OB Exam CH 24

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." Explanation: Assessment indicates that the newborn has caput succedaneum. This is soft tissue swelling caused by edema of the head against the dilating cervix during the birth process. In caput succedaneum, swelling is not limited by suture lines; it extends across the midline and is associated with head molding. It does not usually cause complications other than a misshapen head and usually resolves over the first few days without treatment. Cephalohematoma is the subperiosteal collection of blood secondary to the rupture of blood vessels between the skull and periosteum. Suture lines delineate its extent and it is usually located on one side, over the parietal bone. Cephalohematoma resolves gradually over 2 to 3 weeks without treatment. Subarachnoid hemorrhage (one of the most common types of intracranial trauma) may be due to hypoxia/ischemia, variations in blood pressure, and the pressure exerted on the head during labor. Bleeding is of venous origin, and underlying contusions also may occur. Subarachnoid hemorrhage requires minimal handling to reduce stress. Subdural hemorrhage (hematomas) involves tears of the major veins or venous sinuses overlying the cerebral hemispheres or cerebellum. Increased pressure on the blood vessels inside the skull leads to tears. Subdural hematoma requires aspiration; can be life-threatening if it is in an inaccessible location and cannot be aspirated.

A newly born infant with an Apgar assessment of 5 has made no respiratory efforts despite continuous stimulation. Which actions would the nurse prioritize? Select all that apply.

Begin resuscitation until the newborn has a pulse above 100 bpm. Continue resuscitation efforts until the newborn adequately breathes. Perform resuscitation until the newborn has a pink tongue. Continue resuscitation and provide support to the parents. Explanation: The procedure for newborn resuscitation is to continue resuscitation efforts until the newborn has a pulse above 100 bpm, a good healthy cry, or good breathing efforts and a pink tongue. This last sign indicates a good oxygen supply to the brain. The need for resuscitative measures can be extremely upsetting for the parents, so explain to them the resuscitation activities being performed. This infant needs more than just observation and assessments under a radiant warmer. Continued assessment of mother and baby will occur when the baby is stable, thus not a priority.

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 inserting an NG tube to low suction. Explanation: The preoperative nursing care focuses on preventing aspiration by elevating the head of the bed and inserting an NG tube to low suction to prevent aspiration. Documenting the amount and color of drainage is not needed with the NG tube in place. An infant with esophageal atresia is NPO and fed nothing until after the defect is repaired. Administering antibiotics and total parenteral nutrition is a postoperative nursing intervention when caring for a newborn with esophageal atresia.

A nurse is explaining to the parents the preoperative care for their infant born with bladder exstrophy. The parents ask, "What will happen to the bladder while waiting for the surgery?" What is the nurse's best response?

The bladder will be covered in a sterile plastic bag to keep it moist." Explanation: In the preoperative period, infant care is focused on protecting the exstrophied bladder and preventing infection. The infant is kept in a supine position, and the bladder is kept moist and covered with a sterile plastic bag. Change soiled diapers immediately to prevent contamination of the bladder with feces. Sponge-bathe the infant only (rather than immersing him or her in water) to prevent pathogens in the bath water from entering the bladder. Consult the ostomy nurse if necessary.

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. Explanation: The nurse should know that the infant's mother more than likely had/has diabetes. The large size of the infant born to a mother with diabetes is secondary to exposure to high levels of maternal glucose crossing the placenta into the fetal circulation. Common problems among infants of mothers with diabetes include macrosomia, respiratory distress syndrome, birth trauma, hypoglycemia, hypocalcemia and hypomagnesemia, polycythemia, hyperbilirubinemia, and congenital anomalies. Listlessness is also a common symptom noted in these infants. Infants born to clients who use alcohol during pregnancy, infants who have experienced birth traumas, or infants whose mothers have had long labors are not known to exhibit these particular characteristics, although these conditions do not produce very positive pregnancy outcomes. Infants with fetal alcohol spectrum disorder or alcohol exposure during pregnancy do not usually have hypoglycemia problems.

The nurse suspects a preterm newborn receiving enteral feedings of having necrotizing enterocolitis (NEC). What assessment finding best correlates with this diagnosis?

bloody stools Explanation: NEC assessment includes assessing the newborn's health history and physical examination as well as laboratory and diagnostic testing. The onset of NEC is demonstrated by the development of feeding intolerance, abdominal distention, and bloody stools in a preterm infant receiving enteral feedings. As the disease worsens, the infant develops signs and symptoms of septic shock with RDS, temperature instability, lethargy, hypotension, and oliguria.

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

cephalohematoma Explanation: Vernix caseosa is a thick white substance found on a newborn. Erythema toxicum is a newborn rash. Caput succedaneum is molding or edema.

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 Explanation: Pathologic jaundice occurs within the first 24 hours of life and is often related to blood incompatibility. Conversely, physiologic jaundice occurs 48 hours or more after birth, peaks at the 5th to 7th day, and disappears between the 7th and 10th day postpartum. Physiologic jaundice is caused by the normal reduction of red blood cells and occurs in both breastfed and bottle-fed babies.

The nurse is caring for a 22-hour-old neonate male and notes on assessment at the beginning of the shift: Apgar score of 9, nursing without difficulty, and appeared healthy. As the nurse's shift goes on, subsequent assessment reveals his sclera and skin have begun to take on a yellow hue. The nurse would report this as a possible indication of what condition?

hemolytic disease Explanation: Any infant admitted to the newborn nursery should be examined for jaundice during the first 36 hours or more. Early development of jaundice (within the first 24 hours) is a probable indication of hemolytic disease. Heroin withdrawal symptoms commonly include tremors, restlessness, hyperactivity, disorganized or hyperactive reflexes, increased muscle tone, sneezing, tachypnea, vomiting, diarrhea, disturbed sleep patterns, and a shrill high-pitched cry. The hypoglycemic newborn's blood glucose would be low, and a newborn with hypoxia would show signs of respiratory distress

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) Explanation: Signs that may accompany IVH include hypotonia, apnea, bradycardia, a full or bulging fontanel (fontanelle), cyanosis, and increased head circumference.

Based on maternal history of alcohol addiction, a neonate in the newborn nursery is being assessed for signs of fetal alcohol spectrum disorder. What findings would confirm the diagnosis? Select all that apply.

microcephaly small for gestational age tremors epicanthal folds Explanation: The distinctive pattern identified three specific findings: growth restriction (prenatal and postnatal), craniofacial structural anomalies, and central nervous system dysfunction. Epicanthal folds of the skin of the upper eyelid are also part of fetal alcohol spectrum disorder.

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

necrotizing enterocolitis Explanation: Components specific to breast milk have been shown to lower the incidence of necrotizing enterocolitis in premature neonates. Infantile respiratory distress syndrome isn't directly influenced by breast milk or breastfeeding. Down syndrome and Turner syndrome are genetic defects and aren't influenced by breast milk.