Robin is a staff RN for our unit who exemplified superior nursing knowledge and strong assessment skills regarding our newborn patient. During her initial shift assessment, she noted the change of skin color of the newborn. Baby Girl is a TAGA female born on via C-section 2/2 hand presentation with nuchal cord x 3 around body from a 38 year old G10P1 mother at 39 weeks gestation. Mother received prenatal care at another facility. Complications during pregnancy include: a history of 9 miscarriages, PIH, thrombocytopenia (117), obese, PCOS, and sickle cell trait. Complications during delivery include: hand presentation and nuchal cord x 3. Negative maternal serologies and GBS negative. MBT O+, IAT negative, BBT B+, DAT negative. AROM 12 hours prior to delivery with meconium stained fluid. Apgars 8/9 at 1/5 minutes. At 20 hours of life, the newborn had early jaundice to the level of the thigh. Serum BUBC 22.1/0.4. H/H 13.8/39 and retic 16%. Patient feeding well with stools noted. No voids. No signs of lethargy or neurologic deficits. Called faculty and transferred to NICU for further management. Our standard of care is to check the bili level at 24 hours of life. I am impressed with Robin's skill of assessment of the newborn. Mother is Nigerian with dark skin tone. It would have been difficult for anyone to determine the color change of jaundice. Robin came up to me and said, "The baby is green, from head to torso." She immediately took action and did the TcB. It did not register. She then got the order for the BUBC and encouraged mom to feed her baby. The lab results were significate. Our doctors were informed and the infant was transferred to the NICU for a blood transfusion. Early detection and early intervention were made possible by Robin's critical thinking and advocacy. Robin floats to other areas and represents our MBU. I am glad she is on our team.
Robin Bierman, RN
Mother Baby Unit
University of Texas Medical Branch-Galveston and Ambulatory Care
Early detection and early intervention were made possible by Robin's critical thinking and advocacy.