Skip to main content

Written Case 2

ACT NOW ESC During Training (ESC Care Tool) Written Case 2

Read Written Case 2 before completing the Assessment. Enter your information below and click “Start” to begin the assessment. 

*Note: If you did not enter credentials to log in to this training, you must complete all fields below to receive full credit. For assistance, contact Catrice Banks-Johnson.

*Click the link below the case to download the document.

Nurse/Provider Sign-out

  1.  3-day-old baby girl with in-utero methadone exposure.
  2. Mom stable in recovery for 7 months, re-starting treatment after discovering pregnancy. Had previously been on methadone with her first pregnancy, after not being successful on buprenorphine due to increased anxiety symptoms (sx). Lost custody of her toddler due to relapse while parenting with safety concerns for child.
  3. History (hx) of depression, anxiety, and PTSD – started Prozac mid-pregnancy and tolerating well.
  4. Smokes cigarettes. Had prenatal education provided 2-weeks ago about increased risk for small for gestational age, sudden infant death syndrome, and withdrawal symptoms (including greater chance of being started on medicine for NOWS/NAS). Able to cut back from 1 pack per day to ½ pack per day (still smoking for anxiety).
  5. Newborn Nursery still using Finnegan NAS Scoring Tool as they transition to the ESC Care Tool. Baby with max Finnegan score of 10 at 24 hrs, then scored lower on day of life 2. Sx increasing in past day with last 4 scores = 7, 8, 8, 12. Baby scoring at times for increased tone, tremors when disturbed (occasionally when non-disturbed), hyperactive Moro, decreased sleep < 3 hrs after feeding, sneezing, and yawning. V/S have been stable. Stools loose but not watery.
  6. Either mom or dad here caring for baby in their room all the time, keeping room calm, never sending baby out to Nursery, taking turns napping so they are not sleepy when holding baby.

In-room Assessment

  1. Since last feeding 4-hrs ago, baby slept well for 3 hrs while held swaddled by dad. Mom able to
    sleep during this time.
  2. Baby awoke, became quickly agitated with difficulty calming and getting latched on to the breast
    due to excessive rooting and increased startle causing baby to push breast out of mouth with each
    startle.
  3. After 15 minutes of gentle jiggling up and down, mom expressing colostrum and providing to infant
    with finger feeding, baby finally able to calm down enough to latch on to the breast. Baby then
    able to feed well for 15 minutes.
  4. Infant provider came in to see baby, saw mom breastfeeding (bf), and said he would return later
    to evaluate baby.
  5. Nurse now in room performing ESC assessment and v/s approximately
    4.5 hrs after last assessment, was delayed due to tasks with 2 mother-baby discharges.

Written Case 2 Rating Sheet

Written Case 2

You must fill out this field.
You must fill out this field.
You must fill out this field.
You must fill out this field.