Perinatal Case – Hyperbilirubinemia

Perinatal Case – Hyperbilirubinemia

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 labor and baby Rodrigo was born weighing 2900 gms
after 15 hours of labor. Her delivery included an epidural, augmentation due to failure to
progress and vaginal delivery with failed forceps, vacuum extraction assistance, and 2nd degree
lacerations; the pages 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.

1. Describe and provide a rationale on what you will include in Maritzia’s perinatal
assessment under the following components:
a. Physical assessment in the first trimester and postpartum period
b. Laboratory tests/screening in all trimesters and the postpartum period
2. Identify and describe four (4) priority risk factors and four (4) priority health concerns
that relate to Maritzia throughout the perinatal period. Provide a rationale for your choices.
3. Discuss three (3) priority nursing interventions and three (3) priority health promotion/
teaching strategies that should be included when caring for Martizia throughout her
perinatal experience. Provide a rationale for each.
4. 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.
5. Identify and describe which family form Maritzia is a part of.
Identify and describe two (2) main social determinants of health impacting Maritzia’s
perinatal experience.
Discuss two (2) ways that you will provide culturally competent/sensitive care and two
(2) ways that you will incorporate core concepts of family-centered care when looking
after Maritzia and her family. Provide a rationale for your responses