Newborn Assessment: An infant boy boy was born @ 3:13 pm vaginal delivery the 1
ID: 238187 • Letter: N
Question
Newborn Assessment:
An infant boy boy was born @ 3:13 pm vaginal delivery the 1 minute APGAR is 6 & the 5 minute APGAR is 7. The infant is transferred into nursery and has jittery, cyanosis (face, hand, and feet), shaking when he’s stimulated. Upon auscultation, the lungs are moist. What action would you take with this infant?
What nursing interventions would you do for this patient by 4:15 pm?
At 24 hours of age the infant’s bilirubin level is 13.2. What would be the treatment plan for this patient? Would you transfer the infant to nursery or let the infant remain in the mother’s room?
Mom is trying to decide if she should get her infant circumcised.
What critical information does the nurse need to look for in the chart prior to the procedure?
How is pain managed for the newborn during this procedure?
Identify the patient teaching related to care of the circumcised newborn at home.
Identify the patient teaching related to the care of the uncircumcised newborn at home.
How would you respond to the mother when she asks your opinion about getting her son circumcised?
Explanation / Answer
Apgar score is the tool used since 1958 to assess the newborn at 1st and 5th minutes. It includes the parameters, heart rate, respiratory effort, muscle tone, reflex irritability and colour. Each item is scored 0,1,or 2.
Interpretation:
Score:
Less than 4, needs immediate resuscitation.
4-6, newborns condition is guarded, need to maintain airway patency and supplemental oxygen.
7-10, considered as the good score.
Nursing Duties:
· Assess the newborn frequently.
· Respiratory support if needed.
· Check vitals.
· Check respiration every 10 minutes, Heart rate at 15 minutes till one hour and temperature every 1 hour.
· Measure the circumferences.
· Administer vitamin K.
· Suction if the lung is still moist.
· Side lying position with head slightly lower than the body for easy drainage of fluid from lungs.
Bilirubin level of 13.2 mg/dl at 24 hours of age can be physiological or breast milk jaundice. Which occurs due to the inability of the immature liver to get rid of the unconjugated bilirubin.
Carefully watch the baby’s general condition and bilirubin values.
Phototherapy can be initiated.
The newborn can be kept in the mother’s room and phototherapy can be initiated using portable phototherapy equipment.
Keeping baby in mothers room improves bonding and makes the breast feeding easier.
During phototherapy assess the baby carefully. ( Temperature, signs of dehydration, feeding ability, lethargy, bilirubin values, potential sings of encephalopathy)
Circumcision is the surgical removal of the foreskin. It is done on the grounds of social culture or religion.
Circumcision is a minor surgery and can be done during newborn life itself. But many practitioners postpone it if the bilirubin level is more than 12 mg/dl. The healthcare provider should carefully monitor the condition of the newborn before the procedure.
Circumcision is an elective procedure, it is purely at the discretion of parents. The nurse can explain the potential benefits and side effect of the procedure.
Potential benefits :
Reduced chance of UTI, phimosis,
Decreased risk of foreskin infection, STDs and penile cancer
Drawbacks:
Surgical risks like infection
Penile damage
Decreased protection of genitals
Pain
Care of circumcised newborn at home
Clean the area with soap and water every day
Change diapers frequently
Change dressing
Check for any complications such as infection, low urine out put
Care of uncircumcised newborn at home
Wash the genital area carefully while bathing.
Instruct the parent not to retract the foreskin until age of three for cleaning.
After the age of three teach the baby how to clean the genitals after retracting the foreskin.
Pain Management
Nerve block (DPNB)
Sucrose dipped pacifiers
Frequent breastfeeding
Pain medication as per doctors order
Two methods can be combined and used for more efficiency.