Patient Scenario, Chapter 19, Nutritional Needs of a Newborn

AN INFANT WHO IS BREASTFED

Harris Dupont is a 2-day-old, 8 lb 2 oz boy born by cesarean birth, following

placement of cerclage sutures in his mother. His mother planned on breastfeeding
him since the 4th month of pregnancy; now that he is born and she is experiencing
a great deal of pain from surgery, she is not as certain she still wants to breastfeed.

CHIEF CONCERN:

“My breasts are too sore to breastfeed.”

HISTORY OF CHIEF CONCERN:

The client has breastfed for 2 days, every 2 to 3 hours for 10 minutes each breast.
Breasts are firm and filling; nipples are protuberant. The infant is alert and sucks
well. His weight today is 8 lb.

FAMILY PROFILE:

The parents are married. The father is member of large family; he states he feels
comfortable in caring for newborn, although is not certain breastfeeding is
necessary. The mother is only child; she admits to lacking experience with
newborns. Her mother-in-law will come to stay with her for a week to help with
infant; she is aware mother-in-law never breastfed any of her children.

HISTORY OF FAMILY ILLNESSES:

His paternal grandfather has elevated cholesterol level and blood pressure. His
maternal uncle has hepatitis C.

OBSTETRIC HISTORY:

Girl was born at 28 weeks because of incompetent cervix 2 years ago and died at 2
days of age. Cerclage sutures are placed at 14th week of this pregnancy. There are
no complications or threatened labor during pregnancy. Membranes did not rupture.

REVIEW OF SYSTEMS:

Negative

PHYSICAL EXAMINATION:

Height: 20 in. (51 cm)

Head circumference: 35 cm
Temperature: 98.6°F (37°C)
General appearance: Well-proportioned, alert, male newborn
Head: Normocephalic; no molding; ant. fontanelle: 3 cm × 3 cm; post. fontanelle:
1 cm
Eyes: Red reflex present; follows to midline without difficulty
Ears: Normal alignment; canal patent
Nose: Midline septum; no drainage
Mouth: No teeth; palate intact; midline uvula
Neck: No lymph nodes palpable; midline trachea
Chest: Occasional rhonchi present; no rales; respiratory rate: 20 breaths/min
Heart: No murmurs; heart rate: 145 beats/min
Abdomen: Soft; no masses; liver palpable 1 cm
Genitalia: Normal male; testes palpable in scrotum bilaterally; midline meatus
Extremities: Full range of motion in upper and lower extremities; hips abduct
readily
Neurologic: Moro, sucking and rooting, step-in-place, crossed extension, tonic neck
reflexes present

LABORATORY FINDINGS:

Hemoglobin: 19.0 g/dl

Hematocrit: 56%