Chapter 20
Sibling Adjustments to a Newborn
Please answer the questions by the numbers
Please read the case study. After answering each question provide rationale for the response. Questions 8,9,10 are planning questions.
Nora is a 36-year-old G3 P2 who delivered her second child by repeat c/section 1.5 years ago. She tried to prepare her 15-month-old son, Eric, for the arrival of the new baby. Nora put a baby doll in the crib, the baby seat, and the baby swing. When she showed the doll to her son, Nora would say “nice” and gently pat the baby. Eric would say “nice” and pat the baby like his mother. Yet, the first thing that Eric did when he saw his baby brother in his mother’s arms at the hospital was cry and then he tried to hit the baby. Nora is now 6 months pregnant and she has made an appointment with the nurse practitioner at her pediatrician’s office to discuss effective ways of dealing with sibling rivalry.
1. What is sibling adaptation?
2. How do siblings react toward the arrival of the baby?
3. What are negative behavioral changes of siblings?
4. What are positive behavioral changes of siblings?
5. Nora tells the nurse that her son cries and throws his toy trucks into the crib and playpen. She had to attach a cargo net over the playpen and closes the door when the baby is sleeping in his crib for safety reasons. Is Eric’s behavior toward the baby considered negative or positive?
6. What is sibling rivalry, and why does it occur?
7. What are strategies for facilitating sibling acceptance of a new baby in this case?
8. Write one nursing diagnosis relevant to the case study above.
9. Write one goal for the client(s) to resolve or reduce the problem identified.
10. Write one intervention to help the client(s) reach the goal (must be relevant and active).
Case Study
Part A
Question 1: Sibling adaptation
The delivery of a 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, 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).
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 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 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).
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.