Family Study Jordan Wiedemann

Wiedemann 1Another Great Addition

Another Great Addition

On the afternoon of March 31, 2015 at 1317 hours, a family of three became a family of four with the birth of a beautiful girl (SK) at Freeman Hospital in Joplin, Missouri. SK was surrounded by her father (TK) and mother (JK), as her older sister (HK) was at home with her grandparents since she was too young to endure the long process of labor and delivery.

I. Family History A. Family Constellation

Member Date of Birth

Marital Status

Education Employment

General Appearance

Health Status

JK (Mother)

2/2/1987 Married College Degree

High School Teacher

Good Good

TK(Father)

1/17/1987 Married College Degree

High School Teacher

Good Good

HK(Sister)

2/4/2012 Single Pre-school N/A N/A Good

B. General Description of Family Upon observation, it seemed that SK was born into a very loving and caring family.

TK (father) and JK (mother) showed great affection towards one other. Throughout most of the labor and delivery process, JK’s husband was by her side giving her encouragement to push through. When SK gets to go home for the first time, she will live with her parents and her two year old sister HK.

The family stated that they were Christians who attended church every Sunday, or at least tried their hardest to do so. They both grew up in a small town, grew up in Christian homes, and religion was implemented early on in their lives.

I did not directly ask JK or her husband about their socioeconomic status, however I was able to gather enough information throughout the conversations I had with them, and the observations I took. I would say that with both of them being teachers, they are most likely in the middle-class socioeconomic class. Their clothes were clean, they groomed themselves well and kept up with their personal hygiene. JK stated that her plan when she went home was to take a couple of months of off work to look after her newborn, and oldest daughter. However she stated that her grandmother was more than willing to watch the kids whenever she decided to return back to work.

C. Home and NeighborhoodThe family will be going home to a three bedroom house located in Lamar, Missouri.

Lamar is a small rural town consisting of mostly middle class residents. Their house isn’t located in a neighborhood, instead it is located near downtown Lamar off of a main street. When I asked them about the sleeping arrangements, JK stated that her and her husband sleep together in one room, while the children will get their own rooms. They recently made the vacant third


bedroom into a nursery for SK for when she arrived home. I did not ask the family about plumbing, sanitation, heating, laundry, etc. From what I gathered through multiple observations is that the family is pretty neat and clean when it comes to personal belongings.

D. General Impression of Family RelationshipsAs I stated before, the family seemed to be very affectionate towards one another.

Although I wasn’t able to watch them interact with their oldest daughter due to her not being present, I was able to witness the parents communicating with one another. They were very supportive of each other. During the delivery process JK was relatively calm and didn’t lash out on her husband in times of stress, which made it a lot easier for him to encourage her. The family fully understood the importance of thorough and fluent communication with all of the healthcare providers. They were both very polite towards all doctors, nurses, and students. They were very thorough in personal health history, family health history, etc. This made it easier for the health care team to provide the necessary care for them. JK and her husband both stated they do not smoke, drink, nor do drugs. However, they both heavily rely on a strong cup of coffee to get them going in the morning. The only OTC medication that JK took while pregnant was a prenatal multivitamin, along with iron and folic acid supplements.

E. Growth and Development of Client and Family MembersThe growth and development stages vary throughout the members of the family. JK and

her husband were both in the “Generativity vs. Stagnation” phase of Erikson’s psychosocial developmental stages. Although they are both only 28 years old, they live in the same household, both have full time jobs, and have two young children to look after. Therefore, they are both trying to balance being parents, employees, and still having time to themselves to feel like they are living a life not only to support their family, but for personal enjoyment as well. Their two year old daughter, HK, is in Erikson’s “Autonomy vs. Shame” stage. JK stated that her oldest daughter is a “firecracker”, meaning that she is full of energy and attitude. She feels that she is starting to become her own person and is weaning away from being so attached to her mother and father. The newborn daughter, SK, is in Erikson’s first stage “Trust vs. Mistrust.” The time period between when the baby is born and when she gets to go home is extremely important. It gives the mother and father both time to form a bond with the baby, enabling the newborn to establish a ground of trust towards his/her parents knowing they will take care of them. The family is in the “Expanding” phase currently. New members are still being added to the family, and the parents main focus is home and on the family. This will eventually lead to the parents feeling “tied down” at times, contributing to the stage they are in of “Generativity vs. Stagnation.” It is also a very important time for the parents alone as well. During this time, the number of activities or date nights that a couple share drops drastically. In order to maintain a healthy marriage they will somehow have to find time to themselves here and there to maintain a healthy balance in life.

F. Health Care Practices of Client/Family The health of each family member is very good. JK had 11 prenatal visits, and had a

regular primary physician she would check in with throughout pregnancy. JK is not immune to varicella zoster, however she is Rubella immune. Her father had a CVA when he was in his mid-


fifties. Other than that there is no significant family health history. JK and the rest of her family are very thorough with annual check-ups with their family doctor to ensure they are in the best health possible.

G. Client/Family Attitudes toward Pregnancy While talking with the family briefly before the delivery began, they seemed very

anxious and excited for their new baby daughter to arrive. They stated that they weren’t near as nervous as they were with their first born. She stated that her first labor was near ten hours, and she was hoping that this one would go a lot faster and smoother. All in all though, they seemed very excited and happy to be able to add another girl to their family, even though the dad jokingly said he was waiting for her to have a boy.

II. Clients Health History The family’s health history is exceptionally good. There is no history of significant

health problems in any of the members other than JK’s fathers CVA. The only surgical procedure JK had done was an ACL repair on her right knee when she was 18 years old.

III. Present Pregnancy A. Prenatal CareJK had thirteen total prenatal doctor visits, all of which were on time. Her first visit was

in September of 2014. She went as scheduled, every four weeks for the first 28 weeks gestation. Then every 2 weeks until 36 weeks gestation, then once weekly until delivery. JK had no major complications during this pregnancy. She stated that her main complaint was a dull back pain, which made it hard for her to ambulate as much as she would have liked too. She said she tried her best to at least ambulate around the house as much as she could without exhausting herself or causing too much pain. She also said that she had a lot of nausea and vomiting. She stated that she tried her hardest to maintain a fluid intake of 2-3 L/day so it did not lead to hyperemesis gravidarum, therefore it caused no harm to the fetus.

JK presented to the doctor in September with right lower quadrant pain. She had stated she was starting to gain weight and had suspected she was pregnant. They performed an ultrasound and it showed that there was a gestational sac within her uterus that contained a single live fetus of approximately 7 weeks 6 days gestational age with no obvious fetal abnormalities. At that time, the FHR was 172. Our textbook states that a normal FHR range is 120-160, however it is considered normal for the FHR to be slightly high this early in gestation. The amniocentesis revealed that the amniotic fluid volume was within normal limits. This early in gestation, they were unsure of the placement of placenta develop. The fetal ultrasound also showed no risk for chromosomal defects, and no birth defects that would affect the brain or spinal cord. Everything appeared to be going smoothly and the fetus was doing great so far. The estimated date of confinement was 3/23/2015.

Her first prenatal visit was in September as well. She no longer complained of the pain in her right lower quadrant, and her last menstrual period was 6/6/2014. Medical history shows that she has no known drug allergies, tested AB+, Rb-, and GBS-. As stated before, she was non-immune to varicella zoster, and was immune to Rubella. I looked at her medical records to find


her vitals during her prenatal visit, and they were as follows: BP 130/84, HR 82, T 97.6, R 18, SpO2 98%. All of which were within the normal ranges. According to medical records, she was prescribed Colace for constipation, Dramamine for her nausea, and Tagamet to use for an Antacid. She was also prescribed a prenatal vitamin, and iron and folic acid supplements to help prevent any pregnancy complications or neural tube defects that would harm the fetus. Her pap smear showed no abnormalities, the physician requested a GC/Chlamydia probe to be taken, which came back negative. Prenatal labs were drawn and sent to the lab, the complete table of lab values of JK can be seen on page 13. Most of her labs were normal, however her platelet count was a little too low for comfort. The physician suspected maybe she had an enlarged spleen, however that came back negative. He then put her at risk for thrombocytopenia, and kept a close eye on her platelet count throughout her pregnancy. It never progressed into any diagnosis, as the platelet counts eventually rose. Her WBC count was also elevated throughout much of her pregnancy. The natural thing to think when you see an elevated WBC is some sort of infection, however her medical history shows no history of infection throughout her pregnancy.

In her second trimester, JK had another fetal ultrasound done to determine the placental position, and fetal position. The ultrasound revealed that the placenta was an anterior placenta, attached to the front side of the uterus, facing the mother’s belly. The fetal position was LOA, so the fetal back was on the mothers left side. The fetal face was between the right hip and the spine of the mother. The crown of the head was the presenting part, which made for a smooth and quick vaginal delivery when the time of engagement came. No abnormalities were seen during this time. I was not able to find the biometry measurements at this time, but according to our textbook, the normal values would be: BPD 4.8 cm, 21 weeks 2 days; HC 18.1 cm, 21 weeks 6 days; AC 17.6, 21 weeks 1 day; femur length 3.3 cm, 21 weeks 5 days. Her estimated date of confinement at this time was still the same. When comparing this ultrasound with the one prior, it showed normal fetal growth and development with no complications.

B. Nutritional StatusJK gained a total of 38 pounds throughout her pregnancy. This was slightly above the

normal range of 25-35 pounds by term. According to her prenatal visit charts, she gained 3 pounds within her first three weeks of pregnancy, and then gained roughly one pound per week until delivery at 38 weeks gestation. Her pattern of weight gain was not abnormal, as it is normal for women to gain 2-4 pounds within the first three months of their pregnancy, then 1 pound per week for the rest of pregnancy. Although JK gained a little more weight than normal, she did not look abnormally large. She looked healthy for a women at 38 weeks pregnant. I asked JK about her nutrition during her pregnancy, she stated that she did not really use the Food Pyramid to decide what and when she was going to eat. She did state though that she tried her best to eat what she was supposed to and what she knew was going to be good for both her and her baby nutritionally. JK ate a variety of foods to ensure she got all of the required nutrients. Including 8-11 servings of breads and grains, 2-4 servings of dairy products to ensure she was getting the RDA of 1000-13000 mg of Calcium. The dairy products also helped her consume iodine to help ensure adequate development of her baby’s brain and nervous system. JK also ate 3-4 servings of high protein sources, which were mainly meat and poultry for her. She stated that she did cut


back on her caffeine consumption drastically during her pregnancy. She did experience constipation so she liked to eat food high in fiber to help promote the natural peristalsis of the GI tract. JK is not a big fan of spinach, beans, or breakfast food so the doctor had to put her on an iron supplement to prevent any pregnancy complications related to iron deficiency. In relation, she did not enjoy eating legumes, dark green vegetables, or veal so she was also on a folic acid supplement to try and prevent any neural tube defects. She said that she tried to eat carrots and strawberries at least once or twice a day to get her Vitamin A and Vitamin C. JK and her family did not have any culture, economic, or religious factors that detoured them from the appropriate nutrition during pregnancy.

C. Preparation for ParenthoodJK and her husband did not attend any prenatal, breastfeeding, or sibling classes. They

felt that they had a pretty good grasp on what to expect since this was their second child. As I stated before, they changed their third vacant bedroom into a nursery for their newborn daughter so they were well prepared.

D. Minor/Major Maladaptation’sThe only minor worry that the parents had was their older daughter’s reaction to her new

baby sister. They were worried that the older sister would get jealous because of the attention that the newborn was soon to receive, and that the change could be difficult for her to accept.

IV. Labor and Delivery A. First Stage of LaborJK was admitted at 38 weeks 2 days gestation. She was dilated to 6 cm and 90% effaced

upon admission and had spontaneous rupture of membranes with clear fluid. JK seemed ready to deliver her baby girl. She was excited, and stated that she was not near as nervous as she was with her first born child. She was smiling and actively engaging in conversation with the health care team and her husband. She was great about taking the right precautions with pregnancy, and also very good about doing the extra things to make the labor and delivery process go as fast and smooth as possible, such as ambulating as frequently as she could to promote contractions and further dilatation. Below is a table of JK’s vitals that were taken when she was admitted (antepartum vitals), compared to the normal values of vitals for pregnant women at this stage of pregnancy, according to ATI:

Vitals Taken JK’s results Normal ValuesBlood Pressure* 112/89 mmHg <135/85 mmHgPulse 76 bpm 60-90 bpmRespirations* 18 rpm 10-20 rpmSpO2 100% 90-100%Temperature 98.2 F 97-99.6 F*Blood pressure and respirations may increase during this stage of pregnancy I was unable to find her lab data upon admission, however the table below will show the

labs that are normally taken when a labor patient is admitted and the normal results of each lab taken according BabyMed:


Test Desired ResultSerological tests NegativeBlood type JK is blood type AB+Rh JK was Rh-HGB 11.5-15 gm/dlHCT 32-36.5%Hepatitis B Surface Antigen NegativeGroup B streptococcus culture Negative

My initial contact with JK and her husband was during the active stage of labor in the labor room. I walked in and introduced myself and informed them that I was a nursing student who was going to be observing her labor and delivery process. She was great about the entire process and was excited for me to be able to see my first delivery. JK was induced for labor due to oligohydramnios. Medications that were used in the first stage of labor were; T4 PP Dermatome Epidural, Oxytocin 300 mL/hr, Dextrose 100 mL/hr. The anesthesia management report completed showed that JK had no health problems, does not currently smoke, use street drugs, drink alcohol, and has had no complicated pregnancies. The consent was signed. The epidural charting was as follows:

0703 Anesthesia in Room BP 114/86 HR 110 SpO2 100%0705 Sitting Position BP 132/90 HR 102 SpO2 98%

0708 Local BP 126/86 HR 112 SpO2 98% 0710 Epidural Catheter BP 131/84 HR 110 SpO2 96% 0712 #1 Test Done BP 128/86 HR 104 SpO2 96% 0716 Bolus BP 130/92 HR 94 SpO2 98% 0720 Epidural gtt started BP 126/84 HR 110 SpO2 99% 0730 Post Epidural BP 124/81 HR 90 SpO2 100%

During this stage of labor, JK had controlled breathing and seemed very relaxed and in control. Since JK was admitted at 6cm dilatation, she was already in the active phase of labor. She was having contractions every 3-4 minutes that lasted 40 seconds each with progressive dilatation. The FHT showed slight accelerations with good variability, with no decelerations present. At this time the FHR was 120, and the fetus was engaged +1. For JK, the first stage of labor lasted 7 hours and 4 minutes. The husband played a great role in the process by continuously keeping JK distracted and encouraged, which in return helped her control her breathing. As JK started to go from the active stage of labor to the transition phase, she started complaining of more back pain. The nurses treated this pain with counter pressure to her back which seemed to relieve some of the pain.

Below is a table that shows the normal values and characteristics, according to the textbook, of the latent, active, and transition phase of the first stage of labor:


Latent Phase Active Phase Transition Phase

Duration 4-8 hours 3-7 hours Minutes to hoursCervical Dilatation 0-3 cm 4-7 cm 8-10 cmContractions:

Frequency q 10-30 min at reg. intervals

q 2-5 min q 1.5-2 min

Duration 30-40 sec 40-60 sec 60-90 secIntensity Mild-moderate 25-40

mmHg by IUPCModerate-strong 50-70 mmHg by IUPC

Strong upon palpation 70-90 mmHg by IUPC

During the first stage of labor, there were a few important nursing actions and responsibilities that we did throughout the labor process. The first thing we had to do was establish a therapeutic relationship with JK and her husband to ensure the proper care for them. It was also important for us to monitor the FHR and JK’s vital signs throughout the entire process. Next we performed Leopold’s maneuvers to determine the fetal presenting part and position. We also watched for bladder distention and made sure to help JK to change positions frequently to either standing/walking, or sitting upright.

B. Second Stage of LaborAs stated above, JK was induced for oligohydramnios so she was a vaginal delivery. The

fetus was in the LOA position with a cephalic presentation. For JK, the second stage of delivery lasted only 13 minutes, much shorter than her first delivery. JK was fully dilated to 10 cm, fully effaced, and was engaged to a 3+, so she felt a great urge to push. At the beginning of the second stage of labor, JK’s contractions had calmed down a little bit giving her a little bit of time to relax and gather herself before the final descent of the fetus was initiated. Once her contractions started to intensify again, she was able to bear down and aid the contractions which alleviated some of the pain for her. The fetus descent was very rapid in this case. Soon the fetus began to crown, and the perineum began to bulge. With each contraction, more and more of the baby’s head became visible. At this point, the nurses encouraged JK to focus on her breathing and only bearing down with contractions to prevent a precipitous birth which could cause lacerations to either the birth canal or the perineum. Once the fetal head was fully visible, we saw that it had a nuchal cord x1, so the nurse quickly slipped it over its head to prevent any complications. The nurse then suctioned its mouth and nose. After this, the baby’s head turned to the side as her shoulders rotated inside of JK’s pelvis to get into position to exit the birth canal. Finally the anterior shoulder and posterior shoulder both exited the birth canal, followed by the rest of the baby’s body being expulsed. I did not get JK’s vitals immediately after delivery, but according to ATI the normal ranges would be; BP < 135-85, P 60-90, R 16-24, SpO2 95-100%, Temp 97-99.6 F. The “normal” value for the second stage of labor duration is considered to be prolonged in multiparous women if it exceeds 2 hours with regional anesthesia, or 1 hour without it. During the second stage of delivery, the nursing responsibilities included; encouraging JK to rest between contractions and to bear down with them, position patients legs in stirrups for lithotomy position, prepare the patients perineum with Bedatine scrubs and water with 4x4’s, monitor the


maternal BP and FHT every 5 minutes and with every contraction, watch for crowning, control the delivery of fetal head, control the delivery of the anterior/posterior shoulder and rest of body, and clamping and cutting the cord immediately after delivery to promote natural fetal blood flow.

C. Third Stage of LaborFor JK, the third stage of labor lasted only 5 minutes. The normal duration for the third

stage is anywhere from 10-30 minutes. JK had a spontaneous delivery of the placenta, and lost 350 mL of blood. According to our textbook, the normal blood loss during a vaginal delivery is between 300-500 mL. The doctor ordered the patient to be given 30 units Pitocin after delivery of the placenta to stimulate contractions to try and stop any excessive bleeding from the uterus postpartum. Immediate care of the newborn included:

- Establishing and maintaining airway by wiping mouth and nose, and suctioning any secretions from mouth and nose.

- Keeping newborn warm either with heater, skin to skin contact with mother, hat to prevent heat loss, and/or wrapped in blanket

- Get newborns weight and height - Give prophylactic eye treatment against gonorrhea conjunctivitis or opthalmia

neonatorium. We gave Erythromycin ophthalmic ointment for this. - Give 1 mg Vitamin K IM in the newborn’s vastus lateralis muscle- Clamp and cut the cord within 30 seconds of birth - Clean the cord and area around the cord with antiseptic solution - 1 and 5 minute Apgar scores

JK and her husband were extremely excited about their newborn daughter. The father took role in cutting the umbilical cord, and took many pictures of their new daughter. He was great about comforting JK and making sure she had everything she wanted at that time and was as comfortable as possible. JK started crying tears of joy when she laid eyes on their new baby girl, and was ecstatic when she got to hold her for the first time. Nursing care and responsibilities during this stage included helping with delivery of placenta, monitoring for postpartum hemorrhage risks, monitoring for any postpartum complications, being sure to aid in the mother-newborn bonding period, and getting JK to a certain level of comfort.

D. Fourth Stage of Labor I did not get JK’s vitals during the fourth stage of labor. I imagine everything would have

been about normal. Her pulse may have been a little lower than normal, but this would have been due to the blood from the uteroplacental circulation being returned to the maternal blood circulation. According to our textbook, the normal values would be: BP 120/80, P 50-90, R 16-24, SpO2- 95-100.7%, T- 97.6-99.5 F. JK’s uterus was midline, her fundus height was -1, she stated that she had firm cramping, a scant amount lochia rubra was present that was red in color, her perineum was intact, and had no bladder distention. All of these findings were considered to be normal. JK stated that her pain was at about a 3 on a numerical scale of 1-10 as she was still weaning off of the epidural. It was noted that JK could not move her right foot and had 1+


reflexes, primarily caused by the epidural. JK and her husband continued to interact with their newborn girl, taking pictures and taking turns holding her. JK decided while she was pregnant that she was going to breastfeed, so the nurses allowed her to try and breastfeed their new girl. The newborn quickly latched on to JK and started feeding.

V. Postpartum At this time, JK’s vitals were; BP 125/70, P 69, R 18, SpO2 100%, all of which fell within

the normal ranges. JK’s fundus was now at about -1, firm, midline and going to the left. It is expected for her fundus to continue to drop about 1 cm/day, and be back to her normal prepregnancy position by about 5-6 weeks. She continued to have rubra lochia dark red in color in a scant amount. JK had active bowel sounds, and a little bit of tympanic sound over her right upper quadrant indicating flatulence build up. She had no bladder distention. JK had no breast engorgement at this time, and was actively breastfeeding her new baby girl. JK did not complain of any headaches or postpartal chills. 3+ pitting edema was noted in JK’s legs, which was considered to be a normal finding in a postpartum patient. JK seemed to be doing great mentally. She was trying to catch sleep in between taking care of her newborn, but other than being a little restless she was very active and happy in her newborns care and needs. Her husband was still acting as a great support system for her during this time. I asked JK what that birthing experience was like compared to her first and she simply said, “a lot faster and a lot smoother.” She was glad it was all over, and was extremely happy that their new baby girl was completely healthy. At this time, JK was eating her “celebratory meal” that Freeman Hospital offered all postpartum patients. Her husband was sitting in the chair rocking SK back and forth to keep her calm. JK was currently on lanolin cream for breastfeeding, but other than that there were no other pertinent medications she was taking. I did not get her labs, but the normal values for all labs taken throughout the process can be found on page 13 of this report. Nurses continued to monitor JK and the baby for any sudden changes. We kept a close eye on blood pressure, and took vitals every four hours. JK had to watch multiple teaching videos on how to bathe a child, etc. in order for us to start considering discharging her. At this time, her vitals had to be stable, no bleeding complications, ambulating steadily, and voiding regularly without complication in order to be considered for discharge. In the meantime, the nurses goals prior to discharge included; prevent infection, prevent excessive bleeding, promote rest and comfort, promote ambulation, promote normal bladder and bowel function, and breastfeeding promotion.

VI. Neonate SK was born at 38 weeks 2 days gestation, and was AGA at 7 pounds 3 ounces birth

weight. SK was being breastfed and was feeding well, leading to healthy weight gain. After birth, SK’s APGAR scores were taken at 1 and 5 minutes of life. The results are shown below:

1 minute APGAR Score: 8

APGAR Sign 2 1 0Heart Rate XBreathing XGrimace X


Activity XAppearance X5 minute APGAR Score: 9

APGAR Sign 2 1 0Heart Rate XBreathing XGrimace XActivity XAppearance X

The baby’s vital signs were recorded as:

Time Temp Pulse Resp. Pulse Ox1700 97.9 -- -- --

1720 98.0 164 36 --1740 97.6 -- -- --

1750 97.5 142 44-- 1800 98.2 -- --

-- 2335 98.0 14041 100

I could not find the newborns lab results. Page 14 offers a look at normal neonatal lab values, according to BabyMed. I was in the nursery while they performed the neonatal assessment. The following are the findings of the assessment:

- Heado Hair- evenly distributed (Normal) o Circumference- 33 cm (Normal 32-35 cm) o Sutures- molding (Normal) o Fontanels- anterior diamond shaped/open, and posterior triangle shaped/open

(Normal- anterior closes 12-18 hours, posterior closes 2-3 hours) o Shape- symmetrical (Normal) o Mouth- round, symmetrical, hard palate intact (Normal)o Face- symmetrical, milia present (Normal) o Palate- tonsils not visible, sucking, rooting reflexes present (Normal) o Eyes- symmetrical, white sclera, bluish color to eyes, corneal reflex present,

blink reflex present (Normal)o Ears- symmetrical, reactive to sounds (Normal) o Nose- midline, symmetrical, both nares patent, no nasal flaring present

(Normal) - Chest

o Circumference- 13” (Normal 13”-14”)o Clavicles- symmetrical, no crepitus present, no fracture (Normal)


o Breast Tissue- Witch’s milk present (Normal) - Integumentary

o Color- bright red, acrocyanosis present (Normal) o Birthmarks- none (Normal) o Vernix caseosa present in creases (Normal) o Lanugo present on shoulders (Normal)

- Abdomeno Bowel sounds- 2/min (Normal)o Size- rounded with prominent veins (Normal) o Umbilical Cord 2 arteries 1 vein (Normal)

- Genitaliao Smegma present (Normal) o Labia minor/majora, clitoris present/intact/no lacerations (Normal) o Pseudo-menstruation present (Normal)

- Extremitieso 10 fingers, 10 toes (Normal) o No polydactyly or syndactyly present (Normal) o Crease on anterior 2/3 of foot (Normal) o Symmetrical muscle tone throughout (Normal) o Negative Ortolanis (Normal)

- Back/Spineo Spinal column intact, no dimples, no masses (Normal) o Trunk incurvation reflex present (Normal)

- Reflexeso Rooting/sucking- present (Normal) o Moro’s- present (Normal) o Grasp- present (Normal) o Tonic Neck- present (Normal) o Babinskis-present (Normal) o Scarf Sign- negative (Normal)

The family continued to interact appropriately with their newborn, showing love and affection and caring to the baby girls needs when she cued to do so.

VII. Health TeachingBefore discharging JK and her husband home with their newborn, it was important to

teach them about a couple of things. We figured since she was breastfeeding, that we should inform her of a couple of things regarding breastfeeding, such as; air dry nipples after each feeding, if breasts are engorged, apply warm packs and express milk. We also informed JK to watch for uterine changes, and that after pains and cramping were considered normal and would resolve within 5-6 weeks. Vaginal discharge would last anywhere from 1-4 weeks. We informed her for pain relief, to use mild analgesics such as Tylenol or Advil for breast


engorgement, and uterine cramping. She should continue taking her prenatal vitamin and iron pills until her next postpartum visit. We warned JK that she should not participate in any heavy housework or heavy exercise for two weeks, and to avoid sexual intercourse for about 3-4 weeks. The last thing we informed JK to do was to call her OB 2-3 days after being discharged to schedule her 6 week appointment. There were no indications for referrals to other services for JK or her husband.

VIII. Follow UpI was unable to follow up with JK and her family, due to our clinical day being over.

However I am sure that she and the rest of the family are doing great!

IX. Family AdaptationBased on my personal encounters with this family, I feel that they are adapting to the new

addition just fine at home. They mentioned their worry about their two year old daughter adapting to the new change of not getting all of the attention, however I feel that they knew enough and were aware enough of the situation to avoid any major complications arising from it. JK’s mom is helping out with the care of the SK, allowing JK to return to work when she feels ready to do so. TK continues to teach every day, and comes home and helps out with the kids at night. Overall, the family is adapting well and making everything work in a great manner.

X. What Did I Gain From This Experience? This was a great experience for me. First, it was my first ever labor experience, and it

was awesome to get to see the whole process unfold right in front of my eyes. It definitely gives me a new respect for pregnant women and childbearing families, now that I know all the hard work, planning, teamwork, and dedication it takes to have a healthy pregnancy and maintain a healthy relationship. I found it very cool to get to assess a newborn hands on, and be able to feel the actual fontanels and overriding sutures. The strangest thing to see of the whole thing was probably the spontaneous delivery of the placenta, as I really never heard what that was like until I saw it in person. I enjoyed getting to connect with this family and it was very cool to be a part of such a cool experience, knowing that whenever they talk about the birth of SK, that I will forever be a part of their special story.


MATERNAL LAB NORMAL VALUES

LABLOW HIGH

WBC 4.3 11 10^3/uL

RBC 3.79 5.25 10^6/uL

HgB 11.5 16 G/dL

HCT DET 35 52%

MCV 77 95 FL

MCH 25 34 PG

MCHC 32 36 G/DL

PLT 130 400 10^3/uL

MPV 7.4 10.4 FL

NEUT % 42 75%

LYMPH % 12 44%

MONO % 0 12%

EOS % 0 10%

BASO % 0 10%

RDW 10 14.40%

NEUT# 1.8 7.8 x 10^3

LYMPH# 1 4 x 10^3

MONO# 0 1 x 10^3/uL

EOS# 0 0.3 10^3/uL

BASO# 0 0.1 10^3/uL


RDW-SD 38.4 53.1

GLUC 1 HR 70 135

HEP AG BS NR NR

NORMAL LAB VALUES FOR NEONATE

LABLOW HIGH

RBC 4.2 5.5 X 10^6/uL

HCT 37.4 55.9%

HgB 14.7 18.6 g/dL

Platelet Count 234 346

WBC 8.0 14.3

Alkaline Phosphatase 95 368 IU/L

Sodium 0.3 3.5 mmol/24 h

Calcium 4.0 5.0 mEq/L

Chloride 96 111 mmol/L

Potassium 3.7 5.2 mmol/L

Magnesium 1.7 2.4 mg/dL

Iron 20 157 ug/dL

Ammonia 0 50 mmol/L

Glucose 30 100 mg/dL

Albumin Range 2.6 3.6 g/dL

Albumin 2 1 100 mg/L

C-reactive protein 10 350 g/L

Creatinine Kinase 40 474 IU/L

Creatine 18 58 mg/L

IgG 221 1031 mg/dL

IgA 1 19 mg/dL


IgM 12 117 mg/dL

PTT 42 54 seconds

PT 11 15 seconds

T3 15 210 ng/dL

Works Cited

Rudd, K., and Kocisko, D., (2014) Pediatric Nursing. F.A. Davis, Philadelphia.

Nursing Care of Children, RN Edition 9.0. (2013). Assessment Technologies Institute, LLC.

BabyMed. (2015, February). Normal Laboratory Values and Results During Pregnancy. Retrieved from US

EPA website http://www.babymed.com/info/normal-laboratory-values-and-results-during-

pregnancy

http://www.babymed.com/info/normal-laboratory-values-and-results-during-

Documents

Family Study Jordan Wiedemann