Mother Baby Week 3

The last Mother Baby clinical!
The last clinical of Junior year!

This week, my patient was a new admission, straight from Labor and Delivery. She was rolled over to our floor with Dad strolling along behind her, pushing their little bundle of new baby joy in the crib. And boy did they look tired.

They had been laboring (I should say she had been laboring) for over 24 hours. With an admission, you simply slide mom over from one bed to another and get report from the L&D nurse. Yay! You're admitted! Welcome to Mother Baby! Estimated time of discharge: 3 days. My name's April, I'll be working with your nurse today and I'll be taking care of you!

Everything went on as normal from there; vital signs, mommy assessment, pain rating, check the belly. Quick Chart every 2 hours. I set dad up with some fresh sheets for his bed and explained that I would be doing an assessment on baby. Again, like all new parents, they looked at me like, "You have to take the baby away?". I had to perform a Dubowitz as part of my assessment, but I decided to postpone that until the afternoon; so I took baby's vitals and checked his fontanels, skin, belly, muscle tone, heart, lung and belly sounds, etc. where mom and dad could watch.

Another question you ask frequently on the floor is when and for how long the baby fed/how the baby did feeding. This baby was a champ. I had a hard time keeping up with my charting of the "Intake and Output"! And all that milk has to come out the other end. Poor dad got a lot of practice doing each sticky diaper change (you remember how the first few stools are meconium? The sticky green/black stuff?). It was fun to watch a first-time dad with a diaper. His exact words were, "They said we could expect maybe one bowel movement today." - that was with the 4th or 5th diaper change of the morning/afternoon. I got a couple, too, while doing assessments. The baby also wet the bed a couple times, soaking through most of the things in the crib, and I was able to encourage dad and cheer him on as he learned to change the baby's clothes (which really is a lot of fun to be able to do).

When the afternoon rolled around, the mom and dad had some visitors. Handling babies can stress them out, changing their heart rate and making them really tired. I debated whether or not to take the baby out of the room to do the assessment real quick before having baby get passed around to the first-time grandparents... so my nurse and I decided it may be best to get the assessment over with (so it would be accurate), then give the family time with the baby without needing to disturb them farther. As I walked into the room, mom was handing the baby over to grandma, and I had to take the baby away. I felt so bad! But they were very understanding.

I rolled the baby to the nursery and did a second assessment and the Dubowitz. The Dubowitz scale measures the baby's neurological and physiological development compared with his/her gestational age. A premature baby would have a lower score than a term baby. The assessment takes a while for a first-timer like me, and every so often I'd see dad waltz by the nursery window and smile.

**EXCITMENT!** I was able to autonomously practice something I learned while on the floor - while listening to the baby's lungs, I could hear gas bubbles stirrin' up. I also saw that the baby was trying to swallow the gas bubbles (and baby sure had been eating, but I hadn't seen any burping). So, I scooped the baby up into a sitting position in the crib, put one hand on the chest and cheeks while my elbow was resting in the crib, and gave some productive pats on the back and rubs on the head (which helps the baby to relax so they can get the bubbles out). I've burped babies before, but it just felt so... "nursey" :) haha.
Dad walked by while I was doing it, and when I later took the baby back into the room (I felt terible at how long I deprived those grandmothers the pleasure of holding their first grandchild) I mentioned that the baby was a little gassy and may need to be burped more. I was able to teach them how to recognize when signs of needing to be burped and the best way to do it.

Then the baby had another meconium stool.