NUR 2633 Module 4 Discussion Latest
Complete the discussion in Group A or B as assigned by the instructor and then respond to the alternate group. All students are required to review all posts for general knowledge. Keep in mind that you will earn points for your initial discussion posts, as well as your responses.
Discussion Group A:
Mary’s 1st baby was delivered via c/section due to the baby being in the breech position. She is requesting a VBAC (vaginal birth after c/section) for her second baby. By ultrasound this baby is in the vertex position. In reviewing the postoperative report from her first surgery – it is noted that she had a low transverse uterine incision.
- What are your thoughts on having a vaginal birth with this second baby?
- What education can you provide to her?
- What is the risk to her and does this change your thoughts and advice?
Group B Response
Mary is not progressing in labor appropriately, and the decision has been made to move toward a cesarean section. She understands, agrees, and signs the consent for surgery.
You will again accept this patient in the recovery – or initial postpartum period.
Recognize that you will complete BUBBLEHE assessment. In addition, the abdominal assessment will also include assessment of the incision. Note the type of dressing used to cover the incision. Is it approximated? Is there any bleeding? Does she have bowel sounds? Is the abdomen distended? Is it soft? Do you assess the fundus and where is it located? It should be firm.
Note pain assessment.
- Discussion Group B will provide an initial post to the following questions, and respond to Group A.
Discussion Group B:
Susan P. had a SVD (spontaneous vaginal delivery) today approximately 2 hours ago. The labor and delivery nurse is calling to give you a report. She is new and not sure what you want to know from her.
What questions do you need to ask to provide comprehensive care to this patient once she is transferred into your care?
Group A Response
Note that you discover that Susan is Rh negative, her baby is Rh positive. What now?
- Please discuss Rhogam. The drug, the need, the route, the risk.
- When must you give this and under what circumstances will you give this injection?
- Please also recall any other reason Rhogam would be given, and when.
Complete the discussion in Group A or B as assigned by the instructor and then respond to the alternate group. All students are required to review all posts for general knowledge. Keep in mind that you will earn points for your initial discussion posts, as well as your responses. If you do not post responses, you cannot earn full credit. Refer to the Discussion Rubric on how points are earned.
Group A will complete the initial post. Group B will respond. You are called to the room and find Michael 2 hours old has been very irritable and spitting up large amounts of formula. He is very jittery. You do not know the maternal history before coming into the room so you advise the mother that you would like to return the baby to the nursery for an assessment and monitoring. In the medical record you focus on prenatal history.
You witness the baby having some significant tremors. What would you suspect? Michaels VS are: T (axillary) – 36.0, RR- 70, HR- 166, he is very alert, irritable, and does not console easily. Is moving constantly, and sucking very vigorous on the pacifier you provide for comfort. You place the baby under the warmer and obtain what labs?
It is determined that this baby is going through opioid withdrawal. Neonatal Abstinence
Syndrome requires close observation and scoring. Methadone may be used. Neonatal Abstinence Syndrome Shows both the signs of withdrawal, scoring and the nursing care of a baby with Neonatal Abstinence Syndrome.
Group B Response
What is your feeling and knowledge regarding breastfeeding this baby?
Group B will complete the initial post. Group A will respond. Baby Leah had a very traumatic vaginal birth. After a vacuum extraction for fetal heart rate tracing changes and a resultant shoulder dystocia, Leah has a mild Erb’s palsy, some facial and truncal bruising. Pediatrician has ordered physical therapy for the palsy and the doctor expects routine care to be provided to her.
In addition, do not forget the education you must give to the new parents regarding this injury. Due to the bruising there is an increase in bilirubin levels and some behavioral changes occur with Leah. Please describe what is different and what will you discuss with the family to ensure safety?
The bilirubin level requires phototherapy. What precautions must you take? What is essential to manage and treat the elevated bilirubin in addition to phototherapy?
Group A Response Phototherapy is discontinued at the hospital, but at home the parents are encouraged to provide some ‘routine’ therapy for Hyperbilirubinemia. What would you suggest? Do not forget routine discharge instructions for this parent.