How to Answer Case Study Sammy Questions (Complete Guide)

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Original Question

Case Study #1 Sammy is a newborn boy at 32 hours of life. His birth weight was 8 pounds. He was born via normal spontaneous vaginal birth at 40 weeks of gestation to a 26-year-old G1. There were no maternal prenatal issues. Labor and delivery were complicated by a prolonged second stage of labor, which eventually progressed to spontaneous birth. The Apgar scores were 6 and 8, and the infant was taken to the nursery for an observation period; he received intravenous (IV) fluids but did well and so was discharged to the routine care in the mother’s room at 12 hours of life. Sammy was noted to have facial bruising and a cephalhematoma, which were attributed to the prolonged second stage of labor. All newborn blood work was normal. The group B streptococcal culture was negative. Maternal blood type is A+. Exclusive breastfeeding was initiated at 12 hours of life. On physical examination, Sammy has some jaundice evident on the chest and torso. 1) What risk factors does Sammy have for hyperbilirubinemia? Case Study #1 (continued) The pediatrician orders a bilirubin level, and the total serum bilirubin level is 7 mg/dL. A repeat level is ordered in 8 hours. 2) Does this result indicate a dangerous level of hyperbilirubinemia? Explain your answer. 3) What are the risks to the newborn with elevated bilirubin levels? Case Study #1 (continued) Sammy’s repeat total serum bilirubin was 5 mg/dL at 40 hours of life, and the pediatrician has given discharge orders for this evening when Sammy will be 48 hours old. 4) What education regarding jaundice is appropriate for Sammy’s parents at this time? Case Study #2 Charlotte is a 27-year-old G1P1 who just gave birth to a healthy girl at 39 weeks of gestation. The baby is now 20 minutes old and has transitioned well. Charlotte wants to breastfeed her infant because she has read about the benefits of breastfeeding. Her mother and sisters who are present have not breastfed and are not convinced of any benefit because their children were also healthy. The father of the baby is not involved. 5) what are the benefits of initiating breastfeeding during the postpartum period? 6) What can the nurse do now to help Charlotte succeed in breastfeeding? Case Study #2 (continued) Charlotte’s mother comments that she does not think the baby got enough breast milk from the first breastfeeding attempt. Charlotte agrees and feels that she does not have any milk yet. The baby latched on to both nipples well and effectively sucked for 15 minutes on each side. The infant now is crying, and Charlotte’s mother requests a bottle of formula. 7) How can the nurse address this situation? Case Study #2 (continued) It is now day 2 after birth, and Charlotte is complaining of sore nipples. 8) How should the nurse evaluate this complaint? 9) What nursing interventions can assist Charlotte with sore nipples? 10) What additional nursing interventions may be helpful for Charlotte before hospital discharge?

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