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Case Study #1: A G3P1011 presented to labor and delivery for induction at 39 2/7 weeks...

  1. Case Study #1: A G3P1011 presented to labor and delivery for induction at 39 2/7 weeks with a positive Group B Strep culture but delivered only two hours after the first dose of Penicillin G had infused. The infant’s temperature at birth and 30 minutes of age was 101 degrees F. The neonatologist ordered the following labs: CBC with manual differential and C Reactive Protein. At one hour of age the CBC and differential results were returned. The total WBC count was 31,000. Is the WBC count a reliable indication of infection in a neonate? Why or why not? Immature neutrophils are an important indicator. The may also be referred to as “bands” or “banded neutrophils”. What is an I/T ratio? What is the significance of a normal I/T ratio? Why might a series of CRP values be ordered? What findings are typically seen in bacterial infection?

  2. Case Study #2: A G3P0020 delivered a 6 lb male at 37 weeks. At birth the newborn was visibly jaundiced. The RN noted the mother’s blood type was O positive. Discuss why the neonatologist ordered a Type/Rh, Direct Coombs test, and Bilirubin Direct, Indirect, and Total Bilirubin on this infant. The samples were obtained at one hour of age and the results were reported to be as follows: Blood Type: A, Rh factor= positive, Direct Coombs= positive, Bilirubin direct= 0.8 mg/dl, Indirect= 6.2 mg/dl and Total=7 mg/dl. Is the newborn’s jaundice pathologic or physiologic (include your rationale)? What is the most likely cause of the positive Direct Coombs test and the newborn’s jaundice and hyperbilirubinemia?

  3. Case Study #3: You are caring for the Large for Gestational Age (LGA) infant of a mother diagnosed with gestational diabetes at 28 weeks during her pregnancy. You know that newborns of diabetic mothers are at risk for hypoglycemia in the neonatal period. Discuss the time frame of greatest risk and how point of care monitoring should be carried out. If the glucose reading is below 40 mg/dl, what interventions does the nurse anticipate?

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Answer #1

Wbcs are not reliable indicator as value of wbcs changes with age and during pregnancy.. on the day of birth, number of leukocytes range from 9000- 30000. Their number falls to adult number in 2 weeks.

I/T ratio is the ratio of immature to total neutrophil count. Normal ratio in first 24 hrs is 0.16. This ratio is useful to determine early onset sepsis. As it increases (>0.2)in case of infection

CRP was monitored to assess early onset sepsis in newborn as value increases crp value increases in bacterial infection i.e. >40 mg/l

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