Daniel Vogel was born at 0732 this morning to Anna and Lewis…

Daniel Vogel was born at 0732 this morning to Anna and Lewis. Anna had some meconium stainingwhen her water broke around 0430. Daniel was born via spontaneous vaginal delivery and was 8lb8oz (3856 gm). He was suctioned at the perineum and brought to the warmer for the assessment.He’s doing fine, although his respiratory rate is high, and we are monitoring his respiratory status.They are going to try some skin-to-skin and see how he does. Anna and Lewis are Jewish and haveasked their Rabbi to visit as soon as possible. EHR NURSING ASSESSMENT & NOTES 9/22 0750 NICU Nursing Note: Called to deliver a 39 5/7 weeks infant. Delivery complicated by meconium staining. Bulb suctioned at perineum by the delivery doctor and placed in warmer due to decreased muscle tone. Oral and nasal suctioning was performed with no meconium fluid noted. Breaths sound with fine crackles throughout; respiratory rate irregular. 9/22 0755 Nursing Note: Infant placed on mother’s chest after assessment. Tolerating skin-to-skin with stable temperature. The respiratory rate remains elevated; no respiratory distress noted; waiting to breastfeed at this time. VITAL SIGN TREND Date Temp HR RR BP SpO2 O2 9/22 0745 97.8 °F(36.6 °C) 132 61 irregular deferred deferred RA OTHER TRENDING DATA Apgar 0733 1min 0737 5min 0742 10min Breathing 1 1 1 Heart rate 2 2 2 Muscle tone 1 1 2 Reflex irritability 1 2 2 Color 1 1 1 Total 6 7 8 Before answering this question, review the client’s health information in the EHR. Identify if each action is supported or is contraindicated to care. Select one option in each row. Question Support Care Contraindicated to Care Place in the warmer [blanka] Respiratory assessment [blankb] Deep tracheal suctioning [blankc] Blow-by oxygen [blankd] SpO2 monitoring [blanke] Intubation [blankf]  

EHR Nursing 9/22 0800 Nursing Note:Respiratory Assessment:…

EHR Nursing 9/22 0800 Nursing Note:Respiratory Assessment: Rate 82 and irregular; Grunting, retractions, and nasal flaring noted. Fine crackles remain throughout lung fields. 9/22 0800 NICU Nursing Notes: Daniel began experiencing respiratory distress with worsening effort and tachypnea during skin-to-skin contact with his mother. He was transferred to NICU and placed on 4L O2  via nasal cannula and continuous SpO2 monitoring. IV started in the left foot, infusing well. In isolette on servo-control to maintain body temperature > 36 °C. Father at the bedside. Vital Signs 9/22 0800 97.9 °F(36.6 °C) 132 82 irregular 96/70 89% RA   Before answering this question, review the client’s health information in the EHR. Identify if the assessment change is an improvement or not an improvement in Daniel’s condition. Select one answer in each row. Question Absent breath sounds [blanka] Respiratory rate 80 breaths/minute [blankb] Reduction in grunting [blankc] Nasal flaring [blankd] The body held in a position of flexion [blanke] Sucking on pacifier [blankf] Agonal respirations [blankg] SpO2 90% [blankh]  

You know we are Jewish and follow our religious beliefs fait…

You know we are Jewish and follow our religious beliefs faithfully. You messed up my wife’s mealsand didn’t remember we keep Kosher; now you don’t respect us to know that his Bris is on his 8thday of life and performed by a mohel. This hospital is not what we expected. Many mistakes havebeen made, and we want to complain to an administrator! EHR Nursing 9/23 1100 NICU Nursing Notes: Daniel maintains SpO2 on room air, maintaining temperature with skin-to-skin and bundling. Mom attempted to breastfeed–latching on to the right breast and nursed 1-2 minutes before falling asleep. Nursed on the left side for less than a minute and became mildly tachypneic. Lactation consultant requested. Vital Signs 9/23 1100 98.0 °F(36.7 °C) 132 48 90/62 97% RA PROVIDER PRESCRIPTIONS & NOTES 9/23 0600 Prescriptions: Titrate oxygen to maintain SpO2 > 95% Discontinue servo-control when temperature stable, allow skin-to-skin and monitor temperature Replace infiltrated IV to a saline lock Allow to breastfeed or feed pumped milk via bottle Consult lactation specialist Consult surgery for circumcision before discharge Plan for discharge when tolerating feedings and maintaining SpO2   COLLABORATIVE CARE 9/23 1330 Lactation Consultant: 2 hours since last breastfeeding attempt. Demonstrated several holds for Anna and means to arouse Daniel without expending too much energy. Assisted with the latch on both breasts. Daniel nursed 5 minutes with a good latch and swallowed actively on the left side. Burped and given a 10-minute rest. Latched and nursed on the right side for 7 minutes. Active swallowing, mild tachypnea after nursing. Burped and placed on back in the crib. The family consented to continued lactation consultant visits while in hospital and home. Identify appropriate responses by the nurse. Select three (3) responses.