NU143CL Unit 5 Clinical Journal Example

Pauses That Were Normal: A Clinical Journal Working Rolfe's Three Questions Through a Composite Moment When a Student Counting a Newborn's Breaths Saw Pauses and Blue Hands and Nearly Called for Help

[Student Name]

Purdue University Global

NU143CL: Maternal Infant Nursing Clinical

Unit 5 Clinical Journal

[Instructor Name]

[Date]

The newborn and staff are composite; values are bracketed where illustrative, and no records of time or evaluation are reproduced.

What?

On my third clinical day I was assigned the newborn of a couplet, a composite boy [26] hours old, born at 39 weeks. I counted his breathing for a full minute while he slept. For about twenty seconds he breathed quickly, then stopped for what felt like a long time, [six] or [seven] seconds, then started again. His hands and feet were bluish and cool. My heart rate went up faster than his. I reached for the call light and asked my nurse to come in.

She came, watched him for a minute with me, placed her hand on his chest and looked at his lips and tongue. His lips were pink, his chest rose evenly when he breathed, his heart rate was [128] and his saturation on a quick check was [98] percent. She explained that what I had seen was periodic breathing and acrocyanosis, both common in newborns.

So What?

Periodic breathing is a pattern of breathing with short pauses, usually under ten seconds, that is common in the first weeks because the newborn's breathing control in the brain is immature. It differs from apnea, which is a pause of twenty seconds or more, or a shorter pause with color change or a slow heart rate (Perry et al., 2022). Acrocyanosis, bluish extremities while the lips and body stay pink, comes from immature circulation in the extremities and is expected in the first day or two. Central cyanosis, blue lips, tongue or trunk, is not normal and needs immediate attention.

I had the right instinct to call and the wrong reason; the pauses and blue hands were normal, but I did not yet know which signs would have meant they were not.

What I saw was normal, and what I did was not wrong; calling when unsure is safer than waiting. But I had reacted to the features that alarm adults without checking the features that distinguish normal from abnormal in a newborn: how long the pause lasts, what happens to color centrally and to the heart rate. My nurse checked exactly those three things. She also showed me something about my own state. When I am anxious, my sense of time stretches; the pause I thought lasted many seconds was, when she timed the next one on her watch, [five] seconds. Timing with a watch rather than counting in my head is part of an accurate assessment, especially when the finding is one that frightens me. Looking back, I think part of my reaction came from my own experience: my nephew had a breathing scare as a baby, and the memory came back the moment I saw the pause. Knowing that helps me understand why I reacted so quickly, and why I need the objective checks to keep a memory from deciding for me.

Now What?

From now on in this rotation I plan to count newborn breathing for a full minute, note the longest pause in seconds, and check central color at the lips and tongue and the heart rate whenever I see a pause or blue extremities. I will call if a pause lasts twenty seconds or more, or if any pause comes with color change or a slow heart rate. I have written those thresholds on a card in my pocket. I also want to keep calling when unsure; my nurse said she would rather come for something normal than miss something real.

Rolfe's model asks what happened, what it means and what to do next, and the last question kept the journal from ending at embarrassment (Rolfe et al., 2001). The parents had been watching me, so I asked my nurse whether I could explain periodic breathing to them. She agreed, and I told them what I had just learned: short pauses are common, and the signs to call about are long pauses, blue lips or a baby who will not wake. They said they had noticed the pauses the night before and been afraid to ask.

What I Still Wonder

I want to learn more about how periodic breathing changes over the first weeks, and why some babies have it more than others. I also want to know how safe sleep teaching fits with it, since parents who see pauses at home may be tempted to bring the baby into their bed (Potter et al., 2023).

References

Perry, S. E., Hockenberry, M. J., Cashion, K., Alden, K. R., Olshansky, E., & Lowdermilk, D. L. (2022). Maternal child nursing care (7th ed.). Elsevier.

Potter, P. A., Perry, A. G., Stockert, P. A., & Hall, A. M. (2023). Fundamentals of nursing (11th ed.). Elsevier.

Rolfe, G., Freshwater, D., & Jasper, M. (2001). Critical reflection for nursing and the helping professions: A user's guide. Palgrave.