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Physiological and Behavioral Responses of the Neonate

The nurse is caring for a term male newborn who just delivered via SVD.

This case consists of six clinical judgment questions. Read each question carefully and select the best answer(s). Use the chart to help answer the question. The chart is dynamic and may change as the case progresses.

 

Scenario

The nurse is caring for a term male newborn who just delivered via SVD. Use the chart to answer the questions. The chart may update as the scenario progresses.

 History and Physical Assessment

Maternal obstetric history: The mother of the infant is a 23-year-old Hispanic female, G2P2002, at 39.5 weeks. Blood type B, Rh positive. The patient had hyperemesis that resolved by 19 weeks’ gestation. No other concerns or complications during pregnancy.

First pregnancy 2 years ago: SVD at 40.5 weeks. Moderate meconium at delivery. No other concerns. 3,678 g viable female.
Current pregnancy: SVD at 39.5 weeks. Light meconium at delivery. 3,530 g male infant.

Maternal social history: Nonsmoker. Drank approximately 1-3 alcoholic beverages 3 to 4 days a week during pregnancy. No history of drug use. Works as a cashier at the local grocery store. Father of baby not involved. Lives at home with her parents and brother who are supportive and assist in caring for her older child.
Newborn physical assessment: Assessment performed while skin to skin with mother. 1-minute Apgar 8 (points off for color and reflex activity), 5-minute Apgar 10. Heart sounds normal. Lungs clear to auscultation in all fields. Bowels sounds in all four quadrants. Swelling noted on scalp. Sutures are overriding. Fontanels soft and flat. Face is symmetrical. Ears symmetrical and flexible. Skin tag on left tragus. Moves all extremities equally. Polydactyly on right hand. Chest is symmetrical. Umbilical hernia approximately 2 cm in diameter, easily reduced. Abdomen soft and round. Testes descended bilaterally, urethral opening is on the ventral side of the penis. Gluteal folds equal, legs are symmetrical. Large, darkened area across upper back and on buttocks. Spine intact, no sacral dimple.

 

 Nurses’ Notes

1/23/XX
1639
Provider at perineum for delivery, notes light meconium. Infant ROA, delivered over an intact perineum, placed on mother’s abdomen. Towel dried. Cord clamped after 2 minutes. Warm blanket placed over infant and infant brought to mother’s chest. Assessment performed by nurse.

 

 

The nurse documents the newborn assessment. Select to highlight findings that require further assessment and possible interventions. Select all that apply.

 

Question 1 of 6

The nurse documents the newborn assessment. Select to highlight findings that require further assessment and possible interventions. Select all sentences that apply.

Assessment performed while skin to skin with mother. 1-minute APGAR 8 (points off for color and reflex activity), 5-minute APGAR 10. Heart sounds normal. DTRs are normal and no signs of clonus. Lungs are clear to auscultation in all fields. Bowels sounds in all four quadrants. Swelling noted on scalp. Sutures are overriding. Fontanels soft and flat. Face is symmetrical. Ears symmetrical and flexible. Skin tag on left tragus. Moves all extremities equally. Polydactyly on right hand. Chest is symmetrical. Umbilical hernia approximately 2 cm in diameter, easily reduced. Abdomen soft and round. Testes descended bilaterally, urethral opening is on the ventral side of the penis. Gluteal folds equal, legs are symmetrical. Large, darkened area across upper back and on buttocks. Spine intact, no sacral dimple.

 

SCIENCE
HEALTH SCIENCE
NURSING
NURS 418

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