Question

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III. THINKING CRITICALLY 1. Birth trauma, although decreasing in incidence, is still an important source of neonatal morbidity. Nurses caring for women in labor should be aware of the factors that predispose infants to injury during the process of birth A. IDENTIFY the factors that increase fetal vulnerability to injury and trauma at birth. B. DESCRIBE an approach to labor and birth care that can reduce the incidence of birth injuries. C. Baby boy Timothy's right clavicle was fractured during birth as a result of shoulder dystocia. DESCRIBE the signs that Timothy most likely exhibited that alerted the nurse that his clavicle was fractured. D. EXPLAIN to Timothy's parents the most likely care approach related to his fracture, 2. Baby boy Robert, weighing 11 lb, 4 oz, was born 1 hour ago. His mother, a primipara, had gestational diabetes mellitus A. Robert's mother is thrilled at his size, stating: "He looks so healthy and well nourished, not like the skinny babies in the nursery." EXPLAIN what the nurse caring for Robert should tell his parents about the reason for his large size. B. DESCRIBE the typical characteristics exhibited by a macrosomic infant such as Robert.

Answer 1

1.A.Factors for birth trauma:

overweight babies-weight more than 4 kg,babies who are large for dates,using obstetric instruments during labor,forcible pulling,malpresentation or malposition during labor preterm babies.

These babies and factors are vulnerable for birth trauma.

B.To reduce birth injuries, before labor starts the mother should  be assessed for these above factors.if any of the factors present,then labor should not be induced.Then during labor forcible pulling should be avoided.In some cases instruments are needed to take the fetus out so it must be performed by skilled and experienced one in careful manner.

C.Due to clavicle fracture the baby cannot move or lift the arm in fractured side.The baby starts to cry during moving the arm in fractured side.The fractured side looks to hang downward when compared to unaffected side.Then swelling and redness will occur.thus the nurse can diagnose a clavicle fracture.

D.It does not need any specific treatment.provide instructions to the parents that the child need enough rest and restrict the movement of arm in the fractured side.Provide arm sling to baby and  ask parents to wear it to the newborn to restrict arm movement.

2.A.Explain the parents that it is due to gestational diabetes of the mother.Gestational diabetes cause transport of more glucose to fetus through the placenta.Excess glucose convert as fat and  cause obesity in adults likewise more glucose gets stored in fetus thus the babies put over weight and is termed as macrosomia. Diabetic mother usually have large babies.

B.weight more than 4 kg.Then the babies of diabetic mother have hypoglycemia due to high amount of insulin transported from mother.