CASE STUDY 4:

X 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 extra-uterine 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 a 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?
→ Assess and monitor HR, RR and color every 15-30 min for first hour
→ Apgar test within 5 min of delivery
→ Maintain temp and dry infant
→ Place on mother for skin to skin

2. The sleep phase and second reactive phase might occur in the SRMC or in the nursery.
Identify eight assessments or tasks that the nurse needs to do during the transitional care
period.
→ Observe ability to feed
→ Observe for chocking of mucus
→ Assess the glucose levels
→ Measure height, weight and head/chest circumference
→ Vitamin K should be given to prevent hemorrhage due to immature clotting process

3. You are preparing to give the injection of vitamin K (AquaMEPHYTON). The order is to
give 0.5mg 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.
→ .25ml

4. Once the transitional care and documentation are completed, the infant might be
transferred to the normal newborn nursery if the hospital does not use SRMC. What
ongoing care of newborn is this nurse responsible for?
 → Assessing vitals every 4 hours, maintenance of airway, maintain body temperature
and assessing mother on proper breastfeeding.
5. The laboratory also performs a Coombs' test on Baby H. What is the purpose of the
Coombs' test?
a. It is done to identify the infant's blood type.
b. It tests for damage to the red blood cells from maternal antibodies. (ANSWER)
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 (PKU) blood test can be done any time before an infant
is discharged to home. If false, explain your rationale.
→ False, because it should be completed within 24 - 28 hours.