Question: TYING IT ALL TOGETHER You Are Assigned To The Mother-baby Couplet Unit. Your Assign- Molding Is Present. Ment For The Day Includes The Sanchez Family. Margarite Is A Lung Sounds Are Clear. 28-year-old G3 P2 Hispanic Woman Who Gave Birth To A Healthy There Is Mild Nasal Flaring. Boy, Manuel, At 0839. Margarite Experienced An Uncomplicat- Manuel Is In …

TYING IT ALL TOGETHER You are assigned to the mother-baby couplet unit. Your assign- Molding is present. ment for the day includes the Sanchez family. Margarite is a Lung sounds are clear. 28-year-old G3 P2 Hispanic woman who gave birth to a healthy There is mild nasal flaring. boy, Manuel, at 0839. Margarite experienced an uncomplicat- Manuel is in a sleep state and unresponsive to external stimuli. ed labor of 12 hours. Membranes ruptured 7 hours before Based on the above information, discuss the primary nursing diagnoses for delivery. She received 2 doses of Nubain during labor. The last baby Manuel dose was given at 0440. Discuss the immediate nursing actions for baby Manuel. Provide ratio- Manuel weighs 3800 grams and is 50 cm in length. His nales for your nursing actions. 1- and 5-minute Apgar scores were 8 and 9. Manuel is 2 hours old. The Ballard score indicate that Manuel is 39 weeks. Thirty minutes later you note that Manuel is jittery and exhibits Margarite breastfed her son for 15 minutes on each breast signs of hypoglycemia. immediately after the birth. List the signs and symptoms of hypoglycemia and related nursing actions. Your initial shift assessment findings are: Several hours later, Manuel’s father is present and holding Vital signs: Axillary temperature, 36.2°C; apical pulse, 100 beats Manuel per minute; respirations, 30 breaths per minute. List signs of parent-infant bonding Skin is warm and pink with acrocyanosis. Discuss nursing actions that will support parent-infant attachment. Fontanels are soft and flat. TYING IT ALL TOGETHER Baby girl Polk is a newly delivered 32 weeks’ gestation neonate who is admitted to the NICU. Her mother, Mallory, is a 42-year- old African American single woman. Mallory is a G2 PO who con- ceived after three attempts at in vitro fertilization. Mallory was admitted to the birthing unit for preterm labor. She was given magnesium sulfate, ampicillin, and two doses of betamethasone. Her labor contraction continued. When her cervix was 5 cm dilat- ed, a decision was made to discontinue the magnesium sulfate. A few hours after the magnesium sulfate was discontinued, Mallory gave birth spontaneously to a baby girl. The 1- and 5-minute Apgar scores were 7 and 8, respectively. Baby Polk weighed 2010 grams and was assessed at 32 weeks based on Ballard score. Detail the aspects of your initial nursing assessment List the nursing diagnosis for this neonate. What are the immediate priorities in the nursing care of Baby Polk? Discuss the rationale for the selected priorities. List the anticipated medical care for Baby Polk. 4 hours later: Baby Polk is on NCPAP. There is an increase in intercostal retractions and expiratory grunting. The results of arterial blood gas (ABG) tests are Pco, of 70 and pH of 7.2. CBC indicates an increase in WBC. Medical orders include initial dose of Survanta, IV of D10, glucose monitoring every 4 hours, ampicillin 50 mg/kg, and gentamicin 4 mg/kg. Based on this additional information, list the nursing diagnosis for this neonate. List the anticipated medical care. Discuss the nursing are for this neonate and mother. 1 week later: Baby Polk is extubated and is placed on high-flow nasal cann la at 1 liter. She is tolerating gavage feedings and gaining weight. She is experiencing occasional episodes of apnea and bradycardia. Discuss the criteria for discharge from the NICU. Describe the discharge teaching for the care of baby Polk.