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, Day 1
1800: The client Is a female neonate born at 37 weeks of gestation to a G 2 P 1 mother, who was
diagnosed with gestational dlabetes. Following a spontaneous vaginal birth, she received Apgar scores
of 7 at 1 min and 8 at 5 min. The client weighs 4036.97 g (8 Ibs. 9 oz) and appears pink with acrocyanosis
and a moderate amount of subcutaneous fat. She is noted to be slightly jittery at 30 min of age. Axillary
temperature 96° F (35.6° C), pulse 140, respiratory rate 80. Blood glucose 35 mg/dL (1.9 mmol/L),
bilirubin level 7 mg/dL (119.73 umol/L). Fontanelles soft, Mongolian spot noted on lower back, Ballard
maturity rating 37 weeks. Proactive lactation management, strategies, support, and follow-up for
late-preterm infants and some early term infants are important components that affect breastfeeding
success. Prophylactic phototherapy is often used in preterm infants to prevent a significant increase in
serum bilirubin levels. It is also recommended that healthy late-preterm and term infants (23S weeks of
gestation) receive follow-up care and assessment of bilirubin within 3 days of discharge. Late preterm
infants of a diabetic mother need to be monitored more closely. Parents are taught to evaluate the
number of voids and evidence of adequate breastfeeding after the infant is home. Notify the primary
care practitioner if there are indications the infant is not feeding well, is difficult to arouse for feedings,
or is not voiding and stooling adequately. Seeing the obstetrician at 8 weeks is contraindicated, as most
postpartum visits are between 4 and 6 wecks. ACOG recommends that postpartum care be an ongoing
process in which each woman's individual needs determine the services and support she receives. Early
follow-up is warranted for women who experienced complications such as hypertensive disorders of
pregnancy, those with chronic health conditions, women at high risk for depression, and breastfeeding
mothers who are experiencing feeding problems,
Click to highlight the notes that demonstrate a positive outcome.
Day 2
0630: Vitals have remained stable throughout the night. Oxygen 98% on nasal
canal. Mother to breastfeed in nursery on demand. Able to tolerate breastmilk.
Glucose after feeding was 60 mg/dL (3.3 mmol/L), temp 97.8° F (36.6° C) when
returned to warmer and Bili light. Chest x-ray and echocardiogram results were
normal. Calcium and magnesium within normal llmits, Direct bilirubin 5 mg/dI(5
umol/L), Discharge teaching Initlated, with goal of discharging infant and mother
on day 3. Studies confirm the importance of maintaining serum glucose levels above 45 mg/dL (25
mmol/1) in hyper insulinemic infants with hypoglycemia to prevent serious neurologic sequel. Blood
glucose levels continue to improve. Direct bilirubin improved. Other signs of improvement include a
normal temperature for at least 8 hours, improved respiratory status with no signs of respiratory
distress syndrome and feedings are well tolerated.
A client is being discharged with a prescription for warfarin. Which instruction should the nurse provide
this client regarding diet? Eat approximately the same amount of leafy green vegetables daily so
the amount of vitamin K consumed is consistent.