Essentials Of Maternity, Newborn, And Women’s Health Nursing
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.
Nursing Management of the Newborn
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Nursing Management of the Newborn
Essentials of Maternity, Newborn, and Women’s Health Nursing
As the first squall of a newborn fills the air, nurses move forward as the directing hands that arrange the delicate concord of care and support, accompanying these precious lives into a world of accountabilities through their expert nursing management. Nursing management of the newborn is essential to providing inclusive care during the early stages of life. It entails a range of accountabilities focused on fostering the baby’s and their family’s health and well-being. One of the main aims of nursing management is to ensure a smooth transition from intrauterine to gestation life (Bedwell et al., 2019). This involves conducting thorough evaluations to recognize possible risks or complications like respiratory distress or hypoglycemia and promptly executing suitable interventions. In addition, nurses play a vital role in facilitating parent-infant bonding and fostering lactating initiation and support. They offer education and directions to parents on newborn care, involving feeding methods, hygiene practices, and safe sleep practices. Moreover, nursing management involves observing vital signs, monitoring for signs of infection or jaundice, and partnering with the healthcare team to create personalized care plans for each newborn. By offering compassionate and knowledgeable care, nursing professionals contribute crucially to newborns’ overall health and development to ensure a solid foundation for a healthy future. This essay will explore a case study on an LGA baby boy who was born at 37 weeks gestation, and from the case study, the paper will describe what a routine head-to-toe assessment would be for an infant born at 37 weeks gestation, the type of test to be used to determine this gestation age, the scale used to determine the Apgar score, and if the baby’s scores are standard, the immunizations that would be required, the discharge instructions that would be pertinent to this mother, and education for the family.
A Normal Head-to-Toe Assessment for an Infant Born at 37 Weeks’ Gestation
A normal head-to-toe assessment for an infant born at 37 weeks of pregnancy would entail a thorough evaluation of the baby’s physical and physiological well-being. The evaluation would mainly examine the baby’s vital signs, like heart rate, respiratory rate, temperature, and blood pressure (Qais Saadoon & Qais Saadoon, 2018). The nurse would then continue inspecting the baby’s head, looking for abnormalities like cranial deformities or scalp status. The nurse would also evaluate the fontanels, and the soft spots on the baby’s skull, ensuring they are appropriately developed and not sunken or bulging. Heading down, the nurse would examine the baby’s face, observing for symmetry and any signs of abnormalities. The nurse would monitor the baby’s skin color, checking for jaundice or any other noticeable discoloration. Next, the nurse would assess the baby’s eyes, ears, nose, and mouth, evaluating any signs of disorder or congenital abnormalities. The nurse would continue to examine the baby’s neck, chest, and abdomen, communicating for any masses or abnormalities. The nurse would assess the baby’s extremities, looking for a suitable range of motion and the presence of all fingers and toes. Finally, the nurse would thoroughly evaluate the baby’s genitalia, involving examining the circumcision site if suitable. The nurse closely monitored the baby’s behavior and response to stimuli throughout the assessment.
The test mainly used to determine infant gestational age is termed the Ballard Score or Ballard Examination. The Ballard Score is an inclusive evaluation tool combing physical and neuromuscular features to estimate the gestational age of a newborn (Torres et al., 2019). It entails assessing the baby’s external physical characteristics like skin texture, lanugo, ear cartilage, breast growth, and genitalia, as well as examining neuromuscular maturity by evaluating posture, square window, arm recoil, popliteal angle, and heel-to-ear extension. The results of the Ballard Score are then compared to a standardized scoring system to estimate the baby’s gestational age. This evaluation is vital in determining if the baby is developmentally suitable for their expected due date and assists in guiding the care and interventions offered to support their growth and development.
The Scale used to Determine the Apgar Score
The Apgar score is a quick evaluation tool used to assess a newborn’s physical condition and overall well-being immediately after birth. It consists of five components, including heart rate, respiratory effort, muscle tone, reflex irritability, and color. Each component is scored from zero to two, with a maximum total score of ten (Yeshaneh et al., 2021). A score of eight is generally considered normal. In the case of this significant gestation age baby boy, who was born at 37 weeks’ pregnancy, his Apgar score of eight and nine indicates that he is in good condition. These scores indicate that he had a rapid heart rate, perfect respiratory effort, suitable muscle tone, a strong reflex response, and standard color. Comprehensively, the baby’s Apgar scores are within the expected range and do not develop any immediate concerns regarding his well-being.
Discharge Accountabilities and Screening and Immunizations for Infants in the First 24-48 Hours
As the discharging nurse for a sizeable gestational age baby born at 37 weeks of pregnancy, numerous screenings must be conducted within the first 24 to 48 hours. These screenings focus on evaluating the overall health and well-being of the newborn. One crucial screening is the newborn metabolic screening, commonly known as the heel prick test (Rodrigues et al., 2019). The test assists in identifying metabolic infections that may not be immediately evident but could result in severe health problems if left untreated. In addition, a hearing screening is typically performed to detect any hearing disability early on. The nurse should also evaluate the baby’s vital signs, including heart rate, respiratory rate, temperature, and blood pressure, ensuring they are within the normal range. Moreover, a physical examination is conducted to evaluate the baby’s overall appearance, look for abnormalities, and ensure proper growth. The specific vaccines the baby needs would depend on the national or regional immunization schedule. Generally, throughout the first 24 to 48 hours, the baby may get the first dose of the hepatitis B vaccine (Maini & Pallett, 2018). This vaccine is a viral infection that can cause severe liver disorder, and the vaccine assists in protecting against it. The nurse would ensure proper vaccine administration, following the directions and recommendations offered by the healthcare facility and public health authorities. Educating the parents about the necessity of immunizations and recommended schedules for future vaccinations is essential, fostering their role in protecting the baby’s health and preventing the spread of infectious disorders. The discharge instruction must include information about any upcoming immunization and the schedule for follow-up visits with the pediatrician, ensuring the baby’s immunization needs are met.
Pertinent Discharge Instructions to the Mother
As a postpartum nurse, it is essential to provide inclusive discharge instructions to the mother of the sizeable gestational-age baby boy who was born at 37 weeks’ gestation. Firstly, foster the essence of breastfeeding for a baby’s health and development. Motivate the mother to progress lactating on demand, ensuring proper latch and positioning to facilitate effectual milk transfer. Educate her on the signs of effective breastfeeding, like adequate urine and stool output, weight gain, and contentment after feeding. In addition, discuss the necessity of maintaining good hygiene after the circumcision processes, including keeping the area clean and dry and spreading petroleum jelly to the site during diaper changes. Foster the need for regular follow-up visits with the pediatrician to observe the baby’s development and growth. Offer information on common newborn behaviors and features like sleep patterns, bowel movements, and expected weight gain. Finally, remind the mother about the availability of support groups, resources, and hotlines for any questions or concerns she may have during the postpartum period.
Education for the Family
Felicitations on the birth of your baby boy! As a postpartum nurse, I am here to provide essential information and support. Your baby was born at 37 weeks’ pregnancy and had good Apgar scores of eight and nine, suggesting overall health at birth. He has been circumcised, and I am here to help you with his care. Since you are lactating, ensuring a proper latch and positioning is essential to perfect effectual feeding and prevent nipple soreness. I usher you through these methods and answer any questions you may have. In addition, we will conduct a complete evaluation of your baby, including vital signs, weight, and overall physical examination, ensuring he is thriving. We will also conduct appropriate screenings to detect any possible health concerns. Finally, I will offer you inclusive discharge instructions and documentation, covering topics like newborn care, feeding schedules, signs of potential problems, and follow-up appointments. Please feel free to ask anything during this procedure, as I am here to support you and your baby during this specific time.
Conclusion
Effectual nursing management of the newborn incorporates an inclusive perspective, ensuring the well-being of both the infant and the mother. Nurses play a crucial role in fostering the health and development of newborns through an average head-to-toe assessment, accurate observation of Apgar scores, and proper screenings and immunizations. In addition, offering clear and pertinent discharge instructions to the mother and educating the family on newborn care further improves their ability to offer a nurturing environment. By fulfilling these accountabilities, the postpartum nurse contributes to the overall victory of newborn care and supports families’ transition into their new role.
References
Bedwell, S. M., Leasure, R., & Gibson, T. (2019). The effect of a respiratory algorithm on respiratory transition to extrauterine life. Neonatal Network, 38(2), 80-87.
Maini, M. K., & Pallett, L. J. (2018). Defective T-cell immunity in hepatitis B virus infection: why therapeutic vaccination needs a helping hand. The Lancet Gastroenterology & Hepatology, 3(3), 192-202. https://doi.org/10.1016/S2468-1253(18)30007-4
Qais Saadoon, A., & Qais Saadoon, A. (2018). Examination of the Newborn. Essential Clinical Skills in Pediatrics: A Practical Guide to History Taking and Clinical Examination, 107-129.
Rodrigues, L. P., Tanaka, S. C. S. V., Haas, V. J., Cunali, V. C. A., & Marqui, A. B. T. D. (2019). Heel prick test: maternal-fetal conditions that may have an effect on the test results in newborns admitted to the intensive care unit. Revista Brasileira de Terapia Intensive, 31, 186-192. https://doi.org/10.5935/0103-507X.20190030
Torres, M. T., Valstar, M., Henry, C., Ward, C., & Sharkey, D. (2019). Postnatal gestational age estimation of newborns using small sample deep learning. Image and vision computing, 83, 87-99. https://doi.org/10.1016/j.imavis.2018.09.003
Yeshaneh, A., Kassa, A., Kassa, Z. Y., Adane, D., Fikadu, Y., Wassie, S. T., … & Abebe, H. (2021). The determinants of 5th minute low Apgar score among newborns delivered at public hospitals in Hawassa City, South Ethiopia. BMC Pediatrics, 21(1), 1-10. https://doi.org/10.1186/s12887-021-02745-6
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