Question

Baby Haley’s mother is a 26-year-old, G2P2002, married, black female. Her first child is a health 6-year-old girl. Mrs. Haley works as a cashier at Wal-Mart. There were no complications identified in the pregnancy, although she did not start prenatal care until her 24^th week of pregnancy.

Case Study:

Baby Haley has just been born after a two-hour second stage of labor. Immediately at delivery the nurse notes the following:

• Baby Haley lacks tone. He feels like a “bean bag doll.”
• His color is dusky.
• He mad respiratory effort, but his breathing is irregular and shallow.
• His heart rate is 100 bpm, but irregular; with no murmurs.
• When suctioned, he reacted by sneezing and gagging.

After resuscitation, the nurse continued to examine Baby Haley and further noted:

• He had a large fat pad at the back of his neck.
• He had simian creases on both hands.
• His eyes seemed to be farther apart than usual.
• His ears were low set.
• His tone did not improve after resuscitation even though his color and respirations improved and he was weaned off the oxygen.

Answer the following questions:

1. What is Baby Haley’s initial APGAR score? List the points for each component.
2. The mother was not screened for congenital anomalies. What might be the reason for this?
3. What congenital defects would the nurse suspect from the observed characteristics?
4. The mother wants to nurse her son right after delivery. How should the nurse respond?
5. Baby Haley’s mother asks the nurse, “What is wrong with him? My daughter seemed so different at birth.” How should the nurse respond?
6. The father walks out of the delivery room, sits in a chair in the hall, and puts his head in his hands and cries. How should the nurse approach him?

Answer 1

What is Baby Haley’s initial APGAR score? List the points for each component.

APGAR score is used for assessing the wellness of newborn immediately after birth by fixing a score ranging 0-10.

A-Muscle tone (activity )is assessed.Here Baby Haley lacks muscle tone. Score is 0

P-Pulse is assessed.Baby's pulse is 100 beats/min and irregular. Score is 1

G-Grimace(reflexes are assessed). When Baby was stimulated ,he reacted by sneezing &gagging. Score is 2

A-Skin color is assessed. Baby Haley has dusky skin which may be a sign of acrocyanosis.(Acrocyanosis is discoloration of extremities due to slow blood flow) Score is 1.

R-Respiration is assessed.Baby Harley's respiration is slow and irregular .Score is 1

Total initial score is 5.This indicates he is moderately depressed .

The mother was not screened for congenital anomalies. What might be the reason for this?

The mother didn't attend prenatal visits until her 24th week of pregnancy. Tests done to detect congenital anomalies and any complications are done at 10-12 weeks (chorionic villus sampling) , 15-20 weeks(amniocentesis), ultrasound at 20 weeks which she didn't do.

The mother may have been lethargic to go for prenatal visits and also may have thought her first baby is born normal , so there won't be any complications in her second pregnancy.

What congenital defects would the nurse suspect from the observed characteristics?

Nurse may suspect Baby Haley for features of down syndrome. Down syndrome is characteristics are low set ears, poor muscle tone, widely placed eyes, excess fat at back of neck and simian creases.

The mother wants to nurse her son right after delivery. How should the nurse respond?

Breast feeding is very essential for any newborn .But as Baby Haley lacks muscle tone , he has to be assessed for sucking , any abnormalities in swallowing , oropharyngeal structural deformities to be ruled out as he has congenital anomaly. So the nurse may request the mother to wait until baby is assessed fully for anomalies so that he may not get any complications like choking.

Baby Haley’s mother asks the nurse, “What is wrong with him? My daughter seemed so different at birth.” How should the nurse respond?

Every child is born different . All don't have same characteristics. Don't panic . Be calm and think about how to take care of Baby Haley.

The father walks out of the delivery room, sits in a chair in the hall, and puts his head in his hands and cries. How should the nurse approach him?

Nurse may tell the father to accept the situation and be supportive to his family. Nurse may motivate him to love and play with the child . Baby Haley may be a good child who needs extra care, support , love and medical attention. Baby Haley may be brought up in a way ,so that he may start to be independent in future. So don't lose hope , just invest love .