Concept Map: Part B

Student: Anzhela Fedoronchuk

Student No: N00989267
Date Submitted: March 15, 2016
NURS 252: Complex Issue and Patient Safety
Professor: John Stone
Humber College ITAL

Concept Map: Part B

In this case study the nurse encountered a recently discharged mother wit her two weeks
old baby. The nurse observed that infant were sleeping in a stroller with bed bugs, his mother
also mentioned that sometimes he sleeps in the car as well. Infant seems lethargic to stimuli and
sleeps all the time. The nurse checked his vital signs and the following values were recorded: T
38.3, P 140, R 43, BP 122/64. His mother said that infant has approximately 4 wet diapers per
day and does not remember if her baby had a bowel movement. The nurse also interviewed
mother about the babys sleeping environment, at this time when discussing the bed bugs the
mother stated Oh what are those?. This lack of knowledge shows that she is not paying very
close attention to the conditions in which her baby is sleeping in.Moreover, mother had a postpartum depression which affects her mood and changes in behavior. She has poor hygiene, flat
affect, and disheveled.
I choose two priorities from the case study. The first psychosocial priority is a postpartum depression observed in mother`s behavior. The second pathophysiological priority is
possibility of infant infection. I choose those two priorities based on observation of mother`s
behavior, environment for the baby and mother, and vital signs of infant where fever is present
due to 38.3 temperature reading. According to Jarvis (2014) nursing book Physical
Examination and Health Assessment, the author stated that The normal oral temperature in a
resting patient ranges from 35.8C to 37.3C (mean, 37C). The rectal temperature measures
0.4C to 0.5C higher. Normal resting pulse rates for new born in average 120 beats per minute,
normal limits 70-190 beats per minute (p. 157).

I choose three clinical manifestations for post-partum depression, such as poor hygiene,
lack of knowledge, and flat effect. I think that the priority clinical manifestation for the mother is

flat affect. Flat affect is one of abnormalities of mood where you can observe lack of emotional
response, no expression of feelings, voice monotonous and face is immobile. According to
Mosby`s Dictionary, flat affect is a negative symptom and expression of careless behavior that
affect activities of daily living (2013). It is very important for mother to respond to baby`s
behavior. It is very important for mother to respond to baby`s behavior and have enough
knowledge how to threat her baby in the positive way that promotes well-being and healthy
environment.
I choose three clinical manifestations for infection for the baby, such as vital signs,
lethargy to stimuli, and bed bugs. I think the priority clinical manifestation for the baby is
lethargy to stimuli. The reason why I choose lethargy to stimuli as my priority is because
lethargy is one of the symptoms of very serious neurological infections, such as encephalitis.
Even though the chances of this being a meningitis or encephalitis is rare. It is a very important
symptom to investigate due to the high risk of death if not treated properly. For example, there
was recently a case in the news involving the death of an infant due to undiagnosed meningitis
that was not treated in time. This is why for this case I chose to identify lethargy as my priority to
discuss.
I choose five different nursing interventions for flat affect clinical manifestation for the
mother. The patient will demonstrate knowledge for changing her lifestyle, health, and living
environment. The patient will meet physical, physiological, spiritual needs with assistance of
nurse, family members and her friends. The mother will focus on wellness, disease prevention,
and maintenance at home. She will seek balance among exercise, work, rest, and taking a good
care for her baby. She will understand and demonstrate health-related procedures and treatment.

I choose my path for lethargy to stimuli as a clinical manifestation. My nursing

interventions include five components. The infant will be free of symptoms of illness,
temperature will decrease and within a normal range. Baby will be free of infection by getting
treatment, such as antibiotics. I will perform a mental assessment for Level of Consciousness,
check for cranial nerves, and reflexes. The mother will learn and maintain calm environment for
the baby. It is very important to promote wellness, and support with early ongoing treatment
plan. The mother and nurse will create a plan of care, so mother will learn more about level of
function and how to check baby`s reflexes at home to distinguish the difference between normal
and abnormal behavior or any changes in infant`s level of consciousness. Moreover, she will
learn more about balanced diet for her, so she will breast feed baby on a regular basis.
After visiting mother and her infant at their house, mother will review the plan of care for
her baby. She will learn more about taking care of her child by providing a calm environment,
regular exercise, diet and balanced nutrition for her. The mother will treat her baby according to
doctor`s prescription and instructions based antibiotic therapy.Moreover, mother and her baby
will meet her basic needs and increase the level of confidence in mother in the ability to provide
the best possible care for her child. Finally, the mother will understand her treatment plan and
will review her medications for the depression that she is suffering from. The nurse will come
back in a few weeks to check up on the mother and baby and ensure that whatever shortcomings
have occurred during her absence can be corrected.

References
Jarvis, C., Browne, A., MacDonald-Jenkins, and Lutkar-Flude, M. (2014). Physical Examination
and Health Assessment. Toronto ON. Elsevier Canada
Perry, S., Hockenberry, M., Lowdermilk, L., and Wilson, D. (2013). Maternal Child Nursing
Care in Canada.Toronto ON. Elsevier Canada
Mosby`s Dictionary of Medicine, Nursing, and Health Professions. (2013).Toronto ON. Elsevier
Canada.