laboratory to be tested for bacteria that cause illness. Results are available in about 48 hours.
6. Measuring Weight and Length
7. administration of erythromycin eye drops : Erythromycin drops prevent an eye infection that can lead to blindness. The infection can be spread from mother to baby in the birth canal.
8. Injection of vitamin k Because most babies are low in vitamin K after birth
9. Pulse oximetry test: Critical congenital heart diseases can be detected by placing a sensor on the baby’s skin to measure oxygen in the blood and heart rate.
10. Administration of hepatitis vaccine: It protects against a contagious liver disease that can cause lifelong illness. Mothers can spread the virus to babies at birth
11. Hearing screening: This test baby’s hearing using one of two methods. Otoacoustic emissions testing involves placing a small probe in the ear to measure how the auditory inner ear responds to the sounds. Auditory brainstem response testing involves putting probes on the baby’s scalp to measure brain waves’ response to sounds
12. APGAR scoring

Sign		Point	1 Points.
A	Activity (Muscle Tone)	Absent	Arms and Legs Flexed	2 points Active Movement
P	Pulse	Absent	Below 100 BPM	Above 100 BPM
G	Grimace (Reflex Irritability)	No response	Grimace	Sneeze, cough, pulls away
A	Appearance (Skin Color)	Blue-gray, pale all over	Normal, except for extremities	Normal over entire body
R	Respiration	Absent	Slow, Irregular	Good, Crying