Read Written Case 4 before completing the Assessment. Enter your information below and click “Start” to begin the assessment.
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Nurse/Provider Sign-out
- 2-day-old term small for gestational age baby girl born to 19-year-old first-time mom using heroin until discovered pregnancy approximately 3 months ago.
- Tried to get into addiction treatment program at that time but placed on wait list for 1 month. Switched to street Subutex and experienced signs of withdrawal until found “right dose” of Subutex. Now in treatment program, on Subutex, with negative weekly urine screens for 8 weeks.
- Mom smokes ½ pack per day and takes no other medications. She is otherwise healthy. All prenatal labs performed at that time within normal limits (including infection serologies). Repeat HIV, Hep C, Hep B, and syphilis testing on admission – results pending.
- Delivery complicated by maternal hypotension, tight nuchal cord, and Apgars 21, 55, 910. cord pH 7.02, base deficit 12.
- No withdrawal symptoms appreciated to date. Vital signs stable. Feeding difficulties have been present due to latching difficulties related to ankyloglossia. Sleeping/consoling well thus far, including during last assessment 3 hours ago.
In-room Assessment
- Baby slept 2.5 hours since last assessment. Mom woke baby to try to feed her before she got too hungry. Took a while to get baby to wake up to feed.
- Baby sleepy, latching within a few tries but problems sustaining latch for more than 5 minutes; seemed to tire with feeding. Nurse helped feed baby by bottle, coaching parents on tips to help baby feed better. Over 45 minutes, baby able to take 15 mL with nurse providing frequent palatal stimulation and chin support to help baby maintain seal on bottle nipple.
- Parents present in room the whole time, providing calm room, limiting visitors, holding baby and responsive to teaching regarding all NPIs, including feeding tips.
- Baby not fussy and self-soothes easily.
- Tone slightly lower than expected for term gestation; no jitteriness present. Moro/startle reflex within normal limits for age. As nurse talking with parents regarding ways to optimize feeding, baby had a
few jerking movements of arms and legs.
Written Case 4
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