August 13, 2018

Sharon F. Williams

Case study: Baby H.

1. Name the three phases that occur during this transition
period and state an approximate time frame for each.
 Phase I – From birth to 1 hour
 Phase II – From 1 to 3 hours
 Phase III – From 2 to 12 hours

2. What case is specific to the first period of reactivity?

 Maintaining thermoregulation
 Observing for urination and passage of meconium
 Performing a brief assessment for major anomalies
 Maintaining Cardio and respiratory functions
 Encourage bonding (breastfeeding)
 Identifying the parents and newborn

3. The sleep phase and second reactive phase might occur in

the SRMC or in the nursery. Identify eight assessments or
tasks that the nurse need to do during the transitional care
period.
 Head to toe assessment within 24 hours of birth
 Respiratory rate
 Muscle tone
  Reflex irritability
 Skin color
 APGAR score
 Heart rate
 Vital signs
 Weight and height

4. You are preparing to give the injection of vitamin K

(AquaMEPHYTON). The order is to give 0.5mg
subcutaneously on arrival in the nursery. The medication
comes in a solution of 1mg/0.5mL. Calculate how much
medication you will draw up into the syringe.
 0.25 mL

5. Erythromycin ointment is instilled in both eyes to prevent

which of these infections?
 Gonorrhea

6. Once the transitional care and documentation are

completed, the infant might be transferred to the normal
newborn nursery if the hospital does not use SRMC.
 The nurse should assess the level of maternal fatigue
and initiate appropriate relief measures such as taking
on the care of the newborn for a few hours, or
scheduling care that allows for period of rest.
7. The laboratory performs a Coombs test on Baby H. What
is the purpose of the Coombs test?
 To find out if mom has the IgG antibody that could be
pass on to the baby that may be harmful.
 Tested directly to see if antibody had already bound to
red blood cells.

8. True or False: A phenylketonuria (PKU) blood test can be

done any time before an infant is discharged to home. If
false, explain your rationale.
 False. If the infant has this disorder, a special formula
begun in the first 2 months of life can reduce disability
and prevent severe mental retardation in most cases.

9. Identify six important points to include in your teaching

plan.
 Wash hands before feeding; wash nipples with warm
water and no soap.
 Position self
 Sit comfortably in chair
 Side-lying with pillow beneath head, arm above head,
support infant in side-lying position.
 Turn body of infant to face mother’s breast.
 Stroke infant’s cheek with nipple.
 Infant’s mouth should cover the entire areola.
  Avoid strict time limits for nursing, nurse at least 10
minutes before changing to other breast, or longer if
infant is nursing vigorously.
 Use a safety pin on the bra as a reminder about which
breast to start with at the next feeding.

10. H.’s mother calls you to tell you that her baby seems
too sleepy and is not feeding well. What will your next
action be.
 The infant should be unwrapped, the diaper changed,
the mother should hold the infant upright and talk
softly to him or her or she may provide a gentle
massage of the back, palms, or soles of the feet.

11. Baby H.’s mother asks you about cord care and
circumcision care for her infant. What will you tell her?
 Using drying sol of alcohol and triple dye that is
applied to cord clean the umbilical cord stump several
times a day with soap and water especially after
voiding. To encourage drying of cord expose
umbilical area to air and position diaper below
umbilicus.
 If 5 days infant stump of umbilical cord is moist and
slightly red this is infections it should be dry with no
redness.
 Circumcision care check for bleeding hourly for 12
hours post-procedure, urine output, checks for oozing,
 and parents understanding. Circumcision small sterile
petrolatum gauze dressing may be applied to area
during the first 2-3 days. Circumcision of plastibell
used keep area clean, no jelly the plastic ring will
dislodge when area healed, in 5-7 days.
 Teach parents that whitish yellow exudation around
the glans is granulation tissue and is normal and if not
infection seen 2-4 days don’t remove it.

12. Baby H.’s mother asks you how she can keep her
infant from catching a cold or some other type of infection.
What is the most important measure to teach her?
 Hand washing between handling infants and contact
with inanimate objects, inanimate objects should be
cleaned with appropriate bactericidal solution.

13. After discharge, it is important for Baby H. to receive

follow-up care. What should you teach the mother to help
her understand the importance of regular visits?
 Home safety for newborn
 Umbilical cord
 Circumcision
 Newborn bath
 Newborn well-check.
 Immunization for infants.
 Car seat safety
  Crib/bed safety
 Clothes for newborn
 Signs of Illness report to doctor immediately.

14. You realize the Baby H.’s mother needs information

about safety issues before being discharged. After a review
of safety issues, which statement by Baby H.’s mother
indicates that she needs further instruction?
 I can leave him on the infant table for just a few
moments while he is a newborn.
Case Study Outcome:
Baby H. is discharged to go home with his parents.
 Discharged planning begins on admission when
parents attend childbirth class, because mother and
infant are discharged quickly after birth, self-care and
infant-care teaching must often begin before the
mother is psychologically ready to learn

 Baby H’s parents has past experience and knowledge,

parents-newborn attachment, adjustment to parental
role, social support, educational needs, sibling rivalry,
educational needs, readiness to accommodate, ability
to verbalize, and demonstrate.