Week 4 Newborn Case Study Normal Newborn SKINNY Reasoning Cynthia Sonnesso

Primary Concept Reproduction Interrelated Concepts (In order of emphasis) • Thermoregulation • Nutrition • Perfusion • Pain • Clinical Judgment • Patient Education • Communication • Collaboration NCLEX Client Need Categories Percentage of Items from Each Category/Subcategory Covered in Case Study Safe and Effective Care Environment • Management of Care 17-23% • Safety and Infection Control 9-15% Health Promotion and Maintenance 6-12% Psychosocial Integrity 6-12% Physiological Integrity • Basic Care and Comfort 6-12% • Pharmacological and Parenteral Therapies 12-18% • Reduction of Risk Potential 9-15% • Physiological Adaptation 11-17% SKINNY Reasoning Part I: Recognizing RELEVANT Clinical Data 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 on 6/12/2020 at 2300 without the use of pain medications or an epidural. She came in to labor on 6/12/2020 at 0600 stating she had broken her water yesterday at noon. 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 and is due to stool. 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 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: • Mother is 17 years old • First baby/pregnancy (G1P1) • 39 weeks gestation • SVD • Membranes ruptured longer than 24 hours • Apgars of 8 and 9 • Voided once and has not yet stooled • Weight 7lbs 0oz, length 20in • GBS+ w/ 3 doses of antibiotics administered • Mother’s blood type B- • Mother is rubella immune • The mother is young, which could mean her body has not fully matured, which may mean she could have decreased milk production. This could also mean she is limited financially and may still be dependent on her parents. • Because this is the mother’s first child, she will require a lot of teaching on postpartum care and newborn care. • The mother delivered a term infant, so this infant should be well developed, • Because the membranes ruptured more than 24 hours prior to delivery of the infant, the mother is at higher risk for infection. • Apgars of 8 and 9 indicate that the newborn tolerated delivery and adjusted to life outside of the uterus well. • The infant has urinated within the first 24 hours, which is part of the requirement to pass one stool and urinate at least once within the first 24 hours of life. • The baby currently has a normal birth weight. • The mother’s GBS status can be a possible risk factor for infection for the infant, but she received 3 doses of antibiotics which should help reduce this risk significantly. • The mother’s blood type is B-, so the infant’s blood type will need to be tested to determine whether or not the mother needs to have Rhogam administered. If the infant is Rh+, then the mother will need to be administered Rhogam prior to discharge. • The mother is rubella immune, so she will not need another dose of the vaccine and this there is less risk of her infant contracting rubella from her. RELEVANT Data from Social History: Clinical Significance: • Mother is present for support • Interacting with baby appropriately • Father of baby not involved • Plans to breastfeed • Lives at home with mother • Especially considering she is a minor, it is important for the patient to have her mother present for emotional support and in this case likely financial support. • The mother is interacting well with the baby, indicating that she is accepting her child and this will make attachment behaviors easier for her to achieve. • Without the father of the baby, raising the child can be more challenging for the mother. She will require more support from her family and friends. • Breastfeeding is very beneficial to the infant for multiple reasons, including development of the immune system and proper nutrition. • Because she will be living with her mother at home, the patient will be able to depend on her mother for help and will most likely rely on her mother to provide for both herself and her infant financially. Patient Care Begins: You complete your assessment: