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NR411 Nursing

Assignment Perinatal Case Study – Maritzia
Escaping political persecution in El Salvador, Maritzia (28) and Carlos (26) recently immigrated to Toronto two years ago as refugees. They have two children, aged four and two, and Maritzia is expecting their third child. She is unsure how far along she is in her pregnancy. They are presently living in the basement apartment of the brother of Carlos and his wife who sponsored them to come to Canada. They were both able to obtain work permits from Immigration, Refugees and Citizenship Canada (IRCC). Maritzia works shifts as a cashier at No Frills and Carlos works cleaning office buildings at night; both have a high school education. Maritzia speaks limited English but Carlos only speaks Spanish. She delivered her first two babies in a public hospital in San Salvador where epidurals are not utilized for vaginal deliveries because of the cost and belief that they are not good for the mother and baby. Maritzia states that she would like to have a natural birth. She breastfed both children for 18 months.

During Maritzia’s pregnancy, she often suffered from swollen feet after working a shift. The doctor at the clinic says that all her tests are normal as well as her weight gain but that they want to watch her blood pressure and urine. They also told her at 35 weeks gestation, that she was GBS positive and she was not immune to measles. As refugees, they were eligible for subsidized daycare but since Carlos works long nights it is her responsibility for all the childcare, cooking and house cleaning. Many nights she feels exhausted, she wishes she had more support but her in-laws are just as busy working long hours as well.

At 38 weeks gestation, Maritzia started labour and baby Rodrigo was born weighing 2900 gms after 15 hours of labour. Her delivery included an epidural, augmentation due to failure to progress and a vaginal delivery with failed forceps, vacuum extraction assistance and 2nd degree lacerations; the apgars were 7 and 9. Rodrigo sustained bruises to his head on both temporal areas.

During the first 24 hours, Rodrigo was sleepy and had a difficult time latching to the breast. He was initially hypothermic with a temperature of 36 degrees Celsius but it quickly returned to normal after skin-to-skin time with Maritzia. His discharge weight was 2700 gms and his skin colour was slightly jaundiced. Prior to discharge the nurse proceeded to test his bilirubin levels and they were found to be slightly elevated but still within the normal range at 48 hours.

The day after discharge from the hospital Maritzia and Carlos brought Rodrigo back to the hospital clinic with symptoms of lethargy, poor feeding and increased jaundice. Rodrigo was admitted to the hospital and Maritzia stays near him in the “care by parent” room.
You are the nurse looking after Maritza. As a group, discuss and provide supporting evidence on the following questions. Ensure to state which stage in the perinatal period you are referring to from the case study (antepartum, intrapartum, postpartum).
1. Discuss two (2) priority risk factors related to infants with hyperbilirubinemia as it relates to baby Rodrigo. Provide a rationale for your choices.

What health promotion/teaching strategies would you implement to address the two risk factors you have discussed? Provide a rationale.
Two Risk Factors Supported by Article ( peer reviewed scholarly article by Canadian)
Two Rationale  for you choice 
One paragraph for one risk factor  and one rational 
One paragraph  for  the second  risk factor with its rational
Two Health teaching  strategy  supported by article  and provide rationale for each  strategy 

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