newborn baby is always a source of joy but the older siblings need to be
well prepared for the new member of the family to avoid the harmful effect of sibling rivalry.
Sibling adaptation refers to the way siblings need to be transformed or behave so as to get used
to the newborn baby. Various mechanisms need to be applied to make siblings get used to the
new environment favorably. The sibling needs to get used to the new environment since more
attention will be given to the new born baby and will possible feel abandoned or ignored (Perry,
Hockenberry, Lowdermilk & Wilson, 2014).
Question 2: Reactions of siblings to a new born baby
Siblings often show rivalry when a new baby is introduced into the family. The delivery
of a new baby makes older siblings feel unloved, angry, displaced and frustrated. The reactions
of siblings towards the birth of a new baby include being aggressive toward the newborn,
CASE STUDY 3
regression of behavior, engaging in attention seeking behavior, as well as showing some degree
of independence and maturity (Perry et al., 2014)
Question 3: The negative behavioral changes
Problematic behaviors shown by siblings following the introduction of a new baby
includes anxiety, withdrawal, aggressiveness, bed wetting and dependency. Siblings often
engage in aggressive behaviors to seek the attention of their parents (Nursing, 2007).
Question 4: The positive behavioral changes
Positive behaviors that can be portrayed by the older siblings include independence,
maturity, as well as showing love and support to the new baby and the parents. Siblings can offer
to assist the new born baby in various ways (Perry et al., 2014).
Question 5: Eric’s behavior
The behavior of Eric towards the baby is negative since it is very aggressive and could
possibly harm the baby.
Question 6: Sibling rivalry
It refers to the intense competition between siblings with the sole purpose of seeking
attention from the parents.
Question 7: Strategies of making the siblings accept the new baby
The management of sibling rivalry includes the implementation of the following
measures: equal treatment of siblings; separation; an open parent to child communication;
distraction; and establishing a supportive environment for nurturing the children (Nursing, 2007).
CASE STUDY 4
Question 8: The relevant nursing diagnosis
Nora needs to provide a supportive and secure environment that makes each child feel
loved so as to avoid the destructive effect of sibling rivalry. She needs to provide adequate care
for the older sibling to make him/her feel part of the family (Perry et al., 2014).
Question 9: The goal of resolving the problem
One of the main goals of resolving problems associated with the delivery of the new baby
is to ensure a peaceful co-existence in the family by minimizing feelings of animosity, jealousy
and aggressiveness (Nursing, 2007).
Question 10: Intervention
The older sibling needs to be separated from the new born baby until such a time when
the sibling will be friendly to the baby.
Part B
Question 1: Breast and vulva examination
The examination of breast and vulva of a woman is an important aspect of a woman’s
personal health. A woman should be in a position to periodically examine her breast and vulva.
The self-examination is important in identifying physical changes which may indicate
abnormalities.
Self-examination of breast
A Breast Self-Examination (BSE) needs to be conducted monthly immediately after the
end of the menstrual cycles. This is to determine the initial normal feelings and any changes
CASE STUDY 5
during the checkup. The examination is conducted visually and manually. The visual
examination involves checking for the following on a mirror (Perry et al., 2014):
The puckering of the nipple or skin
Any abnormal changes in the nipple such as reddening, fluid discharge, and the pointing
of nipples in different direction.
Differences in the shape of the breasts such as the bulging or flattening in one breast
The examination of breast should be done through touch. A woman should feel her breast
and identify any changes.
Self-examination of Vulva
This is a simple procedure that assists in the identification of sexually transmitted
diseases. The vulva refers to the external part of the vagina. This procedure involves undressing
and examination of the genitals which is covered with pubic hairs. A mirror can be used to assist
in seeing the whole vulva area. The pubic hair should be spread out to check for blisters, red
sores and warts. The hood of the clitoris can be checked by spreading the outer lips of the vagina.
A woman should check for warts, sores, bumps and blisters in the clitoris. Any abnormal
discharge in the vagina should be noted during the checkup. The examination involves checking
all sides of the vaginal lips, as well as the vaginal and urinary opening (Perry et al., 2014).
Question 2: Reducing HIV transmission from mother to child
Since Martha is pregnant, and she is HIV positive, she should be involved in the
prevention of mother to child transmission (PMTCT), to avoid the risk of transmitting the virus
to her child. A combination of preventive measures referred to as the (PMTCT) is significant in
CASE STUDY 6
reducing the risk of HIV transmission from mother to child. PMTCT involves a combination of
measures such as anti-retroviral therapy (ART), safe feeding of infant and ensuring good hygiene
during delivery. ARV should be availed or both the mother and the newborn child.
Question 3: The importance of water during pregnancy
It is essential for a pregnant woman to be fully hydrated since more water is required to
cope up with the changing demands of the body during the period of pregnancy. Water keeps the
blood cells healthy and the body hydrated. Water is the main component of the breast milk, and
is also important for proper lactation. Dehydration during pregnancy causes the following
symptoms: dizziness, headaches, cramps, nausea and edema. In the third trimester, dehydration
can lead to contraction that may stimulate preterm labor. Since water is very important during
pregnancy, Beth, who is 6 months pregnant, should take more water. She needs to urinate
frequently and need not to hold back her urine for being tired of going to the bathroom. Betha
needs to put in place an improvised urinal container which is emptied once a day after filling it
with urine (Perry et al., 2014).
CASE STUDY 7
References
Perry, S. E., Hockenberry, M. J., Lowdermilk, D. L., & Wilson, D. (2014). Study Guide for
Maternal Child Nursing Care (5th Edition ed.). New York: Elsevier Health.
Nursing. (2007). Ambler, PA: Lippincott Williams & Wilkins.