[cubeo]

Mom’s labor was induced due to gestational diabetes mellitus, diet controlled. A healthy baby was delivered vaginally without complications, Apgar score 9,9.

4234 grams, 9 pounds 5 ounces

24 Hours of Life
The nurse assesses the newborn and finds a cephalhematoma to the left occipital region. Current weight is 4185 grams, 9 pounds 4 ounces.

Dextrostik result is 52. T 37 (98.6) P 140 R 40.
Breast feeding; LATCH of L=1, A=0, T=2, C=2, H=1. (Total 6)
Baby has had 1 void and 1 stool.

Day 2,
Dextrostik result is 60, jaundice noted to nipple line, total bilirubin is 12.
T 98.2 (36.8), 150, RR 50.

Day 2, Weight and Feeding
Current weight is 3984 grams (8#12.5oz) LATCH score is 9, 1 off for audible sucking. There have been 2 wet diapers and 1 stool in the last 24 hours.
Question @ Day 2 of Life
The mother says the baby is being good, the baby sleeps most of the time. The mother asks the nurse, “Is it okay for the baby to be discharged this morning? I am eager to go home.”

Here are my nsg diagnosis:
#1 Risk for newborn injury (neurological), related to elevated serum bilirubin levels secondary to hemolysis of RBCs occurs in cephalohematoma as manifested by bilirubin level of 12 mg/dl.

#2 Risk for newborn injury related to hypoglycemia secondary to trauma from vaginal delivery from large for gestational age infant.

#3 and i need one more.

My plan is to discharge mom, and reschedule her for a follow-up care.

please check to see if im doing correctly. thanks for the help.

[cursenurse]

Originally Posted by cubeo

Mom’s labor was induced due to gestational diabetes mellitus, diet controlled. A healthy baby was delivered vaginally without complications, Apgar score 9,9.

4234 grams, 9 pounds 5 ounces

24 Hours of Life
The nurse assesses the newborn and finds a cephalhematoma to the left occipital region. Current weight is 4185 grams, 9 pounds 4 ounces.

Dextrostik result is 52. T 37 (98.6) P 140 R 40.
Breast feeding; LATCH of L=1, A=0, T=2, C=2, H=1. (Total 6)
Baby has had 1 void and 1 stool.

Day 2,
Dextrostik result is 60, jaundice noted to nipple line, total bilirubin is 12.
T 98.2 (36.8), 150, RR 50.

Day 2, Weight and Feeding
Current weight is 3984 grams (8#12.5oz) LATCH score is 9, 1 off for audible sucking. There have been 2 wet diapers and 1 stool in the last 24 hours.
Question @ Day 2 of Life
The mother says the baby is being good, the baby sleeps most of the time. The mother asks the nurse, “Is it okay for the baby to be discharged this morning? I am eager to go home.”

Here are my nsg diagnosis:
#1 Risk for newborn injury (neurological), related to elevated serum bilirubin levels secondary to hemolysis of RBCs occurs in cephalohematoma as manifested by bilirubin level of 12 mg/dl.

#2 Risk for newborn injury related to hypoglycemia secondary to trauma from vaginal delivery from large for gestational age infant.

#3 and i need one more.

My plan is to discharge mom, and reschedule her for a follow-up care.

please check to see if im doing correctly. thanks for the help.

Okay, now i am not an L&D nurse(I'm ER) and i am not a mom- but only 2 wet diapers in a 24 hour period seems odd. I know that if i had an adult who had only voided twice in a 24 hour period that would be very much a reason for concern. So you would know better than I, should a newborn baby be voiding more than twice per day? If so, your 3rd dx should focus on that.

[core0]

Originally Posted by cubeo

Mom’s labor was induced due to gestational diabetes mellitus, diet controlled. A healthy baby was delivered vaginally without complications, Apgar score 9,9.

4234 grams, 9 pounds 5 ounces

24 Hours of Life
The nurse assesses the newborn and finds a cephalhematoma to the left occipital region. Current weight is 4185 grams, 9 pounds 4 ounces.

Dextrostik result is 52. T 37 (98.6) P 140 R 40.
Breast feeding; LATCH of L=1, A=0, T=2, C=2, H=1. (Total 6)
Baby has had 1 void and 1 stool.

Day 2,
Dextrostik result is 60, jaundice noted to nipple line, total bilirubin is 12.
T 98.2 (36.8), 150, RR 50.

Day 2, Weight and Feeding
Current weight is 3984 grams (8#12.5oz) LATCH score is 9, 1 off for audible sucking. There have been 2 wet diapers and 1 stool in the last 24 hours.
Question @ Day 2 of Life
The mother says the baby is being good, the baby sleeps most of the time. The mother asks the nurse, “Is it okay for the baby to be discharged this morning? I am eager to go home.”

Here are my nsg diagnosis:
#1 Risk for newborn injury (neurological), related to elevated serum bilirubin levels secondary to hemolysis of RBCs occurs in cephalohematoma as manifested by bilirubin level of 12 mg/dl.

#2 Risk for newborn injury related to hypoglycemia secondary to trauma from vaginal delivery from large for gestational age infant.

#3 and i need one more.

My plan is to discharge mom, and reschedule her for a follow-up care.

please check to see if im doing correctly. thanks for the help.

you could do:
Risk for altered parent/child interaction secondary to jaundice and cephalohematoma.

Knowledge deficit related to neonatal jaundice as evidenced by ....

You could also split number one into two different diagnoses. The cephalohematoma really doesn't have anything to do with the jaundice.

Of course with any infant there is always: risk for altered body temperature.

David Carpenter, PA-C

[OzMW]

Originally Posted by cursenurse

Okay, now i am not an L&D nurse(I'm ER) and i am not a mom- but only 2 wet diapers in a 24 hour period seems odd. I know that if i had an adult who had only voided twice in a 24 hour period that would be very much a reason for concern. So you would know better than I, should a newborn baby be voiding more than twice per day? If so, your 3rd dx should focus on that.

This is normal output for a newborn.

[cursenurse]

Originally Posted by OzMW

This is normal output for a newborn.

Really, Wow. Well you learn something new every day.

[LizzyL&DRN]

Originally Posted by core0

You could also split number one into two different diagnoses. The cephalohematoma really doesn't have anything to do with the jaundice.

Of course with any infant there is always: risk for altered body temperature.

David Carpenter, PA-C

The cephalohematoma absolutely does have something to do with the jaundice. Bilirubin is a produced by the breakdown of hemoglobin. As the baby's body breaks down the hematoma, excess bilirubin in the blood is a risk if the baby is not eating well to excrete the bilirubin in the stool . Any infant with a birth injury (i.e. brusing, cephalohematoma, etc) is at risk for jaundice.

[shortstuff31117]

yep, one wet diaper per day of life...well until the milk comes in or is it day

[QTBabyNurse]

Well...there are a couple of things that concern me in this post and replies....first of all you mentioned the baby had 2 wet and 1 soiled diaper in 24 hours...usually 6-8 wet/soiled diapers in 24 hours is more normal. Secondly, another poster stated that the cephalohematoma really had nothing to do with the jaundice...I'd like to respectfully disagree with that comment...it most certainly CAN have something to do with the jaundice. I would add a knowledge deficit diagnosis for the parents r/t hyperbilirubinemia and/or a diagnosis r/t sufficient intake of fluids to help lower the bilirubin. The blood sugars you got were normal. If you are discharging the newborn that day, make sure that baby has another bili done in the morning after discharge because the initial result of 12 that you got in the first 24 hours was rather high. I'd ask the pediatrician to order another one prior to writing a discharge order for that infant.

[cubeo]

Thank you all for the information, so the baby can be discharge right? and i will schedule the baby to come back within 4 days to evaluate the bilirubin level since it can increase from hemolysis of RBCs which place newborn at risk for kernicterus; i would teach mom how to access for jaundice.

any suggestion? Thank you

[cubeo]

Originally Posted by QTBabyNurse

Well...there are a couple of things that concern me in this post and replies....first of all you mentioned the baby had 2 wet and 1 soiled diaper in 24 hours...usually 6-8 wet/soiled diapers in 24 hours is more normal. Secondly, another poster stated that the cephalohematoma really had nothing to do with the jaundice...I'd like to respectfully disagree with that comment...it most certainly CAN have something to do with the jaundice. I would add a knowledge deficit diagnosis for the parents r/t hyperbilirubinemia and/or a diagnosis r/t sufficient intake of fluids to help lower the bilirubin. The blood sugars you got were normal. If you are discharging the newborn that day, make sure that baby has another bili done in the morning after discharge because the initial result of 12 that you got in the first 24 hours was rather high. I'd ask the pediatrician to order another one prior to writing a discharge order for that infant.

Thank you all for the information, so the baby can be discharge right? the rationales you gave me are very nice. i will schedule the baby to come back within 4 days to evaluate the bilirubin level since it can increase from hemolysis of RBCs which place newborn at risk for kernicterus; i would teach mom how to access for jaundice.

p.s what do you think about this nsg diagnosis:
Deficient knowledge related to neonatal jaundice and cephalhematoma as evidence by lack of concern from mother.

RN students
Thanks