MATERNAL AND NORMAL NEWBORN PHARMACOLOGY CASE STUDY.

MATERNAL AND NORMAL NEWBORN PHARMACOLOGY CASE STUDY. History of Present Problem One hour after Delivery: Anne is a 17-year-old, gravida 1 para 1 who is 39 weeks gestation. She recently experienced a normal spontaneous vaginal delivery without the use of pain medications or an epidural. She delivered a baby boy who was placed skin to skin following delivery. You assign Apgars of 8 and 9. Baby voided right after delivery. Weight: 7 lbs. 0 oz. (3.2 kg), 20 inches (50.8 cm) long. After he had his first feeding, erythromycin ointment was applied to his eyes. Vitamin K and hepatitis B vaccine (after consent given) were administered in right and left thigh in the outer aspect of the left thigh. Ann is Group Beta Strep (GBS) positive and received antibiotics at 36 weeks and 3 doses before delivery, blood type is B-, and rubella positive. Cord blood was sent. Personal/Social History: Anne has her mother with her for support. She seems to be tired but is holding and interacting with the baby appropriately. The father of the baby is not involved. Anne plans on breastfeeding for “awhile.” Anne still lives at home, and her mother plans to help with the new baby and appears supportive. What data from the histories are RELEVANT and must be interpreted as clinically significant by the nurse? (Reduction of Risk Potential) RELEVANT Data from Report: Clinical Significance: -Normal spontaneous delivery reported -No pain medications used -Apgar’s of 8 & 9 -Baby voided -All vaccines given to baby -There really isn’t anything of clinical significance here, perhaps because everything appears as either an expected finding and/or appropriate intervention and procedure. RELEVANT Data from Social History: Clinical Significance: -Patient’s mother is present as a support system— patient still lives at home with her -Baby’s father will not be involved -Patient plans on breastfeeding (for undetermined amount of time) -She is holding and interacting with baby -It appears that the patient is doing well at this point in time. She is interacting with her baby and wants to breast feed. She has a solid support system, which is important due to her young age. Patient Care Begins: You complete your assessment: Current VS: P-Q-R-S-T Pain Assessment: T: 97.0 F/36.1 C (axillary) Provoking/Palliative: P: 130 (regular) Quality: R: 50 (irregular) Region/Radiation: BP: none taken Severity: NIPS score 0 O2 sat: pink in color/no central cyanosis noted Timing: What VS data are RELEVANT and must be interpreted as clinically significant by the nurse? (Reduction of Risk Potential/Health Promotion and Maintenance) RELEVANT VS Data: Clinical Significance: -Temperature of 97.0 -Baby’s temp is lower than we’d like to see and he his respiratory rate is on the high end of acceptable range so it’s something I’m going to want to keep an eye on. But all other This study source was downloaded by from CourseH on :32:59 GMT -06:00 -RR of 50/irregular clinical findings are as expected, and he’s only been in this world for 1 hour. Current Assessment: GENERAL APPEARANCE: Calm, quiet, and in a crib next to the bed. RESP: Lusty cry, breath sounds clear, irregular, non-labored respiratory effort, no nasal flaring, no grunting noted. CARDIAC: Pink, warm & dry, heart sounds regular with no abnormal beats, pulses strong, acrocyanosis present in hands and feet, no central cyanosis noted. NEURO: Fontanelles flat and soft, good tone, slight flexion of arms and legs What assessment data are RELEVANT and must be interpreted as clinically significant by the nurse? (Reduction of Risk Potential/Health Promotion and Maintenance) RELEVANT Assessment Data: Clinical Significance: -Irregular respiratory rate is noted -Clear breath sounds, non-labored effort with no signs of distress -Heart sounds auscultated, neg for cyanosis -Fontanelles are within range and flexion is present -Flexion of arms and legs -Everything thing in this assessment appears with appropriate ranges and findings -The only abnormality is the irregular respiratory rate, however everything else indicates that baby is doing well and still in the adjustment phase -“Slight” flexion is reported Clinical Reasoning Begins… 1. Interpreting relevant clinical data, what is the primary concern? What primary health-related concepts does this primary problem represent? (Management of Care/Physiologic Adaptation) Problem: Pathophysiology of Problem in OWN Words: Primary Concept: -Our largest concern at this point is cold stress on the newborn -As the newborn was delivered at 39 weeks and has only been on the outside for about an hour, this is the time he is most susceptible to cold stress. Failure to prevent this causes an increase in metabolic activity which will have a negative impact on some of the other operating systems in the body. Full term babies remain in a flexed position to help maintain warmth, and this is also a time when skin to skin is important as well as frequent feeding. -This comes down to thermoregulation of the newborn This study source was downloaded by from CourseH on :32:59 GMT -06:00 Collaborative Care (Newborn Orders): Medical Management (Pharmacologic and Parenteral Therapies) Care Provider Orders: Rationale: Expected Outcome: -Vital signs q 30 mins until stable for 2 hrs—then every 4-6 hrs -May place skin to skin if vital signs stable -May bathe after 6-8 hours, then bathe prn -Recommend and encourage exclusive breastfeeding. Breastfeed PRN, minimum of 8-10 times in 24 hours. No more than four-hour gap in feedings. Feed infant based on feeding cues. Similac/Enfamil 6-10 mL every 3- 4 hours based on infant’s feeding cues -Weight at birth and then every evening -Input and Output every shift -Newborn work up (blood type, Coombs) if the mother is Rh negative -The newborn screen at greater than 24 hours -Transcutaneous bilirubin level prior to discharge -Newborn hearing screen before discharge -Congenital heart screening -It’s important to be frequently assessing the baby’s vitals in order to quickly determine if there is any type of change or decline -Skin to skin is essential in helping to thermoregulate the baby -Breastfeeding is the gold standard whenever possible, but if formula is being used, education needs to be provided so that it is being done appropriately -Weights should be performed at the same time of day and using the same scale. However, baby was weighed the first time should continue -I&Os help demonstrate if baby is eating enough since they are not able to speak and wear diapers -Bilirubin should be checked to confirm liver function -Hearing and CHD screenings should be tested prior to discharge to allow time for baby to acclimate and for fluid to exit places it should not be in -It’s expected that baby’s vitals signs are all within acceptable ranges during all checks. -The baby should be skin skin if stable with frequent breastfeeding performed. -They should be getting weight twice a day every day, and I&Os should be consistently monitored until discharge -Bilirubin levels will be within normal ranges prior to discharge to ensure no occurrence of jaundice -All screenings, including hearing and CHD will be completed prior to discharge but after 24hrs after birth.