Ch 9 The High-Risk Newborn and Family
The home care nurse is visiting a 6-month-old infant with bronchopulmonary dysplasia (BPD). The nurse assesses the child for which signs of overhydration?
-Edema -Weight gain of 1 lb in 1 week
The nurse is monitoring an infants temperature to avoid cold stress. The nurse understands that cold stress in the infant can cause which complications?
-Hypoxia -Hypoglycemia -Metabolic acidosis
The nurse is caring for a neonate with an intraventricular hemorrhage. What interventions should the nurse avoid to prevent any increase in intracranial pressure?
-Keeping the head of the bed flat -Suctioning the endotracheal tube frequently
The nurse is positioning a preterm neonate. What are therapeutic positions the nurse should implement?
-Neutral or slightly flexed neck -Trunk slightly rounded with pelvic tilt -Hips partially flexed and adducted to near midline
The nurse is caring for a neonate on positive-pressure ventilation. The nurse monitors for which complications of positive-pressure ventilation?
-Pneumothorax -Pneumomediastinum -Pulmonary interstitial emphysema
The nurse is teaching parents of a bottle-fed preterm infant techniques to facilitate feeding. Which techniques should the nurse include?
-Recognize the infants limits -Prepare a calm, quiet area for the feeding -Ensure a restful environment between feedings
The neonatal intensive care nurse is caring for a neonate born at 36 weeks of gestation in an incubator. Which actions should the nurse plan to assure adequate skin care for the neonate?
-Removing adhesives or skin barriers slowly -Applying emollient as needed for dry, flaking skin -Using cleanser or soaps no more than two or three times a week
The nurse is admitting a drug-exposed newborn to the neonatal intensive care unit. The nurse should assess the newborn for which signs of withdrawal?
-Tremors -Nasal stuffiness -Loose, watery stools
The nurse is caring for an infant born at 37 weeks of gestation of a nondiabetic mother just admitted to the neonatal intensive care unit for observation. The nurse notes that which lecithin/sphingomyelin (L/S) ratio obtained before delivery indicates no risk of respiratory distress syndrome (RDS)?
2:1
The nurse is placing an infant in a servocontrol radiant warmer. The nurse should attach the temperature probe to which area of the infants body?
Abdomen
What signs should the nurse expect when a pneumothorax occurs in an infant on mechanical ventilation?
Abrupt duskiness or cyanosis
A mother planned to breastfeed her infant before giving birth at 33 weeks of gestation. The infant is stable and receiving oxygen. What is the most appropriate nursing action related to this?
Assess the infants readiness to breastfeed
What are possible premature infant complications from oxygen therapy and mechanical ventilation?
Bronchopulmonary dysplasia and retinopathy of prematurity
What is an essential component in caring for the very low or extremely lowbirth-weight infant?
Coordinating care to reduce environmental stress
A newborn is diagnosed with retinopathy of prematurity. What should the nurse know about this condition?
Cryotherapy and laser therapy are effective treatments
What can stroking infants who are physiologically unstable result in?
Decreased oxygen saturation
Which is a central factor responsible for respiratory distress syndrome in a newborn?
Deficient surfactant production
The nurse is providing care to a preterm infant. Which characteristic of daily care should be considered supportive?
Directed toward development of sleep organization
A preterm neonate has begun breastfeeding, but the infant tires easily and has weak sucking and swallowing reflexes. What is the most appropriate nursing intervention?
Feed the remainder of breast milk by the orogastric route.
What is the most common cause of iatrogenic anemia in preterm infants?
Frequent blood sampling
A preterm infant of 33 weeks of gestation is admitted to the neonatal intensive care unit. Approximately 2 hours after birth, the neonate begins having difficulty breathing, with grunting, tachypnea, and nasal flaring. What should the nurse recognize?
Further evaluation is needed
Women who smoke during pregnancy are most likely to have infants who are what?
Growth restricted in weight, length, and chest and head circumference
The parents of an infant who has just died decide they want to hold the infant after their infant has gone to the morgue. What is the most appropriate nursing intervention at this time?
Have the infant brought back to the unit, wrapped in a blanket, and rewarmed in a radiant warmer.
What should the nurse anticipate in an infant who was exposed to cocaine during pregnancy?
Hypertonia and jitteriness
What explains why a neutral thermal environment is essential for a high-risk neonate?
It permits the neonate to maintain a normal core temperature with minimum oxygen consumption.
The nurse has been caring for an infant who has just died. The parents are present but appear to be afraid to hold the dead infant. What is the most appropriate nursing intervention?
Keep the infants body available for a few hours in case they change their minds.
A woman in premature labor delivers an extremely lowbirth-weight (ELBW) infant. Transport to a neonatal intensive care unit is indicated. The nurse explains that which level of service is needed?
Level IIIB
What is a priority of care for an infant with an intraventricular hemorrhage?
Minimize interventions that cause crying
A preterm infant who is being fed commercial formula by gavage has had an increase in gastric residuals, abdominal distention, and apneic episodes. Which is the most appropriate nursing action?
Notify the practitioner
What does the nursing care for infants with fetal alcohol syndrome (FAS) include?
Nutritional guidance
Which is a characteristic of postmature infants?
Parchment-like skin
The nurse is caring for a preterm neonate who requires mechanical ventilation for treatment of respiratory distress syndrome. Because of the mechanical ventilation, the nurse should recognize an increased risk of what?
Pneumothorax
The nurse is caring for a newborn who was born at 35 weeks of gestation and is considered a late preterm infant. What intervention should be included in the infants care plan?
Promote skin-to-skin care in the immediate postpartum period
The nurse is preparing to administer a gavage feeding to an infant. The nurse should place the infant in which position for the feeding?
Prone with the head slightly elevated
A preterm infant is being fed by gavage. What is an important consideration for this infant?
Provide a pacifier for nonnutritive sucking during bolus feeding
While a mother is feeding her high-risk neonate, the nurse observes the neonate having occasional apnea, pallor, and bradycardia. What is the most appropriate nursing actio
Recognize that this may indicate an underlying illness
The nurse knows that during deep sleep the neonate should not be disturbed if possible. Characteristics of deep sleep include what?
Regular breathing
Which is an important nursing action related to the use of tape or adhesives on premature neonates?
Remove adhesives with water, mineral oil, or petrolatum
The nurse is caring for a high-risk neonate who has an umbilical catheter and is in a radiant warmer. The nurse notes blanching of the feet. Which is the most appropriate nursing action?
Report the findings immediately to the practitioner.
Which refers to an infant whose rate of intrauterine growth has slowed and whose birth weight falls below the 10th percentile on intrauterine growth charts?
Small for gestational age
The nurse is caring for a 3-week-old boy born at 29 weeks of gestation. While taking vital signs and changing his diaper after stooling, the nurse observes his color is pink but slightly mottled, his arms and legs are limp and extended, he has the hiccups, his respirations are deep and rapid, and his heart rate is regular and rapid. The nurse should recognize these behaviors as signs of what?
Stress
What is a characteristic of most neonatal seizures?
Subtle and barely discernible
What is most descriptive of the signs observed in neonatal sepsis?
Subtle, vague, and nonspecific physical signs
Which statement best describes the characteristics of preterm infants?
Sucking reflex is absent, weak, or ineffectual.
The nurse is caring for a neonate with respiratory distress syndrome. The infant has an endotracheal tube. What should nursing considerations related to suctioning inclu
Suctioning should not be carried out routinely.
In about 1 week, a stable preterm infant will be discharged. The nurse should teach the parents to place the infant in which position for sleep?
Supine
The nurse is attending a delivery of a full-term infant with meconium noted in the amniotic fluid. The nurse should understand that what action should be performed in the delivery room?
The infants mouth, nose, and posterior pharynx will be suctioned just after the head is delivered while the chest is still compressed in the birth canal
An infant of a mother with herpes simplex infection has just been born. What should nursing considerations include?
The mother and infant should be together in a private room
The nurse is planning care for a family expecting their newborn infant to die because of an incurable birth defect. What should the nurses interventions be based on?
The parents should be given the opportunity to parent the infant, including seeing, holding, touching, or talking to the infant in private.
Which statement is true concerning the nutritional needs of preterm infants?
The secretion of lactase is low.
A preterm infant with respiratory distress syndrome is receiving inhaled nitric oxide (NO). What is the reason for administering the inhaled nitric oxide?
To reduce pulmonary vasoconstriction and pulmonary hypertension
When caring for a neonate in a radiant warmer, what should the nurse be alert to?
Transepidermal water loss leading to dehydration
The neonatal intensive care nurse is planning care for an infant in an incubator. Which interventions should the nurse plan to assure therapeutic visual stimulation for the neonate?
Use an incubator cover.
The health care provider has prescribed surfactant, beractant (Survanta), to be administered to an infant with respiratory distress syndrome (RDS). The nurse understands that the beractant will be administered by which route?
Via the ET tube
The nurse is caring for a preterm infant who is receiving caffeine citrate for treatment of apnea of prematurity. What signs should indicate caffeine toxicity?
Vomiting and irritability
Parents of an infant born at 36 weeks gestation ask the nurse, Will our infant need a car seat trial before being discharged? What is the nurses best response?
Yes, to monitor for possible apnea and bradycardia while in the seat.
