Large for gestational age. care plan assist

[racecar]

Hey, Just needing some pointers about priority nurse dx for the neonate presenting large for gestational age.

Here's some background data

Actual Problems: Large for gestational age, precipitous birth. Unknown significant mother/father genetic predispositions (and family medical history) puts child at risk for inadequate disease management and derisory health promotion.

Potential Problems: Hypoglycemia, polycythemia, hyperviscosity, potential problems resulting from precipitous birth include hypoxia, meconium aspiration and staining, low Apgar scores, and intracranial trauma. Difficulty being integrated into family (particularly by siblings).

Here's how the neonate's presenting data after assessment:

Objective Data (Neonate): No signs of hypoxia, hypoglycemia, polycythemia, hyperviscosity, meconium staining (or aspiration). Apargs of 8 and 9. No signs of intracranial trauma. Large for gestational age (neonate measures 3750g which falls above the 90th percentile. Newborn adequately tolerated multiple 2oz feedings throughout shift. *The neonate's blood sugar was not tested. No signs of cyanosis, GFR, or respiratory distress. Mother adapting to newborn appropriately.

with all this stuff, I'm not confident in which way to take this care plan (in terms of nursing dx). Any help formulating my thoughts is greatly appreciated.

thanks

[racecar]

I'm thinking a psychosocial nursing dx would be most appropriate (maybe readiness for enhanced organized infant behavior ?) just a thought

[Jolie, BSN]

How old is this infant?

Newly delivered? 12-24 hours? 1-2 days?

I'm curious as to why no blood sugars were checked on your shift? Have they been stable for the previous 12 -24 hours, in which case further checks may be unnecessary? Or was this an oversight?

An LGA infant is at significant risk for hypoglycemia and/or blood sugar instability, so checking sugars (even on an asymptommatic infant) is an important standard of care, at least for the first 12-24 hours of life until a regular feeding pattern is well established.

What were the baby's lab values? Hgb, Hct, blood type and coombs are important labs for an LGA baby.

Did the baby experience cephalhematoma, bruising or evidence of birth trauma? If so, keep in mind that bruising may increase the baby's likelihood of an elevated bilirubin level over the next few days as those red blood cells break down.

As for mom, what was the cause of LGA? Was there undiagnosed or poorly-controlled gestational diabetes? If so, what are the implications for mom's care now and in the future?

[racecar]

How old is this infant?

Newly delivered? 12-24 hours? 1-2 days?

I'm curious as to why no blood sugars were checked on your shift? Have they been stable for the previous 12 -24 hours, in which case further checks may be unnecessary? Or was this an oversight?

An LGA infant is at significant risk for hypoglycemia and/or blood sugar instability, so checking sugars (even on an asymptommatic infant) is an important standard of care, at least for the first 12-24 hours of life until a regular feeding pattern is well established.

What were the baby's lab values? Hgb, Hct, blood type and coombs are important labs for an LGA baby.

Did the baby experience cephalhematoma, bruising or evidence of birth trauma? If so, keep in mind that bruising may increase the baby's likelihood of an elevated bilirubin level over the next few days as those red blood cells break down.

As for mom, what was the cause of LGA? Was there undiagnosed or poorly-controlled gestational diabetes? If so, what are the implications for mom's care now and in the future?

Infant was greater than 36 hours old. stable; assessment findings were normal (other than LGA). Coombs was not indicated and baby's blood type matched the mother's. TCB was within low risk. Pertinent labs had not been ready for viewing. Mom did not have gestational diabetes, infant did not present with caput, cephalhematoma, bruising, broken clavicle, etc.

[Jolie, BSN]

TCB was within low risk. (I don't know what this means.)

What was the baby's weight, length and head circ?

I'm assuming that with no birth trauma following a precip delivery of a big baby, mom must have given birth at least once before, so she is probably experienced and comfortable with the baby's care.

A Hgb/Hct would be helpful, not sure why that's not available by 36 hours of age, but you may just have to do without.

I guess you essentially have a normal, healty newborn for whom to write a care plan.

Normal transition, teaching about sleep position, car seat safety, handwashing (especially heading into cold and flu season), anticipation of possible concerns such as jaundice (which can be expected to peak @ 4-5 days of age, bonding, siblings, future peds visits for vaccines, etc.

[racecar]

Transcutaneous bili results fell within low risk zone

wt. 3750g (~91 percentile), length 52.1 (~90 percentile), head circ 35.5 (~85 percentile)

gestational age 39 4/7wks

[racecar]

forgot to include: mom is a G5

thanks for your guidance!