2.4 Thermoregulation/ Newborn Complications

What should be included in a plan of care to limit the development of hyperbilirubinemia in the breastfed neonate? 1. Encouraging more frequent breastfeeding during the first 2 days 2. Instituting phototherapy for 30 minutes every 6 hours for 3 days 3. Substituting formula feeding for breastfeeding on the second day 4. Supplementing breastfeeding with glucose water during the first day

1

Jaundice develops in a newborn 72 hours after birth. How should the nurse best explain the probable cause of this jaundice to the parents? 1 An allergic response to the feedings 2 The physiologic destruction of fetal red blood cells 3 A temporary bile duct obstruction commonly found in newborns 4 The seepage of maternal Rh-negative blood into the neonate's bloodstream

2.

A newborn is experiencing cold stress while being admitted to the nursery. Which nursing goal has the highest immediate priority? 1 Minimize shivering 2 Prevent hyperglycemia 3 Limit oxygen consumption 4 Prevent metabolism of fat stores

4. Newborns do not shiver. If the newborn is cold, there is increased brown fat metabolism (nonshivering thermogenesis), which increases fatty acid blood levels and predisposes the infant to acidosis. Hypoglycemia and not hyperglycemia will occur because the newborn's glycogen reserves deplete rapidly while under cold stress.

The nurse notes that a client has mild hypothermia based on what body temperature? 1 29 °C 2 30 °C 3 33 °C 4 35 °C

4. Mild hypothermia refers to a body temperature of 34 °C to 36 °C (93.2 °F to 96.8 °F).

Jaundice becomes visible when the serum bilirubin is at what level?

5-6 mg/dL

A nurse in the newborn nursery is monitoring an infant for jaundice related to ABO incompatibility. What blood type does the mother usually have to cause this incompatibility? 1 A 2 B 3 O 4 AB

3

A nurse is assessing a newborn for signs of hyperbilirubinemia (pathologic jaundice). Which clinical finding confirms this complication? 1 Muscle irritability within 1 hour of birth 2 Neurologic signs during the first 24 hours 3 Jaundice that develops in the first 12 to 24 hours 4 Jaundice that develops between 48 and 72 hours after birth

3

How should the nurse screen the newborn of a diabetic mother for hypoglycemia? 1 Testing for glucose tolerance 2 Drawing blood for a serum glucose determination 3 Arranging for a fasting blood glucose determination 4 Testing heel blood with the use of a glucose-oxidase strip

4

Phototherapy is prescribed for a preterm neonate with hyperbilirubinemia. Which nursing intervention is appropriate to reduce the potentially harmful side effects of the phototherapy?

shielding the eyes

The nurse who works in a birthing unit understands that newborns may have impaired thermoregulation. Which nursing interventions may help prevent heat loss in the newborns? Select all that apply. 1 The nurse keeps the newborn covered in warm blankets. 2 The nurse keeps the newborn under the radiant warmer. 3 The nurse places the newborn on the mother's abdomen. 4 The nurse measures the newborn's temperature regularly. 5 The nurse encourages the mother to feed the newborn well to maintain the fluid balance.

1,2,3

The nurse is caring for the newborn of a mother with diabetes. For which signs of hypoglycemia should the nurse assess the newborn? Select all that apply. 1 Pallor 2 Irritability 3 Hypotonia 4 Ineffective sucking 5 excessive birth weight

1,2,3,4

After assessing a client's reports, the nurse confirms that the client has moderate hypothermia. What should be the nurse's immediate intervention? Select all that apply. 1 Administering heated oxygen gas 2 Positioning the client in supine position 3 Administering high carbohydrate liquids 4 Applying external heat with heating blankets 5 Performing cardiopulmonary bypass technique

1,2,4

The nurse assesses for what client symptoms that indicate hyperthermia? Select all that apply. 1 Vasodilation 2 Dry and flushed skin 3 Pale and cyanotic skin 4 Decreased capillary refill 5 Decreased urinary output

1,2,5 During hyperthermia, vasodilation occurs that causes the flushed appearance of the skin; as a result, the skin may be warm to the touch. Hyperthermia causes loss of water from the body and results in dry skin and mucous membranes, decreased urinary output, and other signs of dehydration and electrolyte imbalance. Clients with hyperthermia may not have pale and cyanotic skin; instead, they have dry, flushed skin. Clients with hyperthermia may not have decreased capillary refill; instead, they have increased capillary refill.

The nurse is testing newborns' heel blood for the level of glucose. Which newborn does the nurse anticipate will experience hypoglycemia? Select all that apply. 1 Preterm infant 2 Infant with Down syndrome 3 Small-for-gestational-age infant 4 Large-for-gestational-age infant 5 Appropriate-for-gestational-age infant

1,3,4

While reviewing the health history of a newborn with suspected jaundice, the nurse recalls that some risk factors place infants at a higher risk for developing jaundice. Which conditions are risk factors for jaundice? Select all that apply. 1 Infection 2 Female sex 3 Prematurity 4 Breast-feeding 5 Formula feeding 6 Maternal diabetes

1,3,4,6

Three days after birth, a breast-feeding newborn becomes jaundiced. The parents bring the infant to the clinic, and blood is drawn for an indirect serum bilirubin determination, which reveals a concentration of 12 mg/dL (100 mcmol/L). The nurse explains that the infant has physiologic jaundice. What is the cause of this benign condition? 1 Immature liver function 2 An inability to synthesize bile 3 An increased maternal hemoglobin level 4 A high hemoglobin and low hematocrit level

1. Jaundice occurs because of the expected physiologic breakdown of fetal red blood cells and the inability of the newborn's immature liver to conjugate the resulting bilirubin. Breast-fed neonates are more prone to physiologic jaundice because of diminished calorie and fluid intake in the 3 days before milk production reaches normal volume. Conjugation and excretion, not synthesis of bile, are compromised because of the immature liver. The mother's hemoglobin level is unrelated to the newborn's; the mother and the fetus had separate circulations. Newborns usually have high hemoglobin and high hematocrit levels.

A nurse is caring for a preterm neonate with physiologic jaundice who requires phototherapy. What is the physiologic mechanism of this therapy? 1 Stimulates the liver to dispose of the bilirubin 2 Breaks down the bilirubin into a conjugated form 3 Facilitates the excretion of bilirubin by activating vitamin K 4 Dissolves the bilirubin, allowing it to be excreted by the skin

2. Phototherapy changes unconjugated bilirubin in the skin to conjugated bilirubin bound to protein, permitting excretion in the urine and feces.

The nurse is assessing the victims of a disaster brought in to the emergency department for signs of hypothermia. Which statements made by the nurse indicate accurate awareness about the conditions associated with hypothermia? Select all that apply. 1 "Shivering is the body's first attempt to conserve heat." 2 "Wet clothing increases evaporative heat loss twice as much as normal." 3 "Hypothermia can often be misdiagnosed as it mimics other disorders." 4 "Near drowning increases evaporative heat loss to 25 times greater than normal." 5 "Older adults are less prone to hypothermia due to medications that alter body defenses."

3,4. Hypothermia mimics cerebral or metabolic disturbances causing ataxia, confusion, and withdrawal, so the client may be misdiagnosed. Immersion in cold water, such as near drowning, increases evaporative heat loss to 25 times greater than normal. Peripheral vasoconstriction is the body's first attempt to conserve heat. As cold temperatures persist, shivering and movement are the body's only mechanisms for producing heat. Wet clothing increases evaporative heat loss to five times greater than normal.

A mother asks the neonatal nurse why her infant must be monitored so closely for hypoglycemia when her type 1 diabetes was in excellent control during the entire pregnancy. How should the nurse best respond? 1 "A newborn's glucose level drops after birth, so we're being especially cautious with your baby because of your diabetes." 2 "A newborn's pancreas produces an increased amount of insulin during the first day of birth, so we're checking to see whether hypoglycemia has occurred." 3 "Babies of mothers with diabetes do not have large stores of glucose at birth, so it's difficult for them to maintain the blood glucose level within an acceptable range." 4 "Babies of mothers with diabetes have a higher-than-average insulin level because of the excess glucose received from the mothers during pregnancy, so the glucose level may drop."

4

The nurse is caring for a client with hypothermia. What should be the nurse's priority of care? 1 Administering electrolytes 2 Monitoring body temperature 3 Increasing the room's temperature 4 Removing the client from cold environment

4. Hypothermia is associated with a decrease in core body temperature, which requires interventions that lead to an increase in the client's internal body temperature. Therefore the client should be first removed from the cold environment.

The nurse is assigned to care for an infant in the newborn nursery who is 24 hours old. During assessment the nurse becomes concerned that the baby is jaundiced. The nurse knows that jaundice first becomes visible in a newborn when serum bilirubin reaches what level? 1 1 to 3 mg/dL (17.1 to 51.3 µmol/L) 2 2 to 4 mg/dL (34.2 to 68.4 µmol/L) 3 5 to 7 mg/dL (85.5 to 119.7 µmol/L) 4 8 to 10 mg/dL (136.8 to 171 µmol/L)

5 to 7 mg/dL Rationale: Jaundice in a newborn first becomes visible when the serum bilirubin level reaches 5 to 7 mg/dL. Jaundice will not be visible at a serum bilirubin level of less than 5 mg/dL.