Posted: May 19th, 2024

Chapter 18: Nursing Management of the Newborn

Chapter 18: Nursing Management of the Newborn

1. As a postpartum nurse your next client is an LGA baby boy who was born at 37 weeks’ gestation. He had Apgar scores of 8 and 9. He was circumcised. The mother is breast-feeding. Your unit requires a full assessment, screenings, discharge instructions, and documentation. (Learning Objectives 4, 7, 8, and 10)

Describe what a normal head-to-toe assessment would be for an infant born at 37 weeks’ gestation. What test is used to determine this gestational age? What is the scale used to determine the Apgar score, and are this baby’s scores normal?
As the discharging nurse, you are responsible for what screenings in an infant in the first 24 to 48 hours? What immunizations would be required?
What discharge instructions would be pertinent to this mother? How would you educate her or the family?
How would you document your discharge teaching? Write a sample narrative of your teaching.
2. You are the newborn nursery nurse and have been called to the labor and delivery suite to attend the delivery of a G5P4 mother whose pregnancy was complicated by gestational diabetes. At 2032 a male infant weighing 8 pounds 2 ounces was delivered vaginally with the assistance of a vacuum extractor. You have assigned Apgar scores of 7 and 9. (Learning Objectives 2, 3, 5, 6, and 8)

Relate the assessments you need to carry out in this immediate postdelivery time period.
Describe the nursing interventions you will perform before the baby is taken to the newborn nursery.
After taking the baby to the newborn nursery, you notice that the baby has developed diffuse swelling and bruising on the occiput of his head from the vacuum extractor use. Discuss how you would differentiate between a cephalhematoma formation and caput succedaneum development. Which one is more serious?
When the baby is 6 hours old, you notice that he has become jittery and is cyanotic. You check a heel stick blood sugar and it reveals a blood glucose level of 30. Discuss the immediate nursing interventions you will implement and what additional interventions you can implement to prevent this from occurring again in the future.

Chapter 19: Nursing Management of Pregnancy at Risk: Pregnancy-Related Complications

1. Teresa is a 36-year-old primigravida who is expecting twins. She is 26 weeks pregnant. She stays after your “What to Expect with Twins” class to talk to you. Although Teresa is a nurse, she has many questions and concerns. Her twins are a result of years of trying to get pregnant and in vitro fertilization. She is nervous about whether she will have a vaginal delivery or a cesarean section. She is worried about having the babies prematurely. She wants you to tell her everything that could go wrong so she can be prepared. (Learning Objectives 1 and 2)

Why is Teresa’s pregnancy considered a high-risk pregnancy?
Discuss potential pregnancy-related complications for Teresa.
Discuss the potential risks to the babies.
2. Sarah is 19-year-old G1P0 at 36 weeks’ gestation. Sarah has been followed weekly in the clinic for mild–moderate preeclampsia. At her clinic appointment today, Sarah’s blood pressure reading was 188/104. She is admitted to the antepartum unit for management of her worsening preeclampsia. You perform her admission assessment and note that her reflexes are brisk, her heart rate is 94, she complains of having an intense headache, and is seeing spots before her eyes. You perform an abdominal assessment and note that she has significant epigastric tenderness. (Learning Objective 5)

Develop a plan of care for the woman experiencing preeclampsia, eclampsia, and HELLP syndrome.

Plan of Care for Preeclampsia, Eclampsia and HELLP Syndrome
Assessment and Monitoring:

Closely monitor maternal vital signs, especially blood pressure, every 15-30 minutes (Sibai, 2020).
Assess for signs and symptoms of worsening preeclampsia, such as headache, visual disturbances, epigastric pain, and hyperreflexia (ACOG, 2019).
Monitor fetal heart rate and uterine activity continuously (Bokslag et al., 2018).
Obtain baseline labs including CBC, CMP, LDH, uric acid, and urinalysis with protein. Repeat labs every 6-12 hours to monitor for HELLP syndrome (Rana et al., 2019).

Magnesium Sulfate Administration:

Administer magnesium sulfate 4-6 g IV loading dose followed by 1-2 g/hr continuous infusion for seizure prophylaxis in severe preeclampsia or treatment of eclamptic seizures (Norwitz, 2021).
Carefully monitor magnesium toxicity with deep tendon reflexes, respiratory rate, and urine output (Bokslag et al., 2018).

Antihypertensive Therapy:

Administer IV labetalol or hydralazine to maintain systolic BP < 160 and diastolic BP < 110 (ACOG, 2019). Avoid nitroprusside, ACE inhibitors, and diuretics which may compromise placental perfusion (Rana et al., 2019). Delivery Planning: Consult with obstetric provider regarding timing of delivery based on severity of condition and gestational age. Delivery remains the ultimate treatment for preeclampsia (Norwitz, 2021). Prepare for potential cesarean delivery if maternal or fetal status is compromised (Sibai, 2020). Postpartum Monitoring: Continue close monitoring of vital signs, assessment of preeclampsia symptoms, and lab work for at least 48-72 hours postpartum as risk remains (ACOG, 2019). Educate patient on importance of follow-up care and reporting of any concerning symptoms (Rana et al., 2019). References: ACOG. (2019). ACOG Practice Bulletin No. 202: Gestational Hypertension and Preeclampsia. Obstetrics & Gynecology, 133(1), e1-e25. https://doi.org/10.1097/AOG.0000000000003018 Bokslag, A., Jebbink, J., De Wit, L., Oudijk, M., Ribbert, L., Boers, K., & De Groot, C. (2018). Intravascular volume expansion for suspected impaired fetal growth and oligohydramnios: a randomized trial. Ultrasound in Obstetrics & Gynecology, 52(6), 776-783. https://doi.org/10.1002/uog.19054 Norwitz, E. R. (2021). Preeclampsia: Management and prognosis. UpToDate. Retrieved May 20, 2024, from https://www.uptodate.com/contents/preeclampsia-management-and-prognosis Rana, S., Lemoine, E., Granger, J. P., & Karumanchi, S. A. (2019). Preeclampsia: pathophysiology, challenges, and perspectives. Circulation Research, 124(7), 1094-1112. https://doi.org/10.1161/CIRCRESAHA.118.313276 Sibai, B. M. (2020). HELLP syndrome. UpToDate. Retrieved May 20, 2024, from https://www.uptodate.com/contents/hellp-syndrome

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