Reference no: EM133260249
Case Study-Baby T.-Premature Birth
Case Scenario
Baby T. is a 32-gestational week, 3½-pound infant, the third child of Mrs. C., a 39-year-old college-educated mother, and her husband of 15 years. Two older siblings, a son, 12 years of age, and a daughter, 9 years of age, were both born at full term. Complications during pregnancy included the premature, preterm rupture of membranes (PPROM). The mother was placed on bed rest at 26 weeks' gestation. The baby was born by cesarean section after Mrs. C. spontaneously went into labor and the infant was found to be in the transverse position. Initial diagnoses for Baby T. include respiratory distress syndrome (RDS), patent ductus arteriosus (PDA), pulmonary hypertension, and possible sepsis.
Although the baby greatly improves over the next 48 hours, his mother appears as distressed as she did after first seeing him 3 hours after his birth. Although willing to pump her breasts, she expresses frustration at the small amounts of colostrum milk obtained. She is heard to say, "I never thought it would be like this." "I don't know what I'm going to do." "I feel so alone." These comments are made in the presence of her husband, who, despite his efforts to give comfort, seems unable to help. Although she visits the baby twice a day, she sits quietly by the isolette, rarely opening the portholes to touch the baby, despite gentle encouragement to do so.
At the bedside, Mrs. C. says, "I don't know how I'll ever be able to care for such a tiny baby." "I feel like I did something to cause this to happen." When the nurse suggests that she try "Kangaroo Mother Care (KMC)" now that the baby is stable, the mother responds, "I'm terrified at the thought of holding him. He looks like he'll break." At times, she feels angry at herself for possibly causing the premature birth. In addition, the frequent changeover of nurses who are caring for her infant son is also distressing to Mrs. C.
Nursing Assessment
Common to mothers of premature infants is a sense of shock, grief, helplessness, isolation, blame, and anger, particularly during the early postpartum period. Although an experienced mother of two, Mrs. C. is unsure how to put her familiar caregiving competencies to use in the high-tech and complex environment of the neonatal intensive care unit (NICU).
The immediate needs of Mrs. C. include reassurance that she will be able to build on her caregiving experiences as a successful mother, psychosocial support, support in her efforts to breast pump milk for the baby, and assistance with becoming comfortable touching and holding her infant, participating in his care, and becoming physically close. Monitoring Mrs. C. for signs of postpartum depression (PPD) is also important at this time.
The nurse is soon able to enlist Mr. C. to engage in "kangaroo care" with his son, an experience that he describes as "unforgettable." Shortly thereafter, the nurse is able to assure Mrs. C. that her feelings are normal. The nurse is also able to reassure Mrs. C. that by the time of the baby's discharge, she will be ready and able to care for him and that the ongoing support available in the hospital can continue. The nurse then suggests that, together, she and Mrs. C. have a list of skills that will be needed at discharge.
A. ASSESS
1. Identify significant symptoms by underlining them in the assessment.
2. List those symptoms that indicate the client has a health problem (those you have underlined).
3. Group the symptoms that are similar.