Nursing Care of the Newborn
The nurse must continually assess a preterm infant's temperature and provide appropriate nursing care because, unlike the full-term infant, the preterm infant has what limitation? Cannot use shivering to produce heat Cannot break down glycogen to glucose ****Has a limited supply of brown fat available to provide heat Has a limited amount of pituitary hormones with which to control internal heat
Because neonates are unable to shiver, they use the breakdown of brown fat to supply body heat; the preterm infant has a limited supply of brown fat available for this purpose. An inability to use shivering to produce heat is not specific to preterm neonates; all newborns are unable to use shivering to supply body heat. The breakdown of glycogen into glucose does not supply body heat. Pituitary hormones do not regulate body heat.
The nurse concludes that a couple with a newborn with Erb palsy has an accurate understanding of the infant's prognosis. Which statement confirms this conclusion? "Surgery will correct the palsy." "This is a progressive disorder with no cure." ****"Recovery usually occurs in about 3 months." "Physical therapy will be necessary for 1 year."
The nerves that are stretched take about 3 months to recover from the trauma sustained during birth. Passive range-of-motion exercise and intermittent splinting performed by a trained family member will help facilitate recovery. Only in rare instances, when avulsion of the nerves results in permanent damage, is orthopedic or surgical intervention necessary. The paralysis is not progressive, and the prognosis is usually excellent. Physical therapy is necessary for about 3 months, not 1 year.
What does a nurse who is assessing a newborn 3 minutes after birth remember is the range of heart rate for a healthy, alert neonate? 120 and 180 beats/min 130 and 170 beats/min ****110 and 160 beats/min 100 and 130 beats/min
The newborn's heart rate varies with activity; crying can increase it to 180 beats/min, whereas deep sleep may lower it to 80 to 100 beats/min; a rate between 110 and 160 beats/min is the average. A heart rate in an alert, noncrying newborn that is faster than 160 beats/min constitutes tachycardia. The heart rate of an alert, noncrying newborn that is slower than 110 beats/min constitutes bradycardia.
A client with chronic hypertension and superimposed preeclampsia gives birth at 39 weeks' gestation to a 4 lb 12 oz (2155 g) infant. What condition does the nurse anticipate when assessing this infant? Prematurity Cardiac anomalies Respiratory infection ****Intrauterine growth restriction
The pathological changes of maternal chronic vascular disease cause uteroplacental insufficiency; vasospasms diminish fetal oxygenation and nutrition, which lead to slow fetal growth. Prematurity is defined as gestational age of less than 37 weeks. There is no greater incidence of cardiac anomalies in infants with intrauterine growth restriction. Neither is there a greater incidence of infection in infants with low birth weight; however, they may have a lower resistance to infection.
A neonate weighing 5 lb 6 oz (2438 g) is born in a cesarean birth and admitted to the newborn nursery. What range of resting respiratory rate should the nurse anticipate? 20 to 40 breaths/min ****30 to 60 breaths/min 60 to 80 breaths/min 70 to 90 breaths/min
After respiration is established, the normal neonate respiratory rate ranges from 30 to 60 breaths/min with short periods of apnea. Twenty breaths per minute is bradypnea. A respiratory rate faster than 60 breaths/min is tachypnea.
Which finding in a newborn whose temperature over the last 4 hours has fluctuated between 98.0° F (36.7° C) and 97.4° F (36.3° C) would be considered critical? Respiratory rate of 60 breaths/min White blood count greater than 15,000 mm3 Serum calcium level of 8 mg/dL (2 mmol/L) ****Blood glucose level of 36 mg/dL (3.8 mmol/L)
Instability of the newborn's temperature is an indication of hypoglycemia. A glucose level below 40 mg/dL (1.7 mmol/L) does not provide enough energy to maintain the body temperature at a normal level. A serum calcium level of 8 mg/dL (2 mmol/L), respiratory rate of 60 breaths/min, and a white blood cell count greater than 15,000 mm3 are all normal findings and do not affect body temperature.
A nurse is caring for a preterm infant with necrotizing enterocolitis (NEC). Which nursing intervention is most important for this infant? ****Measuring abdominal girth frequently Diluting the formula mixture as prescribed Administering oxygen before the gastric feeding Using half-strength formula for gavage feeding
NEC is marked by prolonged gastric emptying; an increase in abdominal girth of more than 1 cm in 4 hours is significant and requires immediate intervention. Formula feeding is stopped and parenteral fluids, usually total parenteral nutrition (TPN), are started instead. Administering oxygen before the gastric feeding will have no therapeutic value for an infant with NEC.
After her baby's birth a client wishes to begin breast-feeding as soon as possible. How can the nurse best assist the client at this time? Giving the infant a bottle first to evaluate the sucking reflex Positioning the infant to grasp the nipple to express colostrum Leaving the infant and parents alone to promote attachment behaviors ****Touching the infant's cheek adjacent to the nipple to elicit the rooting reflex
Stimulating the rooting reflex effectively encourages the newborn to turn toward the breast in preparation for suckling. Giving the neonate a bottle may interfere with the infant's learning to accept the breast. For milk to be expressed the infant must grasp the entire areola, which contains the secretory ducts. At first the mother should be supervised to help ensure a successful experience.
A couple arrives at the newborn nursery asking to take their newborn grandson to his mother's room. What is the best response by the nurse? "I'll get your grandchild. You must be very excited." ****"Please go on to see your daughter. I'll bring the baby to her room." "Show me your identification. I need to see it before I can give you the baby." "Only the mother can ask for the baby. Have her call us to bring the baby to her."
Telling the couple that the baby will be brought to the client's room maintains the nurse's legal responsibility of providing for the infant's safety while still promoting a positive interaction with the client's family. Giving the infant to another person without the mother's knowledge or consent is illegal. Legally the nurse may not give the infant to the grandparents. Although insisting that only the mother can ask for the infant may follow legal policy, it is an abrupt nontherapeutic response to the grandparents.
The nurse is caring for a newborn with caput succedaneum. The nurse is able to differentiate caput succedaneum from cephalhematoma because of what characteristic of the scalp edema in caput succedaneum? Becomes ecchymotic ****Crosses the suture line Increases after several hours Is tender in the surrounding area
Scalp edema that crosses the suture line is the clinical finding that differentiates between these two conditions. With caput succedaneum the swelling crosses the suture line, whereas in cephalhematoma it does not. Bruising may occur in either condition. The swelling diminishes; if the swelling increases, the newborn will need to be observed for signs of increased intracranial pressure. Pain is not associated with either condition