Professional Documents
Culture Documents
Noticing
Upon doing an assessment, I noticed that this baby was the floppiest baby I had ever handled. He had absolutely no
muscle tone which made doing his care rather difficult due to the handling. His lungs had almost no lung sounds and the
baby had serious subcostal and substernal retractions.
This was my first time ever having a patient that had seizures. In school we really only learn about seizures that adults are
experiencing so I followed my nurse’s lead most of the time. The main differences I noticed between this newborn and
the adults we learn about was the movements as well as interventions performed. The newborn had a sort of backwards
circular arm stroke as his seizure rather than a whole body twitching. Also with adults you turn them on their side and
administer ativan or some benzodiazepine right after they stop seizing. With the newborn, we have to keep them in the
crib and we don’t have them supine but we don’t exactly turn them on their sides either. We tried to hold the baby’s arms
down but we were unable to. We took note and documented the length of the seizure and what signs the baby was
exhibiting but we mainly just observed so we were able to fully inform the doctor after the fact.
Interpreting
Describe the clinical judgment or clinical reasoning that you performed. The example should include alternatives you
considered, and rationale for your decision.
I mainly followed my nurse’s lead during this situation because I had never had experience with a seizing adult let alone a
baby. We followed up with the doctor and gave a full report. The doctor then prescribed Phenobarbital for the baby
which we started administering that afternoon and dosage was based upon the newborn’s weight. The doctor had
discussed us giving Ativan but due to the baby’s diminished lung capacity and expansion, the risks outweighed the
benefits and we went with the Phenobarbital.
Responding
What written evidence have you drawn upon for the care of your patient in this example? Provide cites/references.
Nielsen, A., Stragnell, S., & Jester P (2007). Guide for reflection using the Clinical Judgment Model. Journal of Nursing
Education, 46(11), p. 513-516.