Case Study: Hypoglycemia/Sepsis Baby Boy Bobby Part I Case Study adapted from Perinatal Orientation and Education program 2nd Edition 2009 Association of Women’s Health, obstetric and Neonatal Nurses. Providence Clinical Academy Obstetric Curriculum 2016.06 Case Study adapted from AWHONN Perinatal Orientation and Education Program 3nd Ed.

Baby Bobby was born 30 minutes ago with a vacuum assisted birth after a prolonged second stage of labor. His Apgar scores were 3 at 1 minute of life and 7 at five minutes of life. He required bag/mask ventilation on 100% oxygen for the first 2 minutes of life. He was weaned to room air by 5 minutes of age. He is 35 3/7 weeks gestation by dates. You are performing an initial assessment when you note that Bobby is jittery. 2016.06 Providence Clinical Academy

Group 1 What might be causing Baby Bobby to be Jittery? What nursing interventions would you take at this time? Hypoglycemia If that is normal notify the MD: possible metabolic disorder, electrolyte imbalance or substance exposure. Review the prenatal record for any risk factors 2016.06 Providence Clinical Academy

Group 2 What nursing Interventions might help to achieve the following goals for Baby Bobby? Thermoregulation Safety Remove wet linnens, place a cap on newborns head. If stable initiate Skin to skin contact to facilitate wormth and promote bonding. The infant requires medical intervention that radiant warmers could be used. Be sure infant’s temp is stable for at least 4-6 hours prior to bathing. 2016.06 Providence Clinical Academy

Group 3 What nursing Interventions might help to achieve the following goals for Baby Bobby? Respiratory Adaptation Safety Airway, Breathing and Circulation are also assessed at birth by evaluation of HR, RR and color. Infant may be placed skin to skin during the initial assessment. The normal newborn RR is 30-60 brealths per minute and should be rhythmic. During the initial transition period, newborns mab breath up to 80BPM or higher. Chest expansion should be equal on both sides as you observe breathing. Nasal flairing, grunting and retracting are usually indicitave of Respiratory distress and may require further evaluation. Therefore, careful attention should be paid to the rate of breath ,quality of breath sounds and the infants color to determine the need for additional interventions. Vital signs should be monitored every 30minutes for the first 2 hours of life. 2016.06 Providence Clinical Academy

Group 4 Baby Bobby’s mother is concerned about his early gestational birth. What things are considered for a LPT baby that places them at higher risk? How might you educate his mother? Early Course: Birth Trauma Temperature regulation Hypoglycemia Respiratory Distress Problems transitioning to extrauterine life Later: Apnea Feeding problems Jaundice Growth Failure Hospital Readmission 2016.06 Providence Clinical Academy

Group 5 Baby Bobby’s mother is concerned about breastfeeding. What factors influence breastfeeding? How would you assess adequate feeding? Factors that influence breast feeding: How the mothers body makes and stores milk which varies by time of day How completely the child empties the breast at in individual feeding Variation across 24 hours and an infant’s need for feedings Which breast the infant feeds from first-the dominant or non-dominant breast Assess adequate feeding: Adequate nutrition and hydration How many feeds per day? How many stools? What is the trend of the infants weight? Absence of Jaundice Record of the time and duration of each feeding, voiding and stooling. 2016.06 Providence Clinical Academy