RLE3 subgroup B Sekito, Ria Eliza P. Silang, Kristine Mae C. Sinnung, Matthew Jayson R. Sofio, Katrina S.

Soriano, Bea B. Suanico, Aira Mae M. CASE 1 1. Considering the babys condition when he was discovered and the possible conditions surrounding his delivery, what are the dangers he faced in that kind of delivery set up as compared to what should have been an ideal delivery set up? Following the ideal way especially in the Philippine setting, Essential Newborn Care is the standard practice that is observed. This is comprised of 4 aspects which are: 1) immediate drying of the newborn 2) Uninterrupted skin to skin contact 3) properly timed clamping and cutting of the cord 4) non-separation of the newborn from the mother. However in this particular situation the set up was not ideal because the baby was discovered wrapped in a dirty piece of blanket with his umbilical cord still fresh and with some blood still covering his body. This can be dangerous for the newborn since he is predisposed in acquiring infection especially that his immune system is not yet that fully developed. The baby was also seen avidly sucking his fist which can be a sign of hunger that may signify that he was not breastfed adequately. 2. Give at least 2 assessment findings in Baby Tomasino would be considered abnormal? Why would you think this is an abnormality and give the possible causes of this abnormality. Skin is slightly yellow and so are his sclera This is an abnormality since it is a sign of hyperbilirubinemia which predisposes the newborn in acquiring complications such as encephalopathy. The possible causes of hyperbilirubinemia are prematurity, excess production of bilirubin, combined overproduction and underexcretion and genetic predisposition. Weight 5.1 lbs Height 19 cm The weight of Baby Tomasino is abnormal since the normal weight for a newborn is 6-9 lbs. The same goes with his height since the normal height for a newborn is 48-53 cm. These abnormalities may be caused by any alteration in the health and nutrition of the mother during her pregnancy such as smoking, alcohol intake and drug use. 3. Give the rationale for all the doctors order and give at least 2 nursing responsibilities for each order. Vitamin K 1mg IM Vitamin K is administered to prevent hemorrhagic disease of the newborn since the infants intestine is presumably sterile at birth. Their intestinal flora cannot synthesize Vitamin K thus leading to inadequacy. The function of the Vitamin K is to catalyse the synthesis of prothrombin in the liverwhich is essential for blood clotting.

The nursing responsibilities in administering Vitamin K aredo not massage site of injection and not to apply any topical agent to the site as well. AmikacinSulfate 20 mg IM This drug was used as a prophylactic treatment in this case to prevent infection caused by susceptible strains of microorganism wherein the newborn was exposed to. The nursing responsibilities for this drug is to watch out for hypersensitivity reactions like rashes and fever. Also, do not massage the injection site. Cord care with Betadinesolution Betadine Solution is an antiseptic that can promote the drying process of the cord. This can also be utilized to avoid infection of the cord stump. The nursing responsibilities in applying Betadine in the cord is to start from the bottom and vertically up to the end of the stump. Also, there should be a change of cotton tip applicator after every stroke. Tetracycline ointment to both eyes Tetracycline ointment is administered in the newborn as a prophylaxis for ophthalmianeonatorum and infectious conjunctivitis of the newbornwhich may lead to blindness. The nursing responsibilities in applying tetracycline is to start from the inner to outer cantus of the eye and to avoid the tip of the ointment container from touching the lower conjunctival sac. 4. Give at least 3 nursing diagnoses derived from this case with their related cause and suggest at least 2 nursing interventions for the diagnoses. Ineffective thermoregulation related to immature neurologic and metabolic temperature control The nursing interventions for this problem are the following: Place knitted or cloth cap on head to prevent heat loss from exposed scalp. Use environmental controls for decreasing body heat loss like increased ambient temperature to regulate body temperature within acceptable range and minimize heat loss Impaired skin integrity related to increased levels of bilirubin in the blood The responsibilities of the nurses are the following: assess skin color every 8 hours to monitor more possible alterations and to keep skin clean and hydrated. Risk for infection related to inadequate acquired immunity The nursing interventions for this problem are the following: Monitor the newborns visitors/ caregivers for any signs of illnesses to limit exposure, thus to reduce crosscontamination and stress proper hand hygiene by all caregivers between therapies/clients to serve as a first line of defense against further infection.

Case #2 1. Give at least 2 problems that you could derive from the case scenario related to Angelos growth and development. Low birth weight According to Wong, the average normal weight of a six month old child is 7.26 kg and the normal average weight gain for an infant is 0.7-0.8 kg/month. So if we are going to analyze Angelos weight (7kg), is low for his age. Angelos low weight can also be related to the delayed.

Trust vs Mistrust (Erikson) Since Angelo is an orphan, he might fall into Eriksons Trust vs mistrust stage. The crucial element for an infant to achieve trust is the quality of both the relationship between the parent/caregiver and child and the child receives. Considering the fact that there are 25 children in the orphanage, there is a big chance that there is a big delay in addressing his needs leading to mistrust. The child and the parent/caregiver must jointly learn to satisfactorily meet their needs for mutual regulation to occur. Failure to learn delayed gratification leads to mistrust. If the delay is prolonged, the infant will experience constant frustration and eventually mistrust others in their efforts to satisfy them.

Sensorimotor (Piaget) According to Piaget, there are crucial events that take place during this phase. First event involves separation; in which infant learn to separate themselves from other objects in the environment. In Angelos case, he was just noticed to be sitting quietly and would not even smile when spoken to. Considering Angelos case, he may be realized that his caregiver might control him and his environment thats why he was not recognizing the care given by the nurse. This leads to the development of mistrust.

Psychosexual (Oral Stage) Angelo, in his case, might have some difficulties developing Freuds psychosexual , particularly the oral stage. Angelo, recognize that he has a caregiver/nurse in the orphanage, however, he doesnt recognize the care given to meet his needs. And also according to Freud, nutritive feeding and sucking is one of the pleasurable behaviors of an infant and Angelo failed to meet these behaviors as a child since he was been abandoned by his mother.

2. What developmental milestones are expected from an 11-month old child which is evidently not yet done by Angelo? What could be the possible contributory factor to this delay? The developmental milestones expected from Angelo, being an 11 month old baby are: Doubles birth weight o Growth is rapid during the first year, especially during the initial 6 months, infants gain 1.5lbs per month until age 5 months when the birth weight has at least doubled. An average weight for a 6 month old child is 16lbs. Weight gain decreases by half amount during the second 6 months. By 1 year of age the infants weight has tripled to an average of 21.5 lbs. o Angelos most recent weight is noted to be 14lbs, he is already 11 month old so by this time his weight should be around 32lbs. o Angelo currently has low birth weight. Crawls then creeps, moves from prone to sitting, stands with support, cruises and almost ready to walk o An infant aged 11 months then becomes an eager explorer, he can get around quickly when he crawls or scoots. He can sit on his own now and grabs anything he can to pull himself up to standing and cruise. An average 11 month old might even take some solo steps before his first birthday. o During the first year, the infant is developing coordination and muscle strength in every part of the body. Learning to sit, rolls over, and crawl before moving on to pulling up and standing takes time until at about 9 months. From then on, it's a matter of gaining confidence and balance. Most infants take first steps sometime between 9 and 12 months and are walking well by the time they are 14 or 15 months old. o Crawls then creeps, moves from prone to sitting, stands with support, cruises and almost ready to walk o Angelo is noted to be just sitting quietly against his side of the crib. The fact that he is already 11 month old, he should already be exploring the environment, maybe even taking the first steps before he can walk on his own, and yet he is still confined in a crib. Responds when talked to o Infants start to learn what others are saying and doing even before they are born. As a newborn, they do not know the precise meaning of the words used, but they pick up on emotions such as happiness, sadness, love, concern, anxiety, and anger. By 7 months old, they will be able to respond to their own name, and by 8 to 12 months, can also understand simple directives such as "No" or "Don't touch.". o The infants should be able tobegin understanding simple requests. Say "no" when they try to touch an electrical outlet, for example, and they will pause and look at the caregiver and may mimic the reaction and shake his head or say no as well. Testing responses to their behaviour not to be naughty, but to better understand how the world works around them. They usually throw food on the

floor just to see what will happen and then file the caregivers response in their memory bank. Later they will again test the waters to see whether the caregiver react the same way. They are also beginning to associate gestures with certain actions and words, such as waving goodbye when someone leaves the room or shaking his head back and forth to refuse something to eat. In the case of Angelo, he would not even smile when spoken to, observed to be pale and quiet. If he is not quiet however he would be cranky, restless and irritable.

3. What could have been done to prevent those problems? Spend more time with Angelo, prioritize nursing care well, schedule activities that will help him interact well with you and the environment. Learn his ways, how he react, what he wants, what food and company, the certain way he likes being cuddled and all. Pay attention to him; shower him with lots of love and care. Keep talking to him: 11 months is a critical time for language development. Describe the routine, what youre both doing now and what you're going to do next, and what you see these can help him learn his emotions or maybe even start to feel the same way you are describing. Keep reading together and play peek a boo, hide-and-seek, and turn-taking games. As he gets more active, it's important to provide a safe space to explore. He may not be walking quite yet, but you can help him get ready by holding him in a way that puts weight on his legs or by propping him up against the sofa. Pay attention to what he enjoys, and give him the freedom to use all his senses to play and discover. Offer him crayons and paper, stacking blocks, empty food containers, and pots and pans to play with. Praise and reward good behaviour; if he gets into mischief, a brief "no" and redirection is usually enough. Although he's too young to understand and obey rules, you can start showing him which behaviors aren't allowed and helping him find more appropriate activities. Be respectful of his separation anxiety: Build trust by giving him time to get used to new caregivers and always saying goodbye before another one leave. You can encourage the baby to walk by standing or kneeling in front of the infant and holding out his hands or hold both the infants hands and let her walk toward you. The baby might take those early strides with arms out to the side (for balance) and bent at the elbows, feet turned outward, and belly out in front while the infants bottom sticks out behind (also for balance). As always, make sure the baby has a safe environment in which to practice new skills. 4. Considering Angelos situation, could we consider him as a case of an abandoned child? What made you say so? Will Angelo be eligible for possible adoption? Support your answer. -According to PD 603, any child an abandoned child is one who has no proper parental care or guardianship, or whose guardians have deserted him for a period of at least 6 continuous months. Angelo is considered an abandoned child since he was been left when he was 3 months