CASE SIMULATION IN PEDIATRIC NURSING

Case Study 1
Name: Marquez, C. Class/Group: Group 6
INSTRUCTIONS:
All questions apply to this case study. Your responses should be brief and to the point. When
asked to provide several answers, list them in order of priority or significance. Do not assume
information that is not provided.
Scenario
Baby H was just born in a hospital that provides single-room maternity care (SRMC). SRMC
allows the infant to remain with the parents after birth. The nurse will complete the physical
assessment and observe for physiologic changes in the infant’s transition from intrauterine to
extrauterine life. The textbooks will tell you that the infant goes through an initial phase of
reactivity 30 to 60 minutes after birth, then a sleep phase for 4 to 6 hours, then second period
of reactivity. You will see variations of the timing in actual practice.

1. What care is specific to the first period of reactivity?

An awake, alert, and active infant characterizes the initial period of reactivity, which occurs
within the first 30-60 minutes of life. This phase comes to an end when the newborn falls in to a
deep sleep. Suck is strongest at this time therefore this is the best time to breastfeed. “Early
skin-to-skin contact (SSC) begins ideally at birth and involves placing the naked baby, covered
across the back with a warm blanket, prone on the mother's bare chest. This time may
represent a psychophysiological 'sensitive period' for programming future behavior, and may
benefit breastfeeding outcomes, early mother-infant attachment, infant crying and
cardiorespiratory stability.” (Cochrane Database, 2007). Care includes preserving
thermoregulation, observing for urine and meconium transit, performing a short assessment
for significant abnormalities, maintaining cardiac and respiratory function, encouraging
bonding, and identifying the parents and the infant.

2. Identify 8 assessment or tasks that the nurse needs to do during the transitional care
period of reactivity.
 Assess vital signs every 30 minutes until stable for two hours: respiratory rate (30-60
cycles/min), heart rate (120-160 bpm), and temperature (36.5°-37.5°C). Maintain
thermoregulation.
 APGAR Score
 Newborn measurements: weight (around 7.5 lbs./3.5 kg), length ( 20 in./51 cm), head
circumference (about 13.5 in./34.5 cm), chest circumference (30–33 cm/12–13 inches), and
abdominal girth (24.47 cm)
 Assess airway clearance and skin color
 Neuro status: muscle tone, reflexes, response to handling
 Skin-to-skin contact
 Medication administration: Vitamin K and Erythromycin (to prevent neonatal conjunctivitis)

3. You are preparing to give the injection of vitamin K (aquaMephyton). The order is to give
0.5 mg subcutaneously upon arrival to the nursery. The medication comes in a solution of
1mg/0.5ml. Calculate how much medication you will draw up into the syringe.
0.5mg/1mg x 0.5mL = 0.25mg

4. Once the transitional care and documentation are completed, the infant might be
transferred to normal newborn nursery. What ongoing care of newborn is this nurse
responsibility for?
The nurse is in charge of taking periodic vitals, changing diapers, recording inputs and outputs,
and communicating with the infant's mother about feeding preferences.

5. The laboratory also performs a Coomb’s test on baby H. What is the purpose of coomb’s
test?
A. It is done to identify the infant’s blood type
B. It test for damage to the red blood cells from maternal antibodies
C. It checks the red blood cells for anemia
D. It is a test for immunity to the hepatitis virus

6. True or False. A phenylketonuria blood test can be done any time before an infant is
discharge to home. If false, explain your rationale.
False. The test should be performed within 24 hours after delivery to confirm that the infant
has consumed some protein, whether from breast milk or formula. This will aid in the accuracy
of the results. However, to avoid phenylketonuria complications, the test should be performed
within 24–72 hours of delivery.
CASE STUDY PROGRESS
Baby H.’ mother has decided to breastfeed her infant. She asks for assistance.

7. Identify six important points to include in your teaching plan for breastfeeding

 Encourage mom to feed on demand of her infant. This will be roughly every 2-4 hours.
 Do not let baby sleep at the breast. Ensure baby is stimulated to finish a feed.
 Feedings should last 30-40 minutes.
 Baby should be latched on with more areola than nipple. If baby is only latched to nipple,
less milk will be expressed and other will get sore.
 Ensure maternal hydration and nutrition due to breastfeeding's calorie requirements.
 Encourage different positions to ensure full milk expression at each feeding.

8. Baby H.’ mother calls you to tell you that her baby seems too sleepy and not feeding well.
What will your next action be?
Stimulate newborn by unwrapping, diaper change, stroke cheek with finger or mom’s nipple,
hold baby upright, talk to baby, gently rub hands and feet. Also, try skin-to-skin approaches to
wake up the infant, and if that doesn't work, check the temperature and glucose levels.

CASE STUDY PROGRESS

You are meeting with baby H.’ mother to review discharge instructions.
She has many questions.

9. Baby H’s mother asks you about cord care for her infant. What will you tell her?
Hands should be washed with soap and water before and after cord care. Keep the cord dry and
exposed to the air, or cover it loosely with clean clothing. Clean the cord and skin around it with
a cotton ball, two to three times each day, or after each diaper change. Do not touch it or apply
any filthy substances to it. Bandages should be avoided. There should be no tub bathing until
the cord falls off. Fold diapers and tuck them under the cord. Check for indications of illness
such as odor, leaking, or redness around the cord; never pull or try to loosen it.

10. Baby H’s mother asks you how she can keep her infant from catching colds or some other
type of infection. What is the most important measure to teach her?
The more people the infant comes into touch with, the more probable he or she will become
infected. Because newborns' immune systems are still developing, they are more susceptible to
infectious diseases. Visitors with contagious symptoms should be kept away from the infant.
Anyone with a fever, cold, cough, sore throat, vomiting, or diarrhea, for example, should not
visit.
To reduce the transmission of infection, remember to wash your hands before caring for the
infant. The most essential thing we can do to help stop the transmission of infection is to wash
our hands. Make sure that your baby has all of his vaccinations. Immunization helps protect
your child from illnesses that are avoidable but can be fatal.

11. 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?
Within 48 hours of discharge, a follow-up care assessment should be scheduled. Normal infant
care, hyperbilirubinemia evaluation, any severe weight loss, presence of feeding difficulties, and
knowledge gaps in newborn care are all included. It is important to keep track of a baby's
development and weight increase, as well as to ensure that he or she receives all necessary
immunizations to avoid illness or disease.

You realize that 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?
a. "I have a car seat and will use it for my baby every time we use the car."
b. "I can leave him on the infant table for just a few moments while he is a newborn."
c. "I will not drink hot coffee while holding my baby."
d. "I will check the bath water temperature before bathing him."

CASE STUDY OUTCOME

Baby H. is discharge to home with his parents.
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