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Another Great Addition
On the afternoon of March 31, 2015 at 1317 hours, a family of three became a family of
four with the birth of a beautiful girl (SK) at Freeman Hospital in Joplin, Missouri. SK was
surrounded by her father (TK) and mother (JK), as her older sister (HK) was at home with her
grandparents since she was too young to endure the long process of labor and delivery.
I. Family History
A. Family Constellation
Member Date of
Birth
Marital
Status
Education Employment General
Appearance
Health
Status
JK
(Mother)
2/2/1987 Married College
Degree
High School
Teacher
Good Good
TK
(Father)
1/17/1987 Married College
Degree
High School
Teacher
Good Good
HK
(Sister)
2/4/2012 Single Pre-school N/A N/A Good
B. General Description of Family
Upon observation, it seemed that SK was born into a very loving and caring family.
TK (father) and JK (mother) showed great affection towards one other. Throughout most of the
labor and delivery process, JK’s husband was by her side giving her encouragement to push
through. When SK gets to go home for the first time, she will live with her parents and her two
year old sister HK.
The family stated that they were Christians who attended church every Sunday, or at
least tried their hardest to do so. They both grew up in a small town, grew up in Christian
homes, and religion was implemented early on in their lives.
I did not directly ask JK or her husband about their socioeconomic status, however I
was able to gather enough information throughout the conversations I had with them, and the
observations I took. I would say that with both of them being teachers, they are most likely in
the middle-class socioeconomic class. Their clothes were clean, they groomed themselves well
and kept up with their personal hygiene. JK stated that her plan when she went home was to take
a couple of months of off work to look after her newborn, and oldest daughter. However she
stated that her grandmother was more than willing to watch the kids whenever she decided to
return back to work.
C. Home and Neighborhood
The family will be going home to a three bedroom house located in Lamar, Missouri.
Lamar is a small rural town consisting of mostly middle class residents. Their house isn’t
located in a neighborhood, instead it is located near downtown Lamar off of a main street. When
I asked them about the sleeping arrangements, JK stated that her and her husband sleep together
in one room, while the children will get their own rooms. They recently made the vacant third

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bedroom into a nursery for SK for when she arrived home. I did not ask the family about
plumbing, sanitation, heating, laundry, etc. From what I gathered through multiple observations
is that the family is pretty neat and clean when it comes to personal belongings.
D. General Impression of Family Relationships
As I stated before, the family seemed to be very affectionate towards one another.
Although I wasn’t able to watch them interact with their oldest daughter due to her not being
present, I was able to witness the parents communicating with one another. They were very
supportive of each other. During the delivery process JK was relatively calm and didn’t lash out
on her husband in times of stress, which made it a lot easier for him to encourage her. The
family fully understood the importance of thorough and fluent communication with all of the
healthcare providers. They were both very polite towards all doctors, nurses, and students. They
were very thorough in personal health history, family health history, etc. This made it easier for
the health care team to provide the necessary care for them. JK and her husband both stated they
do not smoke, drink, nor do drugs. However, they both heavily rely on a strong cup of coffee to
get them going in the morning. The only OTC medication that JK took while pregnant was a
prenatal multivitamin, along with iron and folic acid supplements.
E. Growth and Development of Client and Family Members
The growth and development stages vary throughout the members of the family. JK and
her husband were both in the “Generativity vs. Stagnation” phase of Erikson’s psychosocial
developmental stages. Although they are both only 28 years old, they live in the same
household, both have full time jobs, and have two young children to look after. Therefore, they
are both trying to balance being parents, employees, and still having time to themselves to feel
like they are living a life not only to support their family, but for personal enjoyment as well.
Their two year old daughter, HK, is in Erikson’s “Autonomy vs. Shame” stage. JK stated that
her oldest daughter is a “firecracker”, meaning that she is full of energy and attitude. She feels
that she is starting to become her own person and is weaning away from being so attached to her
mother and father. The newborn daughter, SK, is in Erikson’s first stage “Trust vs. Mistrust.”
The time period between when the baby is born and when she gets to go home is extremely
important. It gives the mother and father both time to form a bond with the baby, enabling the
newborn to establish a ground of trust towards his/her parents knowing they will take care of
them. The family is in the “Expanding” phase currently. New members are still being added to
the family, and the parents main focus is home and on the family. This will eventually lead to
the parents feeling “tied down” at times, contributing to the stage they are in of “Generativity vs.
Stagnation.” It is also a very important time for the parents alone as well. During this time, the
number of activities or date nights that a couple share drops drastically. In order to maintain a
healthy marriage they will somehow have to find time to themselves here and there to maintain a
healthy balance in life.
F. Health Care Practices of Client/Family
The health of each family member is very good. JK had 11 prenatal visits, and had a
regular primary physician she would check in with throughout pregnancy. JK is not immune to
varicella zoster, however she is Rubella immune. Her father had a CVA when he was in his mid-

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fifties. Other than that there is no significant family health history. JK and the rest of her family
are very thorough with annual check-ups with their family doctor to ensure they are in the best
health possible.
G. Client/Family Attitudes toward Pregnancy
While talking with the family briefly before the delivery began, they seemed very
anxious and excited for their new baby daughter to arrive. They stated that they weren’t near as
nervous as they were with their first born. She stated that her first labor was near ten hours, and
she was hoping that this one would go a lot faster and smoother. All in all though, they seemed
very excited and happy to be able to add another girl to their family, even though the dad
jokingly said he was waiting for her to have a boy.
II. Clients Health History
The family’s health history is exceptionally good. There is no history of significant
health problems in any of the members other than JK’s fathers CVA. The only surgical
procedure JK had done was an ACL repair on her right knee when she was 18 years old.
III. Present Pregnancy
A. Prenatal Care
JK had thirteen total prenatal doctor visits, all of which were on time. Her first visit was
in September of 2014. She went as scheduled, every four weeks for the first 28 weeks gestation.
Then every 2 weeks until 36 weeks gestation, then once weekly until delivery. JK had no major
complications during this pregnancy. She stated that her main complaint was a dull back pain,
which made it hard for her to ambulate as much as she would have liked too. She said she tried
her best to at least ambulate around the house as much as she could without exhausting herself or
causing too much pain. She also said that she had a lot of nausea and vomiting. She stated that
she tried her hardest to maintain a fluid intake of 2-3 L/day so it did not lead to hyperemesis
gravidarum, therefore it caused no harm to the fetus.
JK presented to the doctor in September with right lower quadrant pain. She had stated
she was starting to gain weight and had suspected she was pregnant. They performed an
ultrasound and it showed that there was a gestational sac within her uterus that contained a single
live fetus of approximately 7 weeks 6 days gestational age with no obvious fetal abnormalities.
At that time, the FHR was 172. Our textbook states that a normal FHR range is 120-160,
however it is considered normal for the FHR to be slightly high this early in gestation. The
amniocentesis revealed that the amniotic fluid volume was within normal limits. This early in
gestation, they were unsure of the placement of placenta develop. The fetal ultrasound also
showed no risk for chromosomal defects, and no birth defects that would affect the brain or
spinal cord. Everything appeared to be going smoothly and the fetus was doing great so far. The
estimated date of confinement was 3/23/2015.
Her first prenatal visit was in September as well. She no longer complained of the pain in
her right lower quadrant, and her last menstrual period was 6/6/2014. Medical history shows that
she has no known drug allergies, tested AB+, Rb-, and GBS-. As stated before, she was non-
immune to varicella zoster, and was immune to Rubella. I looked at her medical records to find

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her vitals during her prenatal visit, and they were as follows: BP 130/84, HR 82, T 97.6, R 18,
SpO2 98%. All of which were within the normal ranges. According to medical records, she was
prescribed Colace for constipation, Dramamine for her nausea, and Tagamet to use for an
Antacid. She was also prescribed a prenatal vitamin, and iron and folic acid supplements to help
prevent any pregnancy complications or neural tube defects that would harm the fetus. Her pap
smear showed no abnormalities, the physician requested a GC/Chlamydia probe to be taken,
which came back negative. Prenatal labs were drawn and sent to the lab, the complete table of
lab values of JK can be seen on page 13. Most of her labs were normal, however her platelet
count was a little too low for comfort. The physician suspected maybe she had an enlarged
spleen, however that came back negative. He then put her at risk for thrombocytopenia, and kept
a close eye on her platelet count throughout her pregnancy. It never progressed into any
diagnosis, as the platelet counts eventually rose. Her WBC count was also elevated throughout
much of her pregnancy. The natural thing to think when you see an elevated WBC is some sort
of infection, however her medical history shows no history of infection throughout her
pregnancy.
In her second trimester, JK had another fetal ultrasound done to determine the placental
position, and fetal position. The ultrasound revealed that the placenta was an anterior placenta,
attached to the front side of the uterus, facing the mother’s belly. The fetal position was LOA, so
the fetal back was on the mothers left side. The fetal face was between the right hip and the
spine of the mother. The crown of the head was the presenting part, which made for a smooth
and quick vaginal delivery when the time of engagement came. No abnormalities were seen
during this time. I was not able to find the biometry measurements at this time, but according to
our textbook, the normal values would be: BPD 4.8 cm, 21 weeks 2 days; HC 18.1 cm, 21 weeks
6 days; AC 17.6, 21 weeks 1 day; femur length 3.3 cm, 21 weeks 5 days. Her estimated date of
confinement at this time was still the same. When comparing this ultrasound with the one prior,
it showed normal fetal growth and development with no complications.
B. Nutritional Status
JK gained a total of 38 pounds throughout her pregnancy. This was slightly above the
normal range of 25-35 pounds by term. According to her prenatal visit charts, she gained 3
pounds within her first three weeks of pregnancy, and then gained roughly one pound per week
until delivery at 38 weeks gestation. Her pattern of weight gain was not abnormal, as it is normal
for women to gain 2-4 pounds within the first three months of their pregnancy, then 1 pound per
week for the rest of pregnancy. Although JK gained a little more weight than normal, she did not
look abnormally large. She looked healthy for a women at 38 weeks pregnant. I asked JK about
her nutrition during her pregnancy, she stated that she did not really use the Food Pyramid to
decide what and when she was going to eat. She did state though that she tried her best to eat
what she was supposed to and what she knew was going to be good for both her and her baby
nutritionally. JK ate a variety of foods to ensure she got all of the required nutrients. Including
8-11 servings of breads and grains, 2-4 servings of dairy products to ensure she was getting the
RDA of 1000-13000 mg of Calcium. The dairy products also helped her consume iodine to help
ensure adequate development of her baby’s brain and nervous system. JK also ate 3-4 servings
of high protein sources, which were mainly meat and poultry for her. She stated that she did cut

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back on her caffeine consumption drastically during her pregnancy. She did experience
constipation so she liked to eat food high in fiber to help promote the natural peristalsis of the GI
tract. JK is not a big fan of spinach, beans, or breakfast food so the doctor had to put her on an
iron supplement to prevent any pregnancy complications related to iron deficiency. In relation,
she did not enjoy eating legumes, dark green vegetables, or veal so she was also on a folic acid
supplement to try and prevent any neural tube defects. She said that she tried to eat carrots and
strawberries at least once or twice a day to get her Vitamin A and Vitamin C. JK and her family
did not have any culture, economic, or religious factors that detoured them from the appropriate
nutrition during pregnancy.
C. Preparation for Parenthood
JK and her husband did not attend any prenatal, breastfeeding, or sibling classes. They
felt that they had a pretty good grasp on what to expect since this was their second child. As I
stated before, they changed their third vacant bedroom into a nursery for their newborn daughter
so they were well prepared.
D. Minor/Major Maladaptation’s
The only minor worry that the parents had was their older daughter’s reaction to her new
baby sister. They were worried that the older sister would get jealous because of the attention
that the newborn was soon to receive, and that the change could be difficult for her to accept.
IV. Labor and Delivery
A. First Stage of Labor
JK was admitted at 38 weeks 2 days gestation. She was dilated to 6 cm and 90% effaced
upon admission and had spontaneous rupture of membranes with clear fluid. JK seemed ready to
deliver her baby girl. She was excited, and stated that she was not near as nervous as she was
with her first born child. She was smiling and actively engaging in conversation with the health
care team and her husband. She was great about taking the right precautions with pregnancy,
and also very good about doing the extra things to make the labor and delivery process go as fast
and smooth as possible, such as ambulating as frequently as she could to promote contractions
and further dilatation. Below is a table of JK’s vitals that were taken when she was admitted
(antepartum vitals), compared to the normal values of vitals for pregnant women at this stage of
pregnancy, according to ATI:
Vitals Taken JK’s results Normal Values
Blood Pressure* 112/89 mmHg <135/85 mmHg
Pulse 76 bpm 60-90 bpm
Respirations* 18 rpm 10-20 rpm
SpO2 100% 90-100%
Temperature 98.2 F 97-99.6 F
*Blood pressure and respirations may increase during this stage of pregnancy
I was unable to find her lab data upon admission, however the table below will show the
labs that are normally taken when a labor patient is admitted and the normal results of each lab
taken according BabyMed:

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Test Desired Result
Serological tests Negative
Blood type JK is blood type AB+
Rh JK was Rh-
HGB 11.5-15 gm/dl
HCT 32-36.5%
Hepatitis B Surface Antigen Negative
Group B streptococcus culture Negative
My initial contact with JK and her husband was during the active stage of labor in the
labor room. I walked in and introduced myself and informed them that I was a nursing student
who was going to be observing her labor and delivery process. She was great about the entire
process and was excited for me to be able to see my first delivery. JK was induced for labor due
to oligohydramnios. Medications that were used in the first stage of labor were; T4 PP
Dermatome Epidural, Oxytocin 300 mL/hr, Dextrose 100 mL/hr. The anesthesia management
report completed showed that JK had no health problems, does not currently smoke, use street
drugs, drink alcohol, and has had no complicated pregnancies. The consent was signed. The
epidural charting was as follows:
0703 Anesthesia in Room BP 114/86 HR 110 SpO2 100%
0705 Sitting Position BP 132/90 HR 102 SpO2 98%
0708 Local BP 126/86 HR 112 SpO2 98%
0710 Epidural Catheter BP 131/84 HR 110 SpO2 96%
0712 #1 Test Done BP 128/86 HR 104 SpO2 96%
0716 Bolus BP 130/92 HR 94 SpO2 98%
0720 Epidural gtt started BP 126/84 HR 110 SpO2 99%
0730 Post Epidural BP 124/81 HR 90 SpO2 100%
During this stage of labor, JK had controlled breathing and seemed very relaxed and in
control. Since JK was admitted at 6cm dilatation, she was already in the active phase of labor.
She was having contractions every 3-4 minutes that lasted 40 seconds each with progressive
dilatation. The FHT showed slight accelerations with good variability, with no decelerations
present. At this time the FHR was 120, and the fetus was engaged +1. For JK, the first stage of
labor lasted 7 hours and 4 minutes. The husband played a great role in the process by
continuously keeping JK distracted and encouraged, which in return helped her control her
breathing. As JK started to go from the active stage of labor to the transition phase, she started
complaining of more back pain. The nurses treated this pain with counter pressure to her back
which seemed to relieve some of the pain.
Below is a table that shows the normal values and characteristics, according to the
textbook, of the latent, active, and transition phase of the first stage of labor:

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Latent Phase Active Phase Transition Phase
Duration 4-8 hours 3-7 hours Minutes to hours
Cervical Dilatation 0-3 cm 4-7 cm 8-10 cm
Contractions:
Frequency q 10-30 min at reg.
intervals
q 2-5 min q 1.5-2 min
Duration 30-40 sec 40-60 sec 60-90 sec
Intensity Mild-moderate 25-40
mmHg by IUPC
Moderate-strong 50-
70 mmHg by IUPC
Strong upon palpation
70-90 mmHg by
IUPC
During the first stage of labor, there were a few important nursing actions and
responsibilities that we did throughout the labor process. The first thing we had to do was
establish a therapeutic relationship with JK and her husband to ensure the proper care for them.
It was also important for us to monitor the FHR and JK’s vital signs throughout the entire
process. Next we performed Leopold’s maneuvers to determine the fetal presenting part and
position. We also watched for bladder distention and made sure to help JK to change positions
frequently to either standing/walking, or sitting upright.
B. Second Stage of Labor
As stated above, JK was induced for oligohydramnios so she was a vaginal delivery. The
fetus was in the LOA position with a cephalic presentation. For JK, the second stage of delivery
lasted only 13 minutes, much shorter than her first delivery. JK was fully dilated to 10 cm, fully
effaced, and was engaged to a 3+, so she felt a great urge to push. At the beginning of the second
stage of labor, JK’s contractions had calmed down a little bit giving her a little bit of time to
relax and gather herself before the final descent of the fetus was initiated. Once her contractions
started to intensify again, she was able to bear down and aid the contractions which alleviated
some of the pain for her. The fetus descent was very rapid in this case. Soon the fetus began to
crown, and the perineum began to bulge. With each contraction, more and more of the baby’s
head became visible. At this point, the nurses encouraged JK to focus on her breathing and only
bearing down with contractions to prevent a precipitous birth which could cause lacerations to
either the birth canal or the perineum. Once the fetal head was fully visible, we saw that it had a
nuchal cord x1, so the nurse quickly slipped it over its head to prevent any complications. The
nurse then suctioned its mouth and nose. After this, the baby’s head turned to the side as her
shoulders rotated inside of JK’s pelvis to get into position to exit the birth canal. Finally the
anterior shoulder and posterior shoulder both exited the birth canal, followed by the rest of the
baby’s body being expulsed. I did not get JK’s vitals immediately after delivery, but according
to ATI the normal ranges would be; BP < 135-85, P 60-90, R 16-24, SpO2 95-100%, Temp 97-
99.6 F. The “normal” value for the second stage of labor duration is considered to be prolonged
in multiparous women if it exceeds 2 hours with regional anesthesia, or 1 hour without it.
During the second stage of delivery, the nursing responsibilities included; encouraging JK to rest
between contractions and to bear down with them, position patients legs in stirrups for lithotomy
position, prepare the patients perineum with Bedatine scrubs and water with 4x4’s, monitor the

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maternal BP and FHT every 5 minutes and with every contraction, watch for crowning, control
the delivery of fetal head, control the delivery of the anterior/posterior shoulder and rest of body,
and clamping and cutting the cord immediately after delivery to promote natural fetal blood
flow.
C. Third Stage of Labor
For JK, the third stage of labor lasted only 5 minutes. The normal duration for the third
stage is anywhere from 10-30 minutes. JK had a spontaneous delivery of the placenta, and lost
350 mL of blood. According to our textbook, the normal blood loss during a vaginal delivery is
between 300-500 mL. The doctor ordered the patient to be given 30 units Pitocin after delivery
of the placenta to stimulate contractions to try and stop any excessive bleeding from the uterus
postpartum. Immediate care of the newborn included:
- Establishing and maintaining airway by wiping mouth and nose, and suctioning any
secretions from mouth and nose.
- Keeping newborn warm either with heater, skin to skin contact with mother, hat to
prevent heat loss, and/or wrapped in blanket
- Get newborns weight and height
- Give prophylactic eye treatment against gonorrhea conjunctivitis or opthalmia
neonatorium. We gave Erythromycin ophthalmic ointment for this.
- Give 1 mg Vitamin K IM in the newborn’s vastus lateralis muscle
- Clamp and cut the cord within 30 seconds of birth
- Clean the cord and area around the cord with antiseptic solution
- 1 and 5 minute Apgar scores
JK and her husband were extremely excited about their newborn daughter. The father
took role in cutting the umbilical cord, and took many pictures of their new daughter. He was
great about comforting JK and making sure she had everything she wanted at that time and was
as comfortable as possible. JK started crying tears of joy when she laid eyes on their new baby
girl, and was ecstatic when she got to hold her for the first time. Nursing care and
responsibilities during this stage included helping with delivery of placenta, monitoring for
postpartum hemorrhage risks, monitoring for any postpartum complications, being sure to aid in
the mother-newborn bonding period, and getting JK to a certain level of comfort.
D. Fourth Stage of Labor
I did not get JK’s vitals during the fourth stage of labor. I imagine everything would have
been about normal. Her pulse may have been a little lower than normal, but this would have
been due to the blood from the uteroplacental circulation being returned to the maternal blood
circulation. According to our textbook, the normal values would be: BP 120/80, P 50-90, R 16-
24, SpO2- 95-100.7%, T- 97.6-99.5 F. JK’s uterus was midline, her fundus height was -1, she
stated that she had firm cramping, a scant amount lochia rubra was present that was red in color,
her perineum was intact, and had no bladder distention. All of these findings were considered to
be normal. JK stated that her pain was at about a 3 on a numerical scale of 1-10 as she was still
weaning off of the epidural. It was noted that JK could not move her right foot and had 1+
reflexes, primarily caused by the epidural. JK and her husband continued to interact with their

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newborn girl, taking pictures and taking turns holding her. JK decided while she was pregnant
that she was going to breastfeed, so the nurses allowed her to try and breastfeed their new girl.
The newborn quickly latched on to JK and started feeding.
V. Postpartum
At this time, JK’s vitals were; BP 125/70, P 69, R 18, SpO2 100%, all of which fell
within the normal ranges. JK’s fundus was now at about -1, firm, midline and going to the left.
It is expected for her fundus to continue to drop about 1 cm/day, and be back to her normal
prepregnancy position by about 5-6 weeks. She continued to have rubra lochia dark red in color
in a scant amount. JK had active bowel sounds, and a little bit of tympanic sound over her right
upper quadrant indicating flatulence build up. She had no bladder distention. JK had no breast
engorgement at this time, and was actively breastfeeding her new baby girl. JK did not complain
of any headaches or postpartal chills. 3+ pitting edema was noted in JK’s legs, which was
considered to be a normal finding in a postpartum patient. JK seemed to be doing great
mentally. She was trying to catch sleep in between taking care of her newborn, but other than
being a little restless she was very active and happy in her newborns care and needs. Her
husband was still acting as a great support system for her during this time. I asked JK what that
birthing experience was like compared to her first and she simply said, “a lot faster and a lot
smoother.” She was glad it was all over, and was extremely happy that their new baby girl was
completely healthy. At this time, JK was eating her “celebratory meal” that Freeman Hospital
offered all postpartum patients. Her husband was sitting in the chair rocking SK back and forth
to keep her calm. JK was currently on lanolin cream for breastfeeding, but other than that there
were no other pertinent medications she was taking. I did not get her labs, but the normal values
for all labs taken throughout the process can be found on page 13 of this report. Nurses
continued to monitor JK and the baby for any sudden changes. We kept a close eye on blood
pressure, and took vitals every four hours. JK had to watch multiple teaching videos on how to
bathe a child, etc. in order for us to start considering discharging her. At this time, her vitals had
to be stable, no bleeding complications, ambulating steadily, and voiding regularly without
complication in order to be considered for discharge. In the meantime, the nurses goals prior to
discharge included; prevent infection, prevent excessive bleeding, promote rest and comfort,
promote ambulation, promote normal bladder and bowel function, and breastfeeding promotion.
VI. Neonate
SK was born at 38 weeks 2 days gestation, and was AGA at 7 pounds 3 ounces birth
weight. SK was being breastfed and was feeding well, leading to healthy weight gain. After
birth, SK’s APGAR scores were taken at 1 and 5 minutes of life. The results are shown below:
1 minute APGAR Score: 8
APGAR Sign 2 1 0
Heart Rate X
Breathing X
Grimace X
Activity X
Appearance X

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5 minute APGAR Score: 9
APGAR Sign 2 1 0
Heart Rate X
Breathing X
Grimace X
Activity X
Appearance X
The baby’s vital signs were recorded as:
Time Temp Pulse Resp. Pulse Ox
1700 97.9 -- -- --
1720 98.0 164 36 --
1740 97.6 -- -- --
1750 97.5 142 44 --
1800 98.2 -- -- --
2335 98.0 140 41 100
I could not find the newborns lab results. Page 14 offers a look at normal neonatal lab
values, according to BabyMed. I was in the nursery while they performed the neonatal
assessment. The following are the findings of the assessment:
- Head
o Hair- evenly distributed (Normal)
o Circumference- 33 cm (Normal 32-35 cm)
o Sutures- molding (Normal)
o Fontanels- anterior diamond shaped/open, and posterior triangle shaped/open
(Normal- anterior closes 12-18 hours, posterior closes 2-3 hours)
o Shape- symmetrical (Normal)
o Mouth- round, symmetrical, hard palate intact (Normal)
o Face- symmetrical, milia present (Normal)
o Palate- tonsils not visible, sucking, rooting reflexes present (Normal)
o Eyes- symmetrical, white sclera, bluish color to eyes, corneal reflex present,
blink reflex present (Normal)
o Ears- symmetrical, reactive to sounds (Normal)
o Nose- midline, symmetrical, both nares patent, no nasal flaring present
(Normal)
- Chest
o Circumference- 13” (Normal 13”-14”)
o Clavicles- symmetrical, no crepitus present, no fracture (Normal)
o Breast Tissue- Witch’s milk present (Normal)
- Integumentary
o Color- bright red, acrocyanosis present (Normal)
o Birthmarks- none (Normal)

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o Vernix caseosa present in creases (Normal)
o Lanugo present on shoulders (Normal)
- Abdomen
o Bowel sounds- 2/min (Normal)
o Size- rounded with prominent veins (Normal)
o Umbilical Cord 2 arteries 1 vein (Normal)
- Genitalia
o Smegma present (Normal)
o Labia minor/majora, clitoris present/intact/no lacerations (Normal)
o Pseudo-menstruation present (Normal)
- Extremities
o 10 fingers, 10 toes (Normal)
o No polydactyly or syndactyly present (Normal)
o Crease on anterior 2/3 of foot (Normal)
o Symmetrical muscle tone throughout (Normal)
o Negative Ortolanis (Normal)
- Back/Spine
o Spinal column intact, no dimples, no masses (Normal)
o Trunk incurvation reflex present (Normal)
- Reflexes
o Rooting/sucking- present (Normal)
o Moro’s- present (Normal)
o Grasp- present (Normal)
o Tonic Neck- present (Normal)
o Babinskis-present (Normal)
o Scarf Sign- negative (Normal)
The family continued to interact appropriately with their newborn, showing love and
affection and caring to the baby girls needs when she cued to do so.
VII. Health Teaching
Before discharging JK and her husband home with their newborn, it was important to
teach them about a couple of things. We figured since she was breastfeeding, that we should
inform her of a couple of things regarding breastfeeding, such as; air dry nipples after each
feeding, if breasts are engorged, apply warm packs and express milk. We also informed JK to
watch for uterine changes, and that after pains and cramping were considered normal and would
resolve within 5-6 weeks. Vaginal discharge would last anywhere from 1-4 weeks. We
informed her for pain relief, to use mild analgesics such as Tylenol or Advil for breast
engorgement, and uterine cramping. She should continue taking her prenatal vitamin and iron
pills until her next postpartum visit. We warned JK that she should not participate in any heavy
housework or heavy exercise for two weeks, and to avoid sexual intercourse for about 3-4 weeks.
The last thing we informed JK to do was to call her OB 2-3 days after being discharged to
schedule her 6 week appointment. There were no indications for referrals to other services for JK
or her husband.

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VIII. Follow Up
I was unable to follow up with JK and her family, due to our clinical day being over.
However I am sure that she and the rest of the family are doing great!
IX. Family Adaptation
Based on my personal encounters with this family, I feel that they are adapting to the new
addition just fine at home. They mentioned their worry about their two year old daughter
adapting to the new change of not getting all of the attention, however I feel that they knew
enough and were aware enough of the situation to avoid any major complications arising from it.
JK’s mom is helping out with the care of the SK, allowing JK to return to work when she feels
ready to do so. TK continues to teach every day, and comes home and helps out with the kids at
night. Overall, the family is adapting well and making everything work in a great manner.
X. What Did I Gain From This Experience?
This was a great experience for me. First, it was my first ever labor experience, and it
was awesome to get to see the whole process unfold right in front of my eyes. It definitely gives
me a new respect for pregnant women and childbearing families, now that I know all the hard
work, planning, teamwork, and dedication it takes to have a healthy pregnancy and maintain a
healthy relationship. I found it very cool to get to assess a newborn hands on, and be able to feel
the actual fontanels and overriding sutures. The strangest thing to see of the whole thing was
probably the spontaneous delivery of the placenta, as I really never heard what that was like until
I saw it in person. I enjoyed getting to connect with this family and it was very cool to be a part
of such a cool experience, knowing that whenever they talk about the birth of SK, that I will
forever be a part of their special story.

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MATERNAL LAB
NORMAL VALUES
LAB
LOW HIGH
WBC 4.3 11 10^3/uL
RBC 3.79 5.25 10^6/uL
HgB 11.5 16 G/dL
HCT DET 35 52%
MCV 77 95 FL
MCH 25 34 PG
MCHC 32 36 G/DL
PLT 130 400 10^3/uL
MPV 7.4 10.4 FL
NEUT % 42 75%
LYMPH % 12 44%
MONO % 0 12%
EOS % 0 10%
BASO % 0 10%
RDW 10 14.40%
NEUT# 1.8 7.8 x 10^3
LYMPH# 1 4 x 10^3
MONO# 0 1 x 10^3/uL
EOS# 0 0.3 10^3/uL
BASO# 0 0.1 10^3/uL
RDW-SD 38.4 53.1
GLUC 1 HR 70 135
HEP AG BS NR NR

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NORMAL LAB VALUES
FOR NEONATE
LAB
LOW HIGH
RBC 4.2 5.5 X 10^6/uL
HCT 37.4 55.9%
HgB 14.7 18.6 g/dL
Platelet Count 234 346
WBC 8.0 14.3
Alkaline Phosphatase 95 368 IU/L
Sodium 0.3 3.5 mmol/24 h
Calcium 4.0 5.0 mEq/L
Chloride 96 111 mmol/L
Potassium 3.7 5.2 mmol/L
Magnesium 1.7 2.4 mg/dL
Iron 20 157 ug/dL
Ammonia 0 50 mmol/L
Glucose 30 100 mg/dL
Albumin Range 2.6 3.6 g/dL
Albumin 2 1 100 mg/L
C-reactive protein 10 350 g/L
Creatinine Kinase 40 474 IU/L
Creatine 18 58 mg/L
IgG 221 1031 mg/dL
IgA 1 19 mg/dL
IgM 12 117 mg/dL
PTT 42 54 seconds
PT 11 15 seconds
T3 15 210 ng/dL

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Works Cited
Rudd,K.,and Kocisko,D.,(2014) PediatricNursing.F.A.Davis,Philadelphia.
NursingCare of Children,RN Edition9.0.(2013). AssessmentTechnologiesInstitute,LLC.
BabyMed.(2015, February). NormalLaboratory Valuesand ResultsDuring Pregnancy. RetrievedfromUS
EPA website http://www.babymed.com/info/normal-laboratory-values-and-results-during-
pregnancy