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Breastfeeding Newborn
RAPID Reasoning
Amanda Stevens, 26 years old and baby Grace
Primary Concept
Reproduction
Interrelated Concepts (In order of emphasis)
• Pain
• Patient Education
• Clinical Judgment
NCLEX Client Need Categories Percentage of Items from Each Covered in
Category/Subcategory 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% ✓
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Copyright © 2018 Keith Rischer, d/b/a KeithRN.com. All Rights reserved.
Page 2 of 16
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History of Present Problem:
Amanda Stevens is a 26-year-old female, G1 P1, accompanied by her husband, Brad. She presented to the
maternity unit complaining of contractions every five minutes for the past three hours. She was dilated to 6 cm,
50% effaced, -2 station and admitted for labor. Brad was very supportive throughout her labor. She received an
epidural for pain control and delivered by spontaneous vaginal delivery (SVD) a baby girl 12 hours later at 39
5/7 weeks gestation. Amanda’s blood type is A+ and is Group B strep (GBS) negative.
Baby Grace was 7 pounds 8 ounces (3.4 kg), 20 inches (50.8 cm) long with APGARS of 9 at one minute
and 9 at 5 minutes. Delayed cord clamping for one minute occurred and then she immediately went to breast
and latched with minimal assist and nursed for ten minutes. Initial newborn assessment was completed with no
abnormal findings. Her vital signs at birth were HR: 158, R: 54 T: 98.1 F/36.7 C axillary.
Personal/Social History:
Amanda and Brad have been married for two years and live 15 miles from the hospital in a small, rural
community. Brad is a security guard at a prison located 30 miles from home and Amanda is a preschool
teacher for the local preschool in her town. She will be taking eight weeks off from work before returning full
time.
Amanda’s parents live two hours away and will be coming tomorrow to stay with Amanda for a few days
when she and the baby are discharged. Brad’s parents live out of state and will be coming to visit next month.
Amanda’s sister lives an hour away and has a toddler and has offered to help Amanda if she needs it.
Amanda and Brad just moved to their home six months ago and do not have many friends in the area.
What data from the histories are RELEVANT and must be interpreted as clinically
significant by the nurse?
RELEVANT Data from Present Problem: Clinical Significance:
1. Immediately went to breast and 1. This is a great sign! Patient may feel confident going
latched for five minutes. forward, but this also may not be a full representation of
2. No abnormal findings of newborn at breastfeeding moving forward. We would want to continue
birth to encourage patient and be prepared to provide support.
2. There are no barriers to breastfeeding with the newborn thus
far.
RELEVANT Data from Social History: Clinical Significance:
1. Married for 2 years 1. This couple is new to marriage; they may still be settling into
2. Husband works 30 miles from home life as a married couple, adding extra strain. But they could
3. Patient is taking off 8 weeks also be still in the “honeymoon” phase. We have to be
from work prepared to provide support regardless.
4. Patient’s parents live two hours 2. Once discharged, husband won’t be immediately
away – will be staying with patient available for help while he’s at work
for a few days after discharge. 3. The patient may desire to breastfeed for an extended period
5. Husband’s parents will come to of time and this may make it difficult
visit next month 4. The patient will have some support once discharged,
6. Patient’s sister offered to help if even when husband is at work
needed, but sister also has toddler 5. There will be additional help
7. Do not have many friends in the 6. Sister has offered help. Sister may also have experience
area with breastfeeding and might be able to offer support
7. Once parents and in-laws go home, the patient doesn’t have
much continuous support
Page 3 of 16
Breastfeeding Newborn
RAPID Reasoning
Amanda Stevens, 26 years old and baby Grace
Primary Concept
Reproduction
Interrelated Concepts (In order of emphasis)
• Pain
• Patient Education
• Clinical Judgment
NCLEX Client Need Categories Percentage of Items from Each Covered in
Category/Subcategory 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% ✓
Page 1 of 16
, Page 2
Copyright © 2018 Keith Rischer, d/b/a KeithRN.com. All Rights reserved.
Page 2 of 16
, Page 3
History of Present Problem:
Amanda Stevens is a 26-year-old female, G1 P1, accompanied by her husband, Brad. She presented to the
maternity unit complaining of contractions every five minutes for the past three hours. She was dilated to 6 cm,
50% effaced, -2 station and admitted for labor. Brad was very supportive throughout her labor. She received an
epidural for pain control and delivered by spontaneous vaginal delivery (SVD) a baby girl 12 hours later at 39
5/7 weeks gestation. Amanda’s blood type is A+ and is Group B strep (GBS) negative.
Baby Grace was 7 pounds 8 ounces (3.4 kg), 20 inches (50.8 cm) long with APGARS of 9 at one minute
and 9 at 5 minutes. Delayed cord clamping for one minute occurred and then she immediately went to breast
and latched with minimal assist and nursed for ten minutes. Initial newborn assessment was completed with no
abnormal findings. Her vital signs at birth were HR: 158, R: 54 T: 98.1 F/36.7 C axillary.
Personal/Social History:
Amanda and Brad have been married for two years and live 15 miles from the hospital in a small, rural
community. Brad is a security guard at a prison located 30 miles from home and Amanda is a preschool
teacher for the local preschool in her town. She will be taking eight weeks off from work before returning full
time.
Amanda’s parents live two hours away and will be coming tomorrow to stay with Amanda for a few days
when she and the baby are discharged. Brad’s parents live out of state and will be coming to visit next month.
Amanda’s sister lives an hour away and has a toddler and has offered to help Amanda if she needs it.
Amanda and Brad just moved to their home six months ago and do not have many friends in the area.
What data from the histories are RELEVANT and must be interpreted as clinically
significant by the nurse?
RELEVANT Data from Present Problem: Clinical Significance:
1. Immediately went to breast and 1. This is a great sign! Patient may feel confident going
latched for five minutes. forward, but this also may not be a full representation of
2. No abnormal findings of newborn at breastfeeding moving forward. We would want to continue
birth to encourage patient and be prepared to provide support.
2. There are no barriers to breastfeeding with the newborn thus
far.
RELEVANT Data from Social History: Clinical Significance:
1. Married for 2 years 1. This couple is new to marriage; they may still be settling into
2. Husband works 30 miles from home life as a married couple, adding extra strain. But they could
3. Patient is taking off 8 weeks also be still in the “honeymoon” phase. We have to be
from work prepared to provide support regardless.
4. Patient’s parents live two hours 2. Once discharged, husband won’t be immediately
away – will be staying with patient available for help while he’s at work
for a few days after discharge. 3. The patient may desire to breastfeed for an extended period
5. Husband’s parents will come to of time and this may make it difficult
visit next month 4. The patient will have some support once discharged,
6. Patient’s sister offered to help if even when husband is at work
needed, but sister also has toddler 5. There will be additional help
7. Do not have many friends in the 6. Sister has offered help. Sister may also have experience
area with breastfeeding and might be able to offer support
7. Once parents and in-laws go home, the patient doesn’t have
much continuous support
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