Tanisha Hernandez
NEWBORN CASE STUDY
Learning Objectives
.Analyze assessment data for newborn infants .1
Describe the behavioral adaptations of the newborn, including periods of .2
.reactivity
.Discuss routine neonatal nursing interventions .3
.Identify interventions for newborn infants with common complications .4
.Discuss initial care needs of a newborn infant delivered by C-section .5
Discuss commonly used obstetric medications and their nursing implications .6
CRITICAL THINKING QUESTIONS
1. What physical & behavioral characteristics do you expect to observe in a
newborn infant during the transition period? Include vital signs, breathing
patterns, physical activity & behavior, skin color changes, etc.
The physical & behavioral characteristics you expect to observe in a newborn infant
during the transition period would be during, the first stage of reactivity, the first 30
minutes after birth, the heart rate increases to 160-180 bpm. After 30 minutes, it
gradually drops to a baseline of 100-120 bpm. Also, during this first 30 minutes,
respirations are irregular between 60-80 bpm. Fine crackles may be heard during
auscultation, there may be grunting, nasal flaring, and chest retractions. The baby is
alert and may have spontaneous startles, tremors, crying, and may be moving its head
from side to side. The baby’s bowel sounds can be heard, and a bowel movement.
meconium, may be passed. During the next 60-100 minutes, or the period of decreased
responsiveness, the infant will be pink, the respirations shallow and unlabored, up to 60
bpm. The baby will sleep, or have a decrease in motor activity. Bowel sounds will be
audible, and waves of peristalsis may be seen over the abdomen. Between 2-8 hours
after baby is born, the second period of reactivity occurs. There are brief periods of
tachycardia and tachypnea associated with increased muscle tone, changes in skin
.color, and it is common for meconium to be passed in this period as well
2. Baby Nelson has just been delivered via C-section. It was a long labor
process. Your initial assessment findings reveal: Heart rate of 120,
respirations are 28 irregular and shallow. He has cyanosis on hands and
, feet. He grimaces when he is suctioned and his extremities are flaccid. How
will you record his APGAR score at one minute? What interventions (if any)
should be performed?
APGAR score of the baby is a 5, which would indicate moderate difficulty adjusting to
.extrauterine life. I would evaluate again at 5 minutes after birth as indicated
3. Baby Jane is 23 hours old and has a serum bilirubin of 13. What do you
suspect is happening? What do you expect the plan of care will be for this
baby?
Due to baby Jane’s manifestations I suspect hyperbilirubinemia. In the first 24 hours of
life, the bilirubin level should be within 2-6 and baby Jane’s is 13. The plan of care is
focused on reducing the baby’s serum levels of bilirubin. Two ways to reduce the levels
are phototherapy and exchange transfusion. Phototherapy uses light energy to change
the shape and structure of bilirubin, converting it to a conjugated form that can be
excreted in urine and stool. Close follow up care will be needed, and repeat testing of
bilirubin levels at pediatric follow up visits are expected. If exchange transfusion is
needed then it will be done in an intensive care setting. During this exchange
transfusion the baby’s blood is replaced with a combination of red blood cells mixed with
.5% albumin or fresh frozen plasma
4. The nurse is assessing a 2-hour-old infant during the transition period the
nurse obtains the following: Heart rate 148 – Respirations – 52 –
Temperature 97 F – Blood glucose 30. What are the normal vital signs and
glucose range for a newborn? What do these vital signs and blood glucose
indicate? What are your nursing interventions?
Glucose levels for a baby less that 1 day old should be between 40-60. This baby’s
glucose level, although below the range does not require an intervention. Most healthy
newborns experience a transient decrease in glucose levels to as low as 30 during the
first 1-2 hours after birth, therefore there is no need to routinely check glucose levels of
healthy infants, as adequate feedings will help maintain normal glucose levels. Normal
vital signs for a newborn include an axillary temperature of 37°C (98.6°F) with a range
from 36.5°-37.5°C (97.7°-99.5°F). The average respiration rate is 40 bpm, but will vary
between 30-60 bpm, and can exceed 60 bpm when active or crying. Apical pulse ranges
from 110-160 when awake, but can be between 80-90 when sleeping, and can exceed
160 bpm when crying. Baby’s systolic pressure averages from 60-80, and diastolic
between 40-50. According to these ranges, the heart rate and respiratory rate of the 2-
hour-old infant are within normal limits. The temperature is low but it yet to be stabilized,
the intervention for this would be to place the baby under a radiant warmer or in an
.incubator until the body temperature stabilizes
NEWBORN CASE STUDY
Learning Objectives
.Analyze assessment data for newborn infants .1
Describe the behavioral adaptations of the newborn, including periods of .2
.reactivity
.Discuss routine neonatal nursing interventions .3
.Identify interventions for newborn infants with common complications .4
.Discuss initial care needs of a newborn infant delivered by C-section .5
Discuss commonly used obstetric medications and their nursing implications .6
CRITICAL THINKING QUESTIONS
1. What physical & behavioral characteristics do you expect to observe in a
newborn infant during the transition period? Include vital signs, breathing
patterns, physical activity & behavior, skin color changes, etc.
The physical & behavioral characteristics you expect to observe in a newborn infant
during the transition period would be during, the first stage of reactivity, the first 30
minutes after birth, the heart rate increases to 160-180 bpm. After 30 minutes, it
gradually drops to a baseline of 100-120 bpm. Also, during this first 30 minutes,
respirations are irregular between 60-80 bpm. Fine crackles may be heard during
auscultation, there may be grunting, nasal flaring, and chest retractions. The baby is
alert and may have spontaneous startles, tremors, crying, and may be moving its head
from side to side. The baby’s bowel sounds can be heard, and a bowel movement.
meconium, may be passed. During the next 60-100 minutes, or the period of decreased
responsiveness, the infant will be pink, the respirations shallow and unlabored, up to 60
bpm. The baby will sleep, or have a decrease in motor activity. Bowel sounds will be
audible, and waves of peristalsis may be seen over the abdomen. Between 2-8 hours
after baby is born, the second period of reactivity occurs. There are brief periods of
tachycardia and tachypnea associated with increased muscle tone, changes in skin
.color, and it is common for meconium to be passed in this period as well
2. Baby Nelson has just been delivered via C-section. It was a long labor
process. Your initial assessment findings reveal: Heart rate of 120,
respirations are 28 irregular and shallow. He has cyanosis on hands and
, feet. He grimaces when he is suctioned and his extremities are flaccid. How
will you record his APGAR score at one minute? What interventions (if any)
should be performed?
APGAR score of the baby is a 5, which would indicate moderate difficulty adjusting to
.extrauterine life. I would evaluate again at 5 minutes after birth as indicated
3. Baby Jane is 23 hours old and has a serum bilirubin of 13. What do you
suspect is happening? What do you expect the plan of care will be for this
baby?
Due to baby Jane’s manifestations I suspect hyperbilirubinemia. In the first 24 hours of
life, the bilirubin level should be within 2-6 and baby Jane’s is 13. The plan of care is
focused on reducing the baby’s serum levels of bilirubin. Two ways to reduce the levels
are phototherapy and exchange transfusion. Phototherapy uses light energy to change
the shape and structure of bilirubin, converting it to a conjugated form that can be
excreted in urine and stool. Close follow up care will be needed, and repeat testing of
bilirubin levels at pediatric follow up visits are expected. If exchange transfusion is
needed then it will be done in an intensive care setting. During this exchange
transfusion the baby’s blood is replaced with a combination of red blood cells mixed with
.5% albumin or fresh frozen plasma
4. The nurse is assessing a 2-hour-old infant during the transition period the
nurse obtains the following: Heart rate 148 – Respirations – 52 –
Temperature 97 F – Blood glucose 30. What are the normal vital signs and
glucose range for a newborn? What do these vital signs and blood glucose
indicate? What are your nursing interventions?
Glucose levels for a baby less that 1 day old should be between 40-60. This baby’s
glucose level, although below the range does not require an intervention. Most healthy
newborns experience a transient decrease in glucose levels to as low as 30 during the
first 1-2 hours after birth, therefore there is no need to routinely check glucose levels of
healthy infants, as adequate feedings will help maintain normal glucose levels. Normal
vital signs for a newborn include an axillary temperature of 37°C (98.6°F) with a range
from 36.5°-37.5°C (97.7°-99.5°F). The average respiration rate is 40 bpm, but will vary
between 30-60 bpm, and can exceed 60 bpm when active or crying. Apical pulse ranges
from 110-160 when awake, but can be between 80-90 when sleeping, and can exceed
160 bpm when crying. Baby’s systolic pressure averages from 60-80, and diastolic
between 40-50. According to these ranges, the heart rate and respiratory rate of the 2-
hour-old infant are within normal limits. The temperature is low but it yet to be stabilized,
the intervention for this would be to place the baby under a radiant warmer or in an
.incubator until the body temperature stabilizes
