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Written Case 7

ACT NOW ESC During Training (ESC Care Tool) Written Case 7

Read Written Case 7 before completing the Assessment. Enter your information below and click “Start” to begin the assessment. 

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

Nurse/Provider Sign-out

  1. 3-day old girl born at 40 weeks by vaginal delivery after a long induction to 23-year-old G1 mom on buprenorphine for 1 year and doing well. No other medications/exposures.
  2. Lots of family and friends visited on first day, but mom on her own since. Keeping TV on for company when her husband is not here (he’s working 2 jobs to help pay bills).
  3. In past day: baby fed 10 times, 2 voids, 4 stools (last stool loose and brown), Weight down 6%, 24 hrs. transcutaneous bilirubin (TcB) = 5.8.
  4. Last assessment was 3 hrs. ago. Baby received all Nos for Eating, Sleeping, and Consoling and 2 for Consoling Support Needed.
  5. After the assessment, mom went out for a walk and baby was in the nursery for 1.5 hrs. Baby was jittery with increased Moro on exam and kept waking up (every 30-40 min) due to increased startle and tremors when other babies were crying during their newborn testing. Cuddler held baby and had baby suck on cuddler’s gloved finger because baby was rooting around and showing excessive suck. Cuddler did not have any of mom’s milk to feed baby with. Baby had loose green stool and no void.

In-room Assessment

  1.  Mom now back with baby in their room. Baby was very fussy with tremors when changing her diaper. Mom put baby skin-to-skin and tried latching baby to breast.
  2. Baby would latch but then would unlatch quickly when mom tried to widen the latch due to pain. When doing so, Mom would touch baby’s cheek by mistake and baby would excessively root to baby’s fingers. Baby’s suck also seemed less coordinated this time, with a “chomping” down feeling on mom’s nipple.
  3. RN came in to assist and helped mom express colostrum while baby sucked on mom’s finger. Finally, after 15 minutes of skin-to-skin time and sucking on mom’s finger with drops of colostrum, baby was able to coordinate the latch and breastfeed for 10 minutes. RN left to perform scheduled vitals on another baby.
  4. Mom then loosely swaddled baby and placed her in bassinet. Baby fell asleep quickly but then woke again in 10 minutes due to increased startle and tremors when secretary came in to complete the birth certificate. Baby very fussy when she awoke and did not console with holding, shooshing, and pacifier. After 20 minutes of fussing while held skin-to-skin and sucking on mom’s finger, baby finally fell asleep in mom’s arms about 10 minutes ago. Baby startled when RN came back to do the ESC assessment.

Written Case 7 Rating Sheet

Written Case 7

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