Ob 21

What should the nurse teach new parents about infant urination?

The baby will have at least one or two wet diapers per day on the first day or two, increasing to at least six wet diapers by the fourth day. Notify the physician if there are no wet diapers in 12 hours

What added assessments and interventions should the nurse perform if an infant has a subnormal temperature?

Assess for and correct sources of heat loss, such as wet clothing, drafts, or exposed skin. Place the infant skin to skin with the mother or wrap the flexed infant snugly in warm blankets. Apply a hat and a shirt, and use another shirt with the sleeves over the legs. A radiant warmer, regulated by a skin probe, may be needed for very low temperatures. Have the mother breastfeed or feed the infant formula if it is near feeding time. Teach parents about maintaining the infant's temperature, particularly if their actions have contributed to the low temperature

What are the three primary nursing observations after circumcision?

Bleeding, urination, and infection

What type of heat loss can occur in forgetting to turn the radiant warmer on before placing the infant under it?

Conduction

What type of heat loss can occur in placing the newborn on a cold, unpadded surface?

Conduction

What type of heat loss can occur in using a cold stethoscope to listen to breath sounds?

Conduction

What type of heat loss can occur in placing the infant's crib near an air conditioner vent?

Convection

Explain why erythromycin eye ointment is typically given to newborns

Erythromycin ointment is required by state law to prevent gonorrhea acquired in the mother's birth canal

What type of heat loss can occur in partially drying the infant's hait after the bath?

Evaporation

Explain why hepatitis B immunization is typically given to newborns

Hepatitis B immunization is given to promote the infant's manufacture of antibodies against this viral infection of the liver

What should the nurse teach new parents about holding the baby for burping?

Hold the baby upright against your shoulder or in a sitting position on your lap, with the head and chest supported while you pat the back

What is the primary method of identifying the newborn and mother (or other support person)?

Identification is carried out by matching the electronic device or imprinted numbers on the adult's wristband with those on the infant's identification bands or device. The numbers should be matched every time the infant is reunited with the parent. The nurse should visually match the numbers or have the parent or support person read the imprinted numbers from his or her band

Explain to parents why it is important for their jaundiced infant to eat frequently and adequately

Infants who do not eat well will be slower in passing stools in which bilirubin is eliminated. When feces remain in the intestines, an enzyme (beta-glucuronidase) that was important during fetal life may change the bilirubin back to a form (unconjugated) that cannot be eliminated in the stools. The bilirubin may be absorbed back into the bloodstream and the liver will have added work in changing it back to a form in which it can be excreted

List five general signs of newborn infection

Low temperature; lethargy; poor feeding; periods of apnea without obvious cause; any unexplained change in behavior; drainage from the eyes, cord, or circumcision

Do infants of mothers with hepatitis B need any additional medication? Why?

Mothers who are positive for hepatitis B (carriers) may transmit the organism to their infant at birth. The first dose of a series of three doses of vaccine is given within 12 hours of birth to infants of mothers who are hepatitis carriers. These infants also receive hepatitis B immune globulin within 12 hours to provide passive antibody protection until the infant manufactures his or her own active antibodies to the virus

The correct order for suctioning an infant's airway with the bulb syringe is to suction the ____ first and the ____ second. Why?

Mouth; nose (only if needed). The infant might gasp when the nose is suctioned, drawing any secretions that are in the mouth into the airway

What circumcision problems should parents be taught to report?

Notify the physician if there is no urinary output within 6 to 8 hours, bleeding more than a few drops with first diaper changes, or displacement of the Plastibell. Apply pressure if any bleeding occurs. Report signs of infection, such as redness, edema, tenderness, and discharge (a yellow exudate that dries is normal)

What type of heat loss can occur in placing the infant's crib by a window on a snowy day?

Radiation

List signs that suggest infection at the umbilical cord. What measures can prevent cord infection?

Signs of infection include redness or edema at the cord base and purulent drainage. Keep the cord area dry by folding the diaper below the area. Check with the health care provider regarding tub bathing before the cord has detached and the area is fully healed. Care generally includes cleaning the cord with water if necessary and allowing it to dry naturally

What should the nurse teach new parents about infant stools?

The first stools are called meconium (tarry, greenish-black, and sticky), followed by transitional stools, followed by milk stools. The stools of breastfed babies are mustard yellow, soft, and seedy and have a sweet-sour smell. Stools of formula-fed babies are pale yellow to light brown and formed. The baby is not constipated unless the stools are dry and hard like marbles. A water ring around the stool in the diaper indicates diarrhea and should be reported to the physician

Why is it particularly important that the infant's head be dried promptly?

The head makes up a large part of the newborn's body and thus is a large surface for heat loss. Damp hair presents a continuing source for evaporative heat loss

What are some examples of suspicious behavior in a visitor that should cause the nurse to think about the possibility of abduction?

Visitors who go from one room to another, visitors who ask many questions regarding hospital routines and floor plan (e.g., about location of exits), anyone carrying an infant in the hallway or taking a crib to areas where it should not be taken, anyone carrying a bag or package large enough to hide an infant

Explain why vitamin K is typically given to newborns

Vitamin K, which is necessary for normal blood coagulation, is given because the infant's gastrointestinal tract is sterile at birth and temporarily lacks the microorganisms that will make this vitamin

Parents often have questions about pacifiers. Select all the following that is correct information to teach the parents. (Select all that apply.) a. All infants have an urge to suck. b. Pacifiers will cause malocclusion of the teeth only if they are used after the secondary teeth begin to erupt. c. Pacifiers should be replaced every 1 or 2 months. d. Pacifiers can be placed on a string around the infant's neck. e. If the infant uses thumb sucking instead of a pacifier, it will be easier to give up as the child grows.

a. All infants have an urge to suck. b. Pacifiers will cause malocclusion of the teeth only if they are used after the secondary teeth begin to erupt. c. Pacifiers should be replaced every 1 or 2 months. All infants have a need to suck, although the amount of sucking needed varies among infants. The AAP recommends the use of pacifiers for sleep to help prevent SIDS. Use of pacifiers should be delayed until 1 month in breastfeeding infants. Use of a pacifier for part of the day, not using an upside down pacifier, and stopping sucking on a pacifier before the secondary teeth begin to erupt is unlikely to cause malocclusion. Pacifiers should be replaced every month or two and should never be placed on a string around the infant's neck. Pacifiers are easier to give up than thumb sucking because they are not as easily accessible as a thumb.

A newborn has just been circumcised. The nurse's first priority would be to a. assess the penis for bleeding. b. apply a lubricant such as Vaseline or KY jelly to the site at every diaper change. c. note time of first voiding after the procedure. d. take the newborn to his mother for comfort and feeding.

a. assess the penis for bleeding. Although options B, C, and D are appropriate actions, observation for bleeding is the priority.

When giving an initial bath to a newborn, which one(s) of the following techniques are appropriate? (Select all that apply.) a. Do not bathe the infant until the newborn's temperature is stable. b. Wash all the vernix and blood off of the skin and hair. c. Gloves should be worn. d. The bath should be performed quickly and the infant dried. e. After the bath, the infant may be wrapped in blankets and placed in an open crib.

a. Do not bathe the infant until the newborn's temperature is stable. c. Gloves should be worn. d. The bath should be performed quickly and the infant dried. Gloves should be worn when handling a newborn until the initial bath has been given. A sponge bath is given with the infant under the radiant warmer to help maintain the infant's temperature. The bath should be performed quickly and the infant thoroughly dried to prevent heat loss by evaporation. While shampooing the hair, the nurse combs through it to remove dried blood. Vernix need not be removed. Combing the infant's hair hastens drying. The infant remains under the radiant warmer until the hair is dry and the temperature returns to the previous level. The infant is dressed and wrapped in two warm blankets, and a warm cap is placed on the infant's head before he or she is removed from the radiant warmer. The temperature should be rechecked within 1 hour to ensure that the infant is maintaining thermoregulation adequately.

Choose the correct parent teaching about cord care. a. Fold the diaper below the cord to speed drying. b. Expect the cord to detach in no more than 7 days. c. Scrub the area with soap each day. d. Skin near the cord site may be red until it detaches.

a. Fold the diaper below the cord to speed drying.

A nursing student has been caring for a woman and her newborn all morning. The student takes the infant to the nursery for screening tests before discharge. When the infant is returned to the mother, the correct procedure is to: a. Have the mother read her printed band number, and verify that it matches the infant's band number. b. Ask the mother to state her name and the name of her infant, c. Call out the mother's full name before leaving the infant with her, d. Explain the screening tests and give the infant to the mother,

a. Have the mother read her printed band number, and verify that it matches the infant's band number.

Which one(s) of the following are true concerning colic in an infant? (Select all that apply.) a. It is characterized by irritable crying for no obvious reason for 3 hours/day or longer. b. It occurs only in formula-fed infants. c. Infants will draw their knees onto the abdomen. d. One cause may be an allergic reaction to the type of formula used.

a. It is characterized by irritable crying for no obvious reason for 3 hours/day or longer. c. Infants will draw their knees onto the abdomen. d. One cause may be an allergic reaction to the type of formula used. Colic is described as inconsolable paroxysmal crying periods that occur daily for several days a week. It can last several months. Both breast fed and formula fed infants can have colic. Infants with colic cry as though in pain and draw their knees onto the abdomen, rigidly extend the legs, and may pass flatus. The cause is unknown but allergies to cow's milk or substances in the breastfeeding mother's diet may be a factor.

Parent teaching is an important aspect of care of the newborn and family. Which one(s) of the following are appropriate teaching techniques during the first 2 days after birth? (Select all that apply.) a. Setting priorities b. Giving written material to the family to reinforce learning c. Using audiovisual materials to reinforce learning d. Modeling behavior for the new family e. Teaching as much as possible in one setting to allow more rest time f. Including the father g. Being sensitive to cultural differences

a. Setting priorities b. Giving written material to the family to reinforce learning c. Using audiovisual materials to reinforce learning d. Modeling behavior for the new family f. Including the father To effectively teach parents, priorities should be set and a teaching plan developed. Use a variety of teaching methods to increase effectiveness, make the subject more interesting, and increase retention of the material. Use verbal and written methods, demonstrations, and return demonstrations. Parents often learn best by seeing skills performed correctly and then practicing them while the nurse gives suggestions. To increase the likelihood that parents will follow instructions, explain the rationale for each point made during teaching sessions. Use audiovisual materials, including pamphlets, magazines, television programs, and Internet sites. Highlight the most important areas in written material, discuss the programs with the new parents, and clarify information, as necessary, to reinforce learning.

Which of the following are appropriate goals for a newborn for the first 2 to 3 days of life? (Select all that apply.) a. The infant will maintain a patent airway as evidenced by a respiratory rate within the range of 30 to 60 breaths per minute. b. The infant will show no signs of respiratory distress. c. The infant will maintain an axillary temperature between 34.5 and 35.5°C. d. The infant will show no signs of hypoglycemia.

a. The infant will maintain a patent airway as evidenced by a respiratory rate within the range of 30 to 60 breaths per minute. b. The infant will show no signs of respiratory distress. d. The infant will show no signs of hypoglycemia. Goals for a newborn are that the infant will maintain a patent airway, a respiratory rate of 30 to 60 breaths per minute with no respiratory distress, an axillary temperature between 36.5 and 37.5°C, will feed well and show no signs of hypoglycemia.

A new mother anxiously summons the nurse to her room because the baby has sneezed twice. A brief assessment shows nothing unusual. The appropriate teaching is that: a. This may indicate overstimulation, and the infant may need a quiet time. b. Multiple sneezes are characteristic of the second period of reactivity. c. The baby may be developing a cold, so the pediatrician will be notified. d. Sneezing may indicate sensitivity to the drugs given to the mother during labor.

a. This may indicate overstimulation, and the infant may need a quiet time.

Techniques the nurse can use to prevent heat loss in a newborn include which one(s) of the following? (Select all that apply.) a. Turning on the radiant warmer before the infant's birth b. Drying the wet infant quickly c. Changing wet linens with warm dry linens d. Covering the infant's head with a cap after placing it under the radiant warmer

a. Turning on the radiant warmer before the infant's birth b. Drying the wet infant quickly c. Changing wet linens with warm dry linens The radiant warmer should be turned on and be warm before placing a newborn in the warmer. Dry the wet infant quickly with warm towels to prevent heat loss by evaporation. Pay particular attention to drying the hair because the head has a large surface area and hair that remains damp increases heat loss. Remove towels or blankets as soon as they become wet and replace them with dry, warmed linens. Cover the head with a prewarmed cap when the infant is not under a radiant warmer. Do not use a hat when the infant is under the warmer because it interferes with transfer of heat to the infant's head.

The new parents of their first child tell the nurse that the crib they will be using is the same crib that the father used as a baby. The nurse should teach them which of the following safety considerations to assess in this older crib? (Select all that apply.) a. Crib slats must be no more than 5 inches apart. b. Corner posts should not extend more than 1/16th inch above the end panel. c. The crib mattress should fit snugly, with less than two fingers able to fit into the space between the mattress and sides of the crib. d. Check that all nuts, screws, bolts, and hooks are tight.

b. Corner posts should not extend more than 1/16th inch above the end panel. c. The crib mattress should fit snugly, with less than two fingers able to fit into the space between the mattress and sides of the crib. d. Check that all nuts, screws, bolts, and hooks are tight. The crib mattress should be firm and fit snugly, there should be no more than 2 3/8 inches between crib slats, no corner posts over 1/16th inch high so the baby's clothing cannot catch, no cutouts in the headboard or foot board, have no missing, loose, broken or improperly installed screws or brackets, and the paint should be lead free.

The nurse should teach the parents to position the infant's hospital crib: a. Next to the windows to be exposed to the sun. b. Near the mother's bed, on the side opposite the door. c. At the foot of the bed so the mother can get out of bed easily. d. Near the door of the bathroom, next to the sink.

b. Near the mother's bed, on the side opposite the door.

On discharge from the birthing center the nurse should assess the type of car seat the new parents are using. For a newborn, the seat should be a. No car seat is necessary for infants younger than 3 months of age; they can be placed in an adult's lap. b. Rear-facing in the back seat of the car. c. Front-facing. d. Sitting straight up.

b. Rear-facing in the back seat of the car. Infants who are younger than 1 year old must ride in a rear-facing seat to protect them. Car restraints are required in all 50 states and Canada for all infants and young children. The seat should recline at approximately a 45-degree angle for an infant.

A new mother should be taught to support her baby's head when holding the infant because: a. Doing so will promote better eye contact and bonding. b. The baby's muscles are too weak to support his or her heavy head. c. It allows better guidance of the head toward the breast. d. Less regurgitation of gastric contents will occur.

b. The baby's muscles are too weak to support his or her heavy head.

To care for the uncircumcised penis, parents should be taught to: a. Retract the foreskin with each diaper change. b. Wash under the foreskin as far as it will retract when the child is older. c. Use an emollient cream to hasten foreskin separation. d. Avoid putting soap on the foreskin before separation.

b. Wash under the foreskin as far as it will retract when the child is older.

A newborn's mother has tested positive for hepatitis B. When should the newborn receive the hepatitis B vaccine? a. By 2 months b. Within 12 hour c. Within 1 week d. By 6 months

b. Within 12 hour For infants of hepatitis B-positive mothers, the vaccine is given within 12 hours of birth and then at 1 to 2 months and 6 months. Hepatitis B immune globulin is also given within 12 hours of birth.

A new mother with no hospitalization insurance asks to be discharged with her baby at 24 hours after birth. To assist this new mother best after discharge, the nurse can a. allow the mother time to ask all her questions about newborn care just before discharge. b. plan for a home visit within 48 hours of discharge. c. give the mother plenty of pamphlets about newborn care before discharge. d. inform the mother about the dangers of early discharge.

b. plan for a home visit within 48 hours of discharge. Home visits have been found to be a cost-effective way to avoid hospital admissions or emergency department visits. The home visit allows for assessment, intervention, and follow-up teaching. It is important to allow the mother time to ask questions before discharge, but at 24 hours after birth she may not be prepared to do so. Giving the mother pamphlets before discharge is helpful; however, nursing assessments or follow-up teaching will not be done.

The nurse notes an infant sleeping on her or his back in the crib in the mother's room. The nurse should: a. Turn the infant to the side to avoid aspiration from regurgitation. b. Suggest that the mother hold the infant to enhance bonding. c. Commend the mother for positioning the infant correctly. d. Explain the importance of the prone position for sleep.

c. Commend the mother for positioning the infant correctly.

An infant's axillary temperature is 35.9° C (96.6° F). The priority nursing action is to: a. Recheck the infant's temperature rectally. b. Have the mother breastfeed the infant. c. Place the infant in a radiant warmer. d. Chart the normal axillary temperature.

c. Place the infant in a radiant warmer.

When suctioning a newborn, which technique is correct? a. Use of a suction catheter attached to low suction is appropriate for nasal suction. b. The bulb syringe should be used to suction the mouth only. c. The mouth should be suctioned first and then the nose, with the bulb syringe. d. The bulb syringe is placed inside the mouth and then depressed.

c. The mouth should be suctioned first and then the nose, with the bulb syringe. The mouth should be suctioned first because the infant may gasp when the nose is suctioned, causing aspiration of mucus or fluid in the mouth. Then gently suction the nose only if necessary. A bulb syringe should be used for infant suctioning unless deeper suctioning is necessary. The bulb syringe should be depressed first and then put inside the mouth.

A new mother expresses concern to the nurse that her 8-hour-old newborn has developed some edema in both eyes. The best response would be based on the fact that a. birth trauma usually will not develop until a few hours after birth. b. the edema is a sign of eye infections and will need to be investigated. c. the eye medication given at birth may cause a mild inflammation and edema. d. this is a sign of lack of rest for the newborn during the labor process.

c. the eye medication given at birth may cause a mild inflammation and edema. Some infants develop a mild inflammation a few hours after prophylactic eye treatment.

A crying infant is a major concern for most new parents. The nurse can teach the parents that answering an infant's cry a. may spoil the infant and the parents need to be cautious. b. usually means attending to an unanswered need, but until the infant is about 6 months old it is difficult to determine what that need may be. c. will help the infant develop trust. d. may become frustrating for the parents; they may need to close the door and ignore the infant at times.

c. will help the infant develop trust. Infants express their needs by crying. These needs must be met in a consistent, warm, and prompt manner for the development of trust to occur. Parents should be taught the importance of consistently and quickly answering infant cries.

A newborn has been assessed as high risk for hypoglycemia. The nurse assesses the newborn's blood glucose and it is 38 mg/dL. What should be the nurse's next action? a. Notify the pediatrician. b. Feed the newborn approximately 1 ounce of glucose water. c. Keep the newborn in the nursery and reassess the glucose in 30 minutes. d. Breast-feed or bottle-feed formula to the newborn.

d. Breast-feed or bottle-feed formula to the newborn. Glucose water alone is not recommended for newborns because the rapid rise in glucose results in increased insulin production, causing a further drop in blood glucose. Milk provides a longer lasting supply of glucose. Action should be taken prior to notifying the pediatrician or health care provider.

Choose the normal circumcision assessment. a. Plastibell positioned well down the shaft of the penis b. Oozing of blood from the site after a Gomco circumcision c. Delay in urination for 12 to 16 hours after the procedure d. Development of a dry yellow crust on the circumcision site

d. Development of a dry yellow crust on the circumcision site

A nursing student is asked to administer vitamin K to a newborn. The student is aware that vitamin K must be administered within 1 hour of birth but is not sure about which route is appropriate. Vitamin K should be given by which route to this newborn? a. Oral b. Subcutaneous c. Intravascular d. Intramuscular

d. Intramuscular Oral vitamin K has been used for newborn prophylaxis. It is not recommended at this time because it has not been shown to be as effective as parenteral vitamin K. The appropriate route is intramuscular. It is usually given within the first hour after birth but can be delayed until the infant has finished breastfeeding at birth.

The correct site for injection of hepatitis B immunization for a newborn is the: a. Subcutaneous tissue of the thigh. b. Dorsogluteal muscle. c. Deltoid muscle. d. Vastus lateralis muscle.

d. Vastus lateralis muscle.

The nurse should assess all newborns for jaundice every 8 to 12 hours. This is done by a. ordering the appropriate blood work. b. monitoring the color and consistency of the stools. c. monitoring intake and output. d. blanching the newborn's skin.

d. blanching the newborn's skin. Assess for jaundice by blanching the infant's skin on the nose or sternum at least every 8 to 12 hours. Blood work is ordered if changes in color are seen.

When placing a newborn under a radiant heat warmer to stabilize temperature after birth, the nurse should a. place the probe on the left side of the chest. b. cover the probe with a nonreflective material. c. recheck the temperature by periodically taking a rectal temperature. d. prewarm the radiant heat warmer and place the undressed newborn under it.

d. prewarm the radiant heat warmer and place the undressed newborn under it. The probe should be placed on the upper abdomen. It should be covered with reflective material. Rectal temperatures should be avoided because rectal thermometers can perforate the intestine. The radiant heat warmer should be preheated to avoid heat loss by conduction.

One important and simple measure that can be used to prevent infection in newborns is _____________

handwashing

Prickly heat develops in infants who are too warmly dressed in any weather. This is called _____________

miliaria

Most infant abductions in a hospital setting occur in the _____________

mother's room

Chronic inflammation of the scalp or other areas of the skin characterized by yellow, scaly, oily lesions is called _________________

seborrheic dermatitis

Diarrhea stools can be identified by a _____________ in the diaper around the stool

water ring