Chapter 24: Nursing Management of the Newborn at Risk: Acquired and Congenital Newborn Conditions

A nurse makes a home visit to a new mother and her 5-day-old newborn. Assessment of the newborn reveals slight yellowing of the skin on the face and forehead and slowed skin turgor. The mother tells the nurse that she's been having trouble breastfeeding the newborn. "My baby's been feeding about every 4 to 5 hours." Additional assessment reveals about 3 wet diapers per day and 1 to 2 stools per day. Which action by the nurse would be the priority?

Call the provider to obtain a prescription for a bilirubin level.

A nurse is assigned to care for a newborn with hyperbilirubinemia. The newborn is relatively large in size and shows signs of listlessness. What most likely occurred?

The infant's mother probably had diabetes.

The nurse is caring for a neonate with an exstrophy of the bladder. When the nurse is planning care, which client goal is the priority?

The neonate will be free from infection.

The nurse is caring for a preterm neonate and has chosen the following goal: improvement of the neonate's respiratory function. Which expected outcome is most appropriate for the first week?

The neonate will not use accessory muscles when breathing.

The NICU nurse is caring for a preterm neonate with respiratory distress syndrome on mechanical ventilation. Which assessment data would alert the nurse that a pneumothorax might have developed? Select all that apply.

The neonate's respiratory rate is 68. Neonate is exhibiting nasal flaring and grunting. The neonate's chest is asymmetrical with decreased breath sounds on one side.

Which assessment finding within the first 24 hours of birth requires immediate health care provider notification?

The skin is jaundiced.

The nurse is examining a newborn and notes that there is bruising and swelling on the newborn's head, limited to the right side of the scalp and does not cross the suture lines. How will the nurse interpret this finding?

This is a cephalohematoma that typically spontaneously resolves without interventions.

The nurse is admitting to the nursery a newborn of a mother who continued to drink alcohol during her pregnancy. Which finding does the nurse predict to encounter on the newborn's assessment?

Hyperactive and irritable

A nurse is caring for a preterm newborn born at 29 weeks' gestation. Which nursing diagnosis would have the highest priority?

Ineffective thermoregulation related to decreased amount of subcutaneous fat

A preterm newborn is noted to have hypotonia, apnea, bradycardia, a bulging fontanel (fontanelle), cyanosis, and increased head circumference. These signs indicate the newborn has which complication?

Intraventricular hemorrhage (IVH)

A client with group AB blood whose husband has group O blood has just given birth. Which complication or test result is a major sign of ABO blood incompatibility that the nurse should look for when assessing this neonate?

Jaundice within the first 24 hours of life

Which nursing measure is most effective in reducing newborn infections?

Maintain medical asepsis while providing care.

At birth, a neonate is diagnosed with brachial plexus palsy. The parent asks how the nurse knows the neonate's positioning of the arm is a result of the palsy and not just a preferred position. The nurse would show the parent that the neonate has asymmetry of which neonatal reflex?

Moro

The nurse is caring for a neonate with epispadias. In which location will the nurse assess the anomaly?

On the dorsal end of the penis

A newborn, born at 33 weeks' gestation, is on a ventilator in the neonatal intensive care unit (NICU). The newborn receives surfactant therapy. Which would the nurse expect to assess as a positive response to this therapy?

Oxygen saturation of 98%

Which intervention is helpful for the neonate experiencing drug withdrawal?

Place the isolette in a quiet area of the nursery.

The nurse is caring for a neonate. Which is the most important step the nurse can take to prevent and control infection?

Practice meticulous hand washing.

A nurse is assigned to care for a newborn with esophageal atresia. What preoperative nursing care is the priority for this newborn?

Prevent aspiration by elevating the head of the bed and insert an NG tube to low suction

Which environmental consideration is most helpful to promoting comfort when the neonate is withdrawing from alcohol and drugs?

Provide a dark, quiet environment

An infant is suspected of having persistent pulmonary hypertension of the newborn (PPHN). What intervention implemented by the nurse would be appropriate for treating this client?

Provide oxygen by oxygen hood or ventilator.

Which nursing action is required when caring for the post-term infant?

Serial blood glucose levels

Four weeks before the birth of a client's already large child, the health care provider has told the client that if the baby gets bigger and the baby's lungs are ready, a cesarean birth is preferred. The woman asks the nurse what the downside is to having a cesarean rather than a vaginal birth. What is an appropriate response by the nurse?

"As the baby passes through the birth canal some of the excess fluid is expelled from the lungs, if that doesn't happen there's a higher risk of respiratory distress."

Which congenital condition is an immediate emergency requiring notification of the health care provider?

Tracheoesophageal fistula

The nursing instructor is teaching a session on techniques that the nursing students can use to properly address concerns of parents with children who are born with a cleft lip and palate. The instructor determines the session is successful when the students correctly choose which nursing intervention as being the most effective in these situations?

Use reflective listening with nonjudgmental support.

A woman gave birth to a healthy term newborn about 2 hours ago. She asks the nurse about the appearance of her newborn's head. Assessment reveals swelling of the head that extends across the midline. Which response by the nurse would be appropriate?

"The swelling in your newborn's head is due to the head pressing against your cervix during labor and birth. It will go away on its own in a few days."

A newborn boy is diagnosed with esophageal atresia and tracheoesophageal fistula. After the nurse provides preoperative teaching, which statement indicates that the parents need additional teaching?

"We can probably start feeding him with the bottle about a day after the surgery."

A nurse is concerned that a 1-day-old newborn is becoming ill and may be septic. What sign of distress would validate the nurse's concerns?

Temperature instability

A nursing instructor is teaching about newborn congenital disorders and realizes that the student needs further instruction after making which statement?

All congenital disorders can be diagnosed at birth.

As the nurse examines the birth records, which newborn would the nurse expect to monitor closely for respiratory distress syndrome (RDS)?

a term male newborn, born by a repeat cesarean birth, whose mother has diabetes mellitus It is necessary to review the maternal history for risk factors associated with RDS. Risk factors in the term infant placing the infant at most risk include a cesarean birth in the absence of preceding labor, male gender, and maternal diabetes, which produces high levels of insulin which inhibit surfactant production. The other infant situations would not be the priority.

A nurse is reading a journal article about birth defects and finds that some birth defects are preventable. Which risk factor would the nurse expect to find as being cited as the current leading preventable cause of birth defects?

alcohol

The nurse is providing care to a newborn with macrosomia who has sustained a midclavicular fracture. When reviewing the mother's labor and birth record, the nurse notes the following information: Breech birth Amniotomy APGAR score: 7 at 1 minute; 8 at 5 minutes Oxytocin augmentation Which information would the nurse correlate with the newborn's current injury?

breech birth

What is the term for a small collection of blood that forms underneath the skull as a result of birth trauma?

cephalhematoma

A nurse is caring for a newborn who was diagnosed with an imperforate anus. Assessment reveals drooling, copious bubbles of mucus in mouth, rattling respirations, and abdominal distention. During feeding, the newborn coughs and becomes cyanotic. Which action by the nurse would be appropriate?

clear airway

The nurse is teaching the parents of a newborn who was born with a high type of imperforate anus the care the newborn will need at home after surgery. The parents need to be aware that the newborn will require which measure temporarily?

colostomy

The nurse is caring for an infant born to a mother with cocaine use disorder during her pregnancy. The nurse would likely notice that this infant:

cries when touched.

When providing postpartum teaching to a couple, the nurse correctly identifies what time as when pathologic jaundice may be found in the newborn?

during the first 24 hours of life

A woman with hydramnios has just given birth. The nurse recognizes that the infant must be assessed for which condition?

esophageal atresia

The nurse observes a newborn experiencing coughing, choking, and unexplained cyanosis during feeding. These are classic signs of what condition?

esophageal atresia

Which physical features are characteristic in a neonate born with fetal alcohol spectrum disorder? Select all that apply.

flattened nasal bridge eyelid folds small height and head circumference. low birth weight

A newborn admitted to the neonatal intensive care unit is diagnosed with persistent pulmonary hypertension of the newborn (PPHN). What findings in the mother's prenatal history would best correlate with this diagnosis?

fluoxetine use during last trimester of pregnancy

The newborn nursery nurse suspects a newborn of having neonatal abstinence syndrome. What assessment findings would most correlate with the diagnosis?

frequent yawning and sneezing

A newborn requires resuscitation secondary to asphyxia. The resuscitation team frequently assesses the newborn's response and continues resuscitation efforts based on which assessment finding?

heart rate of 70 beats/min

A newborn has not passed any stools in the first 24 hours after birth, and his abdomen is becoming distended. The nurse recognizes that which condition could explain such findings?

imperforate anus

What would the nurse expect to prioritize in the assessment of a newborn who has a positive Coombs test?

jaundice development

A nurse is caring for a 25-year-old G1P0 at 37 weeks' gestation. The client's history indicates that the client has had alcohol abuse disorder throughout their pregnancy. What signs and symptoms does the nurse expect the newborn to exhibit?

jitteriness flat midface Thin upper lip high-pitched, shrill cry

While caring for a neonate born of a mother with diabetes, the nurse should monitor the neonate for which complication?

macrosomia

A newborn is diagnosed with respiratory distress syndrome (RDS). While assessing the newborn, the nurse realizes that which maternal factor would most place the infant at risk for RDS?

maternal gestational diabetes Prolonged rupture of membranes, gestational or chronic maternal hypertension, maternal narcotic addiction, and the use of prenatal corticosteroids reduces the newborn's risk for RDS because of the physiologic stress imposed on the fetus. Chronic stress experienced by the fetus in utero accelerates the production of surfactant before 35 weeks' gestation and thus reduces the incidence of RDS at birth. Maternal diabetes produces high levels of insulin that inhibits surfactant production thus placing the newborn more at risk for developing RDS.

A nurse is caring for a newborn whose chest X-ray reveals marked hyperaeration mixed with areas of atelectasis. The infant's arterial blood gas analysis indicates metabolic acidosis. For which dangerous condition should the nurse prepare when providing care to this newborn?

meconium aspiration syndrome

When providing care to the newborn withdrawing from a drug such as cocaine or heroin, which drug is given to ease the symptoms and prevent complications?

morphine

The use of breast milk for premature neonates helps prevent which condition?

necrotizing enterocolitis

A newborn is found to have hemolytic disease. Which combination would be found related to the blood types of this newborn and the parents of the newborn?

newborn who is type A, mother who is type O

A 32 weeks' gestation newborn is admitted to the neonatal intensive care unit. The assessment reveals a pale dyspneic newborn with marked tremors, a bulging anterior fontanel (fontanelle), and a high-pitched cry. What diagnosis best correlates with the assessment findings?

periventricular-intraventricular hemorrhage

When attempting to interact with a neonate experiencing drug withdrawal, which behavior would indicate that the neonate is willing to interact?

quiet alert state

The newborn nursery nurse is admitting a large-for-gestational age infant with a fractured clavicle. What laboratory tests would the nurse expect to monitor? Select all that apply.

serum calcium total bilirubin hematocrit

Which facial change is characteristic in a neonate with fetal alcohol spectrum disorder?

short palpebral fissures

Which sign appears early in a neonate with respiratory distress syndrome?

tachypnea more than 60 breaths/minute

A nurse is assessing a newborn diagnosed with fetal alcohol spectrum disorder. Which findings would the nurse expect to assess? Select all that apply.

thin upper lip poor hand-eye coordination

A nurse is caring for a newborn with meconium aspiration syndrome. Which interventions should the nurse perform when caring for this newborn? Select all that apply.

• Place the newborn under a radiant warmer or in a warmed Isolette • Administer oxygen therapy • Administer broad-spectrum antibiotics