Destiny’s behaviors appear to be normal for a newborn, and several typical behavioral responses have been observed

QUESTION

Baby girl Destiny was born by cesarean delivery 2 days ago. Destiny weighed 7 lb 3 oz, length 19 in, head circumference 34 cm, and chest circumference 34 cm. Her newborn course has been unremarkable. You observe that when held, Destiny appears alert and stares into her caregiver’s face. Destiny appears to be a content baby and cries only when she is hungry or when she needs a diaper change. When hungry, you observe that she brings her hand to her mouth and starts sucking on her fist and then begins to cry. Destiny falls asleep immediately after the feeding. The telephone, which is next to Destiny on her mother’s bed, rings loudly and Destiny does not appear to respond to the loud sound by moving her extremities or awakening briefly. (Learning Objectives 7 and 8)

A. Based on your observations of Destiny, are her behaviors normal? Which of the five typical behavioral responses were observed?

B. Does Destiny exhibit any behaviors that may be cause for concern? What is the concern and what might you as the nurse do to assess further? please include in-text citations and references for further readings

ANSWER

Destiny’s behaviors appear to be normal for a newborn, and several typical behavioral responses have been observed. The five typical behavioral responses observed in Destiny are:

Alertness and Visual Engagement: Destiny appears alert and actively engages with her caregiver by staring into their face. This behavior is typical for newborns and demonstrates their ability to focus on faces and visual stimuli.

Contentment and Crying: Destiny is content and cries only when she is hungry or in need of a diaper change. Crying is a normal communication method for newborns to express their needs.

Rooting Reflex: When Destiny is hungry, she brings her hand to her mouth and starts sucking on her fist. This behavior is known as the rooting reflex, a natural response that helps newborns find the nipple for feeding.

Sleep Patterns: After feeding, Destiny falls asleep immediately, which is a normal sleep pattern for newborns. Newborns sleep for most of the day and night and may wake up for feeding and diaper changes.

Startle Response: When the telephone rings loudly, Destiny does not appear to respond to the sound by moving her extremities or awakening briefly. This lack of response is indicative of the startle reflex, a typical newborn behavior where sudden loud noises may cause a brief startle response.

Destiny’s behaviors do not raise any immediate concerns. However, it is essential for the nurse to conduct further assessments to ensure her well-being and development. One concern that may arise is related to Destiny’s lack of response to the loud sound of the ringing telephone. This lack of response could indicate a possible hearing impairment or an issue with her auditory system.

As the nurse, to assess Destiny’s hearing further, I would conduct a hearing screening using an age-appropriate method. One common method is the otoacoustic emissions (OAE) test, which measures the response of the cochlea in the inner ear to sound stimulation. Another option is the auditory brainstem response (ABR) test, which evaluates the auditory nerve and brainstem’s response to sound. These screening tests can help identify any potential hearing issues that may require further evaluation by an audiologist or pediatric specialist.

In addition to hearing assessment, the nurse should also conduct routine developmental assessments to ensure Destiny’s overall growth and development are progressing as expected. Developmental assessments may include evaluating her milestones, motor skills, and social interactions. Regular developmental monitoring allows for early identification of any developmental delays or concerns, enabling timely interventions and support.

Conclusion

Destiny’s behaviors are typical for a newborn, demonstrating alertness, contentment, and normal responses to stimuli. However, her lack of response to the loud sound of the telephone ringing may raise concerns about her hearing. Conducting further hearing and developmental assessments will help ensure her well-being and identify any potential issues that may require intervention. As the nurse, providing comprehensive and early assessments is essential in supporting Destiny’s healthy growth and development.