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Written Case 5

ACT NOW ESC During Training (ESC Care Tool) Written Case 5

Read Written Case 5 before completing the assessment. Enter your information below and click “Start” to begin the assessment. 

*Note: If you did not enter credentials to log in to this training, you must complete all fields below to receive full credit. For assistance, contact Catrice Banks-Johnson.

*Click the link below the case to download the document.

Nurse/Provider Sign-out

  1. 3-day-old baby girl born at 39 weeks to 35 year-old G3, P3 mom on buprenorphine for history of opioid use disorder. Mom in recovery since birth of her first child 4 years ago. No concerns for illicit substance use in pregnancy.
  2. Mom on Paxil for depression and anxiety; mom has counselor she is well connected with through her PCP’s office. PCP is mom’s buprenorphine prescriber.
  3. Baby with tremors, hypertonia, and increased Moro on first day. On 2nd day, tone and Moro within normal limits and only mildly jittery when unswaddled or not skin-to-skin with mom. In past day, mom hasn’t noticed a difference in baby’s tone or jitteriness. Mom is holding baby skin-to-skin often and breastfeeding ad lib. Newborn team thinks baby slightly jitterier today with mildly increased tone noted.
    • Baby had difficulties feeding on 1st day with spitting up colostrum. Spitting resolved by 24 hrs. Baby then feeding well at breast. In past day, breastfed 9 times, 4 voids/stools. Stools now yellow and seedy. Weight down 6%.
  4. On last assessment approximately 3 hrs. ago: vital signs stable. Jaundiced to face. Baby fussy with slight increase in muscle tone and tremors on exam. Symptoms improve as soon as baby is picked up.
  5. Mom’s sister has been here helping (when father of baby is at work). Maternal grandmother is helping to care for mom’s 2 other children at home.
  6. Mom received prenatal education from her PCP’s office. Hospital staff stressing the importance of rooming-in, skin-to-skin contact, and breastfeeding and how these will help her baby go home sooner. Mom keeping baby with her all the time in a calm, quiet room, spending lots of time holding baby skin-to-skin when she is awake. Mom’s sister holds the baby when mom is sleeping (and takes naps herself when mom is awake and caring for baby).

In-room Assessment

  1.  Mom asleep in bed, baby’s aunt is holding baby and helps wake mom up when the RN comes in.
  2. Baby slept for 2 hrs. after feeding with her aunt holding her. Mom able to nap during this time.
  3. Baby was fussy when woke up and cried through diaper change with tight muscle tone and tremors.
  4. Was able to calm down after a few minutes of skin-to-skin time with mom.
  5. After calming, baby breastfed well for 15 min on left and 10 min on right. Upon RN’s specific questioning, mom shares that baby latched within a few min.
  6. Last stool was watery and green, and baby just sneezed 4 times in a row. Vitals signs are stable.
  7. Baby gets fussy as soon as put in bassinet and breaks out of swaddle. Calms within a few minutes and stays consoled once picked up and held.

Written Case 5 Rating Sheet

Written Case 5

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