• Are there any stressors in the family that could potentially affect this patient, and why?

Stressors in this scenario that can affect this patient are the mother is in nursing school which is a stressful situation. The father of the patient is leaving the home to work offshore and will be gone for 2-3 weeks at a time. These stressors could contribute to the mother experiencing postpartum depression. Risk factors for postpartum depression in this case are interpersonal factors such as lack of social support in the presence of a stressful life event such as nursing school (Cardoso & Fonseca, 2022).

  • What questions would you ask to gain more information?
  1. Does the mother have family and friends to help when the father is off working?
  2. How does the mother feel about the father working offshore for long periods?
  3. How does she plan to balance having a newborn and nursing school?
  4. Is the mother experiencing any detachment from the patient?
  • Are there any social determinates of health that could affect this patient, and why?

When looking at the social determinants of health there are environmental, material, and social conditions that could affect this patient. The patient could be affected if the parents are having economic instability due to the mother not working. With the father working offshore, there can be limited healthcare access if the mother does not have transportation.

  • What questions would you ask to gain more information?
  1. Do you have transportation to get yourself and your baby to the doctor?
  2. Do you have the financial means to provide essentials for the patient such as formula?
  3. Is the mother a full-time student and does she have family help/support to allow her to study or attend classes?
  4. How is the mental state of both parents? Can they benefit from therapy?
  • What are the expected physical, developmental, nutritional and sleep norms for this patient?

During this visit, it will be important to establish a baseline of weight, length, and head circumference. It is common for the skin to be dry and cracked. The anterior fontanels are expected to be 2-3 cm in diameter and the posterior fontanels are expected to be 1 cm in diameter. The face should be symmetric. It is common for eye movements to be uncoordinated during the first few weeks. Establishing the ear’s external canals are patent and the size, shape, and position of the ears should be noted. Hold one nasal passage at a time to test patency. Evaluating the palate of the mouth to ensure it is intact is important to rule out cleft lip (Cardoso & Fonseca, 2022).

For development at 1 week, the patient should be able to move his neck while lying on their stomach. Newborns try to locate the sound by responding to higher-pitched voices. All extremities should be assessed for symmetry and equality. Newborns have some motor reflexes such as the Moro, rooting, sucking, and stepping reflexes. Sleep norms for newborns are 14-17 hours daily. It’s normal for newborns to wake up every 2-3 hours to eat. Breastfeeding is the best choice for nutrition and this patient is currently doing well with breastfeeding.

  • What newborn assessment or behaviors would be concerning, and why?

If the patient has a significant murmur this should be investigated further to rule out serious cardiac abnormalities. If the newborn does not pass the hearing test in the hospital or is at high risk of hearing abnormalities. If the patient has not established a feeding pattern or is not getting adequate intake would be concerning for her growth. If the patient appears jaundiced on assessment the practitioner should order or repeat the bilirubin test. If the lab is abnormal the practitioner should address the abnormal bilirubin result promptly (Lucas, 2023). When performing the Moro reflex if the newborn does not appear startled and flings her arms out sideways with palms up this could indicate an injury or disease and should be further investigated.

  • Provide health promotion screenings and family education needed during this visit.

It will be important to screen the newborn for a variety of congenital and inherited disorders. Screenings are typically done before the newborn is discharged from the hospital but should be repeated or rescreened before 2 weeks of age. A hearing screening should be conducted before the patient is 1 month old. The patient should also be screened for critical congenital heart disease (CCHD) before discharge from the hospital. The CCHD can help identify pulmonary atresia and Tetralogy of Fallot. This requires a pulse oximetry to complete this test. Screening the mother for postpartum depression will be important during this visit. Repeating the patient’s bilirubin level will be important during this visit (Cardoso & Fonseca, 2022).

Education would include discussing adequate intake and feeding for the patient. Education on placing the diaper beneath the umbilical cord to allow for air-drying is important. No alcohol should be applied to the umbilical cord as this is no longer recommended. If around the umbilicus starts to rapidly expand or become foul smelling, seek immediate evaluation. Education of smoke smoke-free environment for the patient is important. Discussing a plan for immunizations and healthcare maintenance. The mother should also be screened for supplemental programs such as Women’s, Infants, and Children (WIC) and Supplemental Nutritional Assistance Program (SNAP) and be provided a referral as needed (Cardoso & Fonseca, 2022).

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