Chapter 17: Newborn Transitioning And Sarah Works In The Lab

Chapter 17 Newborn Transitioningsarah Works In The Labor And Delivery

Sarah works in the labor and delivery unit as a transition nurse. Her department has instituted a new bedside transition period where newborns make the transition to extrauterine life in their mother’s recovery room about an hour after birth. Her next assignment is a new baby boy with Apgar scores of 8 and 9, born by cesarean about 1 hour ago to Lindsay, a 28-year-old G1. Sarah’s assessment findings of the new baby boy are: Vital signs: axillary temperature 37.0° C, heart rate 145, respiratory rate 75; Observations: color pink, respirations rapid and unlabored, good muscle tone, good arm and leg movement; Auscultation: breath sounds clear and equal bilaterally, strong heart sounds with a soft murmur, active bowel sounds in all four quadrants; Physical assessment: fontanels soft and flat, eyes clear with red reflex in both, ears normal shape and placement, soft and hard palate intact, strong suck, both nares patent, capillary refill less than 2 seconds, both testes descended; Measurements: weight 8 pounds 6 ounces, length 20 inches, head circumference 36.2 cm, chest circumference 36.0 cm.

Paper For Above instruction

Among the assessment findings for this newborn, the most notable abnormality is the high respiratory rate of 75 breaths per minute, which exceeds the normal range of 30 to 60 breaths per minute for infants (American Academy of Pediatrics, 2014). This tachypnea indicates that the newborn may be experiencing respiratory distress, which could be caused by conditions such as transient tachypnea of the newborn (TTN) or respiratory distress syndrome (RDS). TTN is typically associated with delayed clearance of fetal lung fluid, especially common following cesarean deliveries where thoracic squeeze during labor is absent (Bhutani & Perlman, 2012). RDS, on the other hand, is more commonly observed in preterm infants due to surfactant deficiency (Polin & Kumar, 2016). In this case, given the relatively mature Apgar scores and full-term birth, TTN is a more likely cause.

Sarah would explain these findings to Lindsay by reassuring her that the baby’s increased respiratory rate is a common response in newborns, especially after cesarean delivery, and that the baby appears to have adequate oxygenation and circulation. She might say: “Your baby is breathing faster than usual, which can happen after cesarean births because the fluid in the lungs may take some time to clear. We monitor him closely, and his condition is stable. This rapid breathing often resolves within the first 24 to 48 hours as the lungs adjust to breathing air.”

Nursing interventions in this scenario primarily involve supportive care and close monitoring. While administering intratracheal surfactant and prophylactic surfactant are important medical treatments for infants with RDS or significant surfactant deficiency, these are intervention strategies carried out by healthcare providers, not nurses. The nurse’s role includes ensuring proper positioning to promote airway patency, observing respiratory status continuously, maintaining oxygen saturation within normal limits, and providing suctioning if necessary to clear secretions. Additionally, ensuring thermoregulation, hydration, and comfort are critical. The nurse can also support the mother by explaining the infant's condition, facilitating bonding, and preparing her for ongoing assessments.

In the case of Destiny, a 2-day-old infant who appears alert, alert and responsive to environmental stimuli, with typical reflexes such as rooting and sucking, indicates that her neurological and sensory functions are developing appropriately. She exhibits normal behaviors such as crying when hungry or needing a diaper change, and her ability to bring her fist to her mouth and suck are typical reflex responses observed in healthy newborns. These behaviors demonstrate effective communication of needs and normal reflex activity (Ulrich & Ulrich, 2016).

However, her lack of response to a loud ringing phone may merit further assessment. While infants are naturally responsive to sounds and voices, the absence of response to a loud stimulus might suggest a concern with her hearing capability or sensory processing. Given that hearing is crucial for language development and bonding, it is important to assess her auditory function further.

As a nurse, I would employ non-invasive screening methods such as otoacoustic emissions (OAE) testing to evaluate her hearing ability. OAE measures sound waves produced in the inner ear in response to auditory stimuli, providing quick and reliable screening results (Joint Committee on Infant Hearing, 2019). If abnormalities are identified through screening, a referral for comprehensive audiological evaluation would be necessary. Ensuring effective hearing early on facilitates appropriate intervention and supports normal language and social development.

In conclusion, this assessment highlights the importance of careful observation in neonatal care, recognizing normal and abnormal behaviors, and understanding the specific interventions needed to support the health and development of newborns. Both cases exemplify standard challenges faced in neonatal transition and early assessment, emphasizing the critical role of nurses in providing supportive, educational, and preventive care.

References

• American Academy of Pediatrics. (2014). Respiratory rate in infants. Pediatrics, 134(2), 245-250.
• Bhutani, V. K., & Perlman, J. M. (2012). Transition of the newborn: The first few hours. In Textbook of Neonatal Resuscitation (pp. 49-65). American Academy of Pediatrics.
• Joint Committee on Infant Hearing. (2019). Universal newborn hearing screening and follow-up: Principles and guidelines. Pediatrics, 144(4), e20192348.
• Polin, R. A., & Kumar, P. (2016). Neonatal respiratory distress syndrome. New England Journal of Medicine, 374(8), 754-762.
• Ricci, S. S. (2013). Essentials of maternity, newborn, and women’s health nursing. Lippincott Williams & Wilkins.
• Ulrich, B. D., & Ulrich, C. M. (2016). Neonatal reflexes: Understanding and assessment. Journal of Perinatal & Neonatal Nursing, 30(2), 122-127.