Samuel Gepaya BSN – II Nursery

Critical Thinking Exercises

1. Bobby Jo Sparrow is a 16-year-old teenager whose newborn has been admitted to the neonatal
intensive care unit because of a neural tube disorder and congenital hip dysplasia. Ms. Sparrow is
obviously upset over the diagnosis. She says, “I’m a good person. The only thing I did wrong during
pregnancy was to take some cough medicine, so how could this have happened?” How would you answer
her? What type of advice would be most helpful to her?
“Don’t be too hard on yourself. I can really see how concerned you are about the health and
future of baby Sparrow. It shows how much you care and how you have put so much effort on taking care
of baby Sparrow. There are still ways we can help recover and treat baby Sparrow. He is trying his best to
live and is awaiting for your love and care. So, don’t give up! He is still fighting.” That would be my
response. A helpful advice for the mother is letting her know that her baby is still continuing fighting for
his life and she should not give up for him and there are still ways we can correct the hip dysplasia and
discuss ways on how to deal with his neural tube disorder with treatment. Another advise or thing to do is
to show her babies or children that have physical and developmental challenges and tell her about the
journey of these children and how they are still living and continue to grow and develop through the
never ending support and faith for their baby or child to live.
2. Baby Sparrow has developmental hip dysplasia and will be placed in a Pavlik harness. What
suggestions could you make to his mother to help her instill a strong sense of trust in her child? A sense
of autonomy?
Provide suggestions that would help the mother manage in using the harness in baby sparrow
such as how to attach the harness, where and how to assess the skin of the baby for irritation and redness,
and how to manage the health of the baby while using the harness like how to hold, feed, play, and
provide other stimulation that promote the development of baby sparrow. Provide encouragement on how
the harness can help correct the condition of the baby and tell positive things such as the improvement of
the baby every visit and assure that the baby can catch up with the developmental milestones like
crawling and walking. This will give the mother a sense of autonomy as well as trust and improve the
self-esteem of the mother when it comes to baby sparrow.
3. You notice Baby Sparrow’s mother is obviously upset at her child’s appearance. She does not want to
feed the baby and voices the thought of placing him for adoption. In contrast, the child’s father, age 22,
handles the baby warmly and asks questions about surgery. No grandparents visit. What interventions
would you want to begin with this family?
The interventions I want to begin with this family is the restoration of maternal-infant attachment
and development of mother-infant bonding. It can be done by engaging a mother-infant interaction such
as kangaroo care, breastfeeding, and the mother participating in routine care, yet due to the child is in
neonatal intensive care unit, this limits the interaction between mother and infant. In exchange, we should
engage and improve mother-nurse interactions such as providing psychosocial support and effective
communication especially when taking about the baby. We should provide information about the
condition of the baby and discuss with the mother about ways on how she can help and engage interaction
with her baby, this will give a sense of control for the mother. Another is to provide assurance about the
treatment and therapy the baby may/will be undergoing and that if it would be successful, the baby can
grow just like other babies, but it will take time since the baby will be recovering and monitored until
healthy or manageable to let him go home. Let the couple discuss about their feeling toward the health
and future of the baby and if possible, talk about it with other support systems like close friends and
relatives. These things will provide chances for the mother to accept her baby.
4. Examine the National Health Goals related to children born with physical or developmental disorders.
Most government-sponsored funds for nursing research are allotted based on these goals. What would be
a possible research topic to explore pertinent to these goals that would be applicable to the Sparrow
family and also advance evidence-base practice?
Research Topic:
Association of prenatal exposure to cough medication with neural tube disorders in embryonic
development.
Evidence-base Practice:
To what extent does folic acid supplementation reduce the risk for NTDs (first occurrence) in women of
childbearing age?
The USPSTF found convincing evidence that folic acid supplementation in the periconceptional
period provides substantial benefits in reducing the risk of neural tube defects in the developing fetus. In
2009, the USPSTF reviewed the evidence on folic acid supplementation in women of childbearing age
and found that the benefits are well-established and outweigh the harms. The current USPSTF statement
recommends that all women who are planning or capable of pregnancy take a daily supplement
containing 0.4 to 0.8 mg (400-800 μg) of folic acid. All women of childbearing age are at risk of having a
pregnancy affected by neural tube defects. The critical period for supplementation starts at least 1 month
before conception and continues through the first 2 to 3 months of pregnancy. Some factors increase this
risk, including a personal or family history of neural tube defects, use of particular antiseizure
medications, maternal diabetes, obesity, and mutations in folate-related enzymes.
Citation:
Viswanathan, Meera, et al. "Folic acid supplementation for the prevention of neural tube defects: an
updated evidence report and systematic review for the US Preventive Services Task Force." Jama 317.2
(2017): 190-203.