NU143- Chapter 24: Nursing Management of the Newborn at Risk: Acquired and Congenital Newborn Conditions

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

bloody stools

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 caring for a neonate with transient tachypnea of the newborn. Which is the priority nursing intervention?

Administer IV fluids; gavage feedings.

From which pair of metabolic disorders must the nurse instruct the parents to eliminate breast and cow's milk from the diet?

Galactosemia and phenylketonuria

A male newborn is born with hypospadias. The nurse doing the newborn physical assessment notes that the penis is also curved downward. What information would the nurse provide the parents for this infant?

His ability to void and have an erection in adulthood may be impaired and surgery is needed.

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

birth trauma

Injuries to the newborn from the forces of labor and birth

Upon shift handoff the nurse reports meconium staining of the amniotic fluid. Which neonatal system requires close monitoring by the incoming nurse?

Respiratory system

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

Serial blood glucose levels

The nurse is assessing the neonate shown. From the assessment, the nurse notes that there is paralysis of the lower extremities. For which condition does the nurse anticipate performing care?

Spina bifida with myelomeningocele

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 client will be free from infection.

The pediatrician tells a mother the baby has pseudotalipes. What is the best explanation of this condition by the nurse?

The infant's foot can be brought into a straight position by manual manipulation.

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.

A newborn is born with a myelomeningocele. Which assessment data is most important to consider when managing care?

The newborn drips urine throughout the shift.

The community health nurse is preparing a presentation which will illustrate the various forms of spina bifida for a health fair. Which explanation should the nurse use to explain spina bifida with meningocele?

The spinal meninges protrude through the bony defect and form a cystic sac.

gastroschisis

a herniation of the abdominal contents through an abdominal wall defect, at the umbilicus

Periventricular-intraventricular hemorrhage is suspected in a newborn of 30 weeks' gestation. The nurse would anticipate preparing the newborn for which diagnostic tool to confirm the diagnosis?

cranial ultrasound

A newborn with tracheoesophageal fistula is likely to present with which assessment finding? a. Subnormal temperature b. Absent Moro reflex c. Inability to swallow d. Drooling from mouth

d. Drooling from mouth

Which finding would lead the nurse to suspect that a newborn is experiencing respiratory distress syndrome? a. Abdominal distention b. Acrocyanosis c. Depressed fontanels d. Nasal flaring

d. Nasal flaring

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

esophageal atresia

A nurse is assessing a newborn for jaundice. The nurse would first notice jaundice at which area?

face

While caring for a neonate of a diabetic mother, the nurse should monitor the neonate for which complication?

macrosomia

When planning preoperative care for a newborn with a cleft lip and palate, the nurse would plan interventions for which major need?

nutrition

late-onset breast-feeding jaundice

occurs later in the newborn period, with the bilirubin level usually peaking in the first 6 to 14 days of life

meconium aspiration syndrome

occurs when the newborn inhales particulate meconium mixed with amniotic fluid into the lungs while still in utero or on taking the first breath after birth. It is a common cause of newborn respiratory distress and can lead to severe illness

infant of a diabetic mother (IDM)

one born to a woman with pregestational or gestational diabetes

early-onset breast-feeding jaundice

probably associated with ineffective breast-feeding practices because of relative caloric deprivation in the first few days of life

A nursing student is caring for a newborn with a defect in the neural arch where the posterior laminae of the vertebrae have failed to close. The nurse knows that this infant is suffering from which disorder?

spina bifida

A nurse is performing a newborn assessment and notices a small dimple on the sacral area. The infant has a normal neurological assessment and moves all extremities well. What does the nurse suspect that the dimple indicates?

spina bifida occulta

cephalohematoma

subperiosteal collection of blood secondary to the rupture of blood vessels between the skull and periosteum

omphalocele

a defect of the umbilical ring that allows evisceration of the abdominal contents into an external peritoneal sac

A nurse is caring for a child with complex esophageal atresia who will be undergoing surgery for repair. What comment by the parents indicates further teaching is required?

"After this surgery is done tomorrow, my baby will be able to eat and drink."

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."

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."

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."

early-onset neonatal infections

(<72 hours) are associated with acquisition of microorganisms from the mother

late-onset infections

(>72 hours), acquired in the postpartum period, are primarily through horizontal transmission from family members or caregivers or through environmental exposures

5 A's

Ask: Ask all women if they smoke and would like to quit. Advise: Encourage the use of clinically proven treatment plans. Assess: Provide motivation by discussing the "5 Rs": Relevance of quitting to the woman Risk of continued smoking to the fetus Rewards of quitting for both Roadblocks to quitting Repeat at every visit Assist: Help the woman to protect her fetus and newborn from the negative effects of smoking. Arrange: Schedule follow-up visits to reinforce the woman's commitment to quit.

Which feeding method is best for the infant with a cleft lip and palate?

Breastfeeding

exchange transfusion

If the total serum bilirubin level remains elevated after intensive phototherapy, an exchange transfusion with albumin administered before the transfusion, the quickest method for lowering serum bilirubin levels, may be necessary

The nurse caring for a newborn notes a distended abdomen approximately 24 hours after birth. Which action should the nurse take after review of the medical record reveals an apparent healthy newborn at birth but no documentation of a bowel movement?

Inform the health care provider immediately.

Which types of play are most appropriate for the 3-month-old who is in an orthopedic cast?

Mobiles and rattles

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

A nurse is providing postoperative care to an infant who had a ventriculoarterial shunt placed. Approximately 8 hours after surgery, the nurse notes on assessment shrill crying and projective vomiting. Which response should the nurse prioritize at this time?

Notify the primary care provider immediately.

Which nursing interventions are essential when caring for a newborn with macrosomia born to a mother with diabetes? Select all that apply.

Obtain blood glucose reading. Obtain IV glucose for potential infusion. Assess for respiratory distress. Anticipate supplemental oxygen.

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 nurse is caring for a newborn with a repaired cleft lip. What intervention can the nurse provide to facilitate drainage of mucus and secretions to prevent aspiration?

Position the child on the side.

The nurse is preparing a nursing care plan for an infant who was born with spina bifida with myelomeningocele. Which nursing goal should the nurse prioritize for this child?

Preventing infection

neonatal abstinence syndrome (NAS)

a constellation of drug-withdrawal symptoms that result from chronic intrauterine exposure to a variety of substances, including opioids, barbiturates, SSRIs, alcohol, benzodiazepines, caffeine, and nicotine

The nurse is educating the parents of a neonate with Down syndrome regarding nutrition. Which provides the biggest challenge in feeding the neonate?

Thick, fissured tongue

respiratory distress syndrome

a breathing disorder resulting from lung immaturity and lack of alveolar surfactant

persistent pulmonary hypertension of the newborn (PPHN)

a cardiopulmonary disorder characterized by marked pulmonary hypertension that causes right-to-left extrapulmonary shunting of blood and hypoxemia

neonatal sepsis

a clinical syndrome of bacteremia with systemic signs and symptoms of infection in the first month of life

transient tachypnea of the newborn (TTN)

a self-limiting condition involving a mild degree of respiratory distress that requires minimal intervention, and resolves over 24 to 72 hours. It is described as the retention of lung fluid or transient pulmonary edema

A nurse is caring for a neonate of 25 weeks' gestation who is at risk for intraventricular hemorrhage (IVH). Which assessment finding should be reported immediately?

a sudden drop in hematocrit

hyperbilirubinemia

a total serum bilirubin level above 5 mg/dL resulting from unconjugated bilirubin being deposited in the skin and mucous membranes

periventricular-intraventricular hemorrhage

bleeding that usually originates in the subependymal germinal matrix region of the brain, often extending into the ventricular system

In which of the following infants would the nurse would be most alert for the development of transient tachypnea? a. Infant born by cesarean section b. Neonate who received no sedation c. Newborn of a mother with heart disease d. Baby who is small for gestational age

a. Infant born by cesarean section

The nurse is assessing a newborn who is large for gestational age. The newborn was born breech. The nurse suspects that the newborn may have experienced trauma to the upper brachial plexus based on which assessment finding?

absent Moro reflex

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

necrotizing enterocolitis (NEC)

an inflammatory disease of the bowel which can cause ischemic and necrotic injury in the gastrointestinal tract

A newborn with high serum bilirubin is receiving phototherapy. Which nursing intervention is the most appropriate for this client?

application of eye dressings to the infant

The nurse is caring for term neonate who was exposed to cocaine throughout the pregnancy. What effect would this exposure have on the neonate's vital signs? a. They would be lower than normal. b. They would be higher than normal. c. They would not be affected at all. d. BP would be lower, pulse would higher.

b. They would be higher than normal.

kernicterus

bilirubin encephalopathy

When assessing the substance-exposed newborn, which finding would the nurse expect? a. Calm facial appearance b. Daily weight gain c. Increasing irritability d. Feeding and sleeping well

c. Increasing irritability

Characteristics of a newborn with fetal alcohol syndrome would include which of the following? Select all that apply: a. Hypocalcium and hypokalemia b. Malformed ears and cataracts c. Microcephaly and thin upper lip d. Congenital cardiac defects and SGA e. Prominent cheekbones and LGA f. Hyperactive behavior and feeding problems

c. Microcephaly and thin upper lip d. Congenital cardiac defects and SGA f. Hyperactive behavior and feeding problems

A nurse is assigned to care for a high-risk newborn with a periventricular-intraventricular hemorrhage (PVH-IVH) in the home environment after discharge. For which condition should the nurse monitor the infant?

hydrocephalus

chronic bilirubin encephalopathy

kernicterus is characterized by four clinical manifestations: movement disorder (athetosis, dystonia, spasticity, hypotonia), auditory dysfunction (deafness), oculomotor impairment, and dental enamel hypoplasia of deciduous teeth

perinatal asphyxia

known as hypoxic-ischemic encephalopathy, is characterized by clinical and laboratory evidence of acute or subacute brain injury due to systemic hypoxemia or reduced cerebral blood flow

Which newborn would the nurse suspect to be most at risk for intellectual disability due to the mother's actions during pregnancy?

the child of a client who admits to drinking a liter of alcohol daily during the pregnancy

When assessing a newborn, the nurse determines that the newborn is most likely experiencing respiratory distress syndrome (RDS) based on which finding?

see-saw respirations

caput succedaneum

soft tissue swelling

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

tachypnea more than 60 breaths/minute

acute bilirubin encephalopathy

the effects of hyperbilirubinemia in the first weeks of life

phototherapy

used to convert unconjugated bilirubin to the less toxic water-soluble form that can be excreted