Nursing Management

Nursing Management of the Newborn at Risk: Acquired and Congenital Newborn Conditions

1. On the evening shift in the special care nursery, you are paged to delivery room 5. When you arrive, the labor nurse says the baby has been stuck in the birth canal for a while, and the fetal heart tones are down. They use the vacuum suction to assist delivery. The doctor gets the baby out and places the infant on the radiant warmer. You are the resuscitating nurse for the infant, and you observe the following: the infant is limp, pale, gasping, has poor tone, and the heart rate is 101. (Learning Objective 1)

What are your first actions to aid in this infant’s recovery?
What Apgar score would you assign at 1 minute with these results? Explain the score for each category.
2. Tammi is an 18-year-old single mother who delivered a full-term infant 3 days ago. The father is not involved, and Tammi’s aunt is her support person. The infant is very fussy in the nursery, with mild tremors noted. Tammi is having a hard time feeding her baby, the baby spits up a lot and he does not console easily. The physician has been called to assess the infant. (Learning Objective 7)

What is the probable cause of the infant’s symptoms, and what questions do you need to ask the mother?
What is the acronym of the tool used in assessing the infant’s condition, and what are the top three substances used that can cause this condition?
Name what measures are used to test for this condition and on whom you perform the test.
3. Mandy just gave birth vaginally to her first child. Mandy and James had attended prenatal classes and had a natural childbirth. They were totally unprepared to see that baby “Rose” has a severe left-sided unilateral cleft lip and cleft palate. James is having a hard time with this and just keeps staring at the baby. Mandy begins to cry and states “I thought I was going to breast-feed my baby and now it’s impossible.” (Learning Objectives 12, 14, and 15)

A. Discuss the implications for bottle feeding and breast-feeding a baby with a unilateral cleft lip. Is it possible for Mandy to breast-feed Rose?
B. What is involved in the surgical correction of the defect? When can she eventually have a “normal” mouth and facial features?
C. What other problems may develop for Rose since she has this type of defect?
D. How can you assist the family bond with Rose?

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