OB Ch. 18

Gonorrhea and chlamydia

A prophylactic agent is instilled in both eyes of all newborns to prevent which of the following conditions?

How should the nurse respond to this mother's questions? In a calm manner, explain to Ms. Scott that all her observations are normal variations and address each one separately: • "Banana-shaped head"—is molding where the newborn had a slight overriding of the skull bones to navigate the bony pelvis and birth canal during the birth process • "Mushy" feel to head—caput succedaneum, which is an edematous area of the scalp as a result of sustained pressure of the occiput against the cervix during labor and birth process • "White spots on nose"—milia, which are plugged, distended, small, white sebaceous glands that are present in most newborns and should not be squeezed by the mother • "Blue bruises on buttocks"—Mongolian spots, which are bluish-black areas of pigmentation that are common in African Americans and have no clinical significance, but can be mistaken for bruises b. What additional newborn instruction might be appropriate at this time? At this time, it might be appropriate for the nurse to unwrap the newborn and complete a thorough bedside assessment, pointing out any minor deviations to the mother and explaining their significance. This will allay any future anxiety about her newborn and will afford the opportunity to instruct Ms. Scott on various physiologic and behavioral adaptations present in her daughter. c. What reassurance can be given to this new mother regarding her daughter's appearance? One can assume that this mother's concern is that these various normal deviations might be permanent. The nurse can identify each and provide reassurance about their approximate time of disappearance: • Molding—transient in nature and should disappear within 72 hours • Caput succedaneum—disappears spontaneously within 3 to 4 days • Milia—will clear up spontaneously within the first month • Mongolian spots—will gradually fade during the first or second year

1. An African-American mother who delivered her first baby and is on the mother-baby unit, calls the nursery nurse into her room and expresses concern about how her daughter looks. The mother tells the nurse that her baby's head looks like a "banana" and is mushy to the touch, and she has "white spots" all over her nose. In addition, there appear to be "big bluish bruises" all over her baby's buttocks. She wants to know what is wrong with her baby and whether these problems will go away.

Phenylketonuria

7. Which condition would be missed if a newborn were screened before he had tolerated protein feedings for at least 48 hours?

Head circumference 32 cm, chest 34 cm

8. Which of the following findings in a newborn would the nurse document as abnormal when assessing the newborn head?

blood clotting

The nurse administers a single dose of vitamin K intramuscularly to a newborn after birth to promote:

Oxidize bilirubin on the skin

The nurse is explaining phototherapy to the parents of a newborn. The nurse would include which of the following as the purpose?

Passage of meconium within the first 24 hours

Which of the following findings in a newborn would be considered normal?

Hepatitis B

Which one of the following immunizations is most commonly received by newborns before hospital discharge?

What impact does an infant abduction have on the family and the hospital? The abduction of an infant is a devastating event that poses significant emotional, legal, and financial risks to both the family and the hospital. The sudden, unexpected loss of an infant followed by an indefinite period of uncertainty concerning the child's well-being places the traumatized family in crisis. The hospital typically will change its security systems, policies, and procedures; heighten supervision; and increase accountability for all staff. b. What security measure was the weak link in the chain of security? The woman was able to pass into the hospital via the emergency room posing as a "nurse" without anyone checking her name tag. The security cameras were not working at the time of the abduction. This allowed the abductor to pass down the hall with the infant unnoticed and unrecorded. The nurses on the unit were unaware of this woman on their unit, which should not happen. There should be an alarm on the doors leading into the unit and the doors should remain locked and only be opened electronically by a staff member on the unit after the person has been identified. There was truly a breakdown of several security measures in this scenario. c. What can hospitals do to prevent infant abduction? Keys to infant security are awareness and education. The hospital staff should attend annual in-services on these measures and participate in a mock infant abduction drill to heighten awareness of infant security. Specially color-coded staff badges should be worn by all obstetrics staff, and parents should be instructed not to give their newborn to anyone without that specific color badge. Parents' wristbands should match the infant's ankle and wristbands. Everyone must work together to keep all infants safe.

At approximately 12:30 AM on a Friday, a woman enters a hospital through a busy emergency department. She is wearing a white uniform and a lab coat with a stethoscope around her neck. She identifies herself as a new nurse coming back to check on something she had left on the unit on an earlier shift. She enters a postpartum client's room containing the mother's newborn, pushes the open crib down a hallway, and escapes through an exit. The security cameras aren't working. The infant isn't discovered missing until the 2 AM check by the nurse.

8 points

At birth, a newborn's assessment reveals the following: heart rate of 140 bpm, loud crying, some flexion of extremities, crying when bulb syringe is introduced into the nares, and a pink body with blue extremities. The nurse would document the newborn's Apgar score as:

Sudden infant death syndrome

The AAP recommends that all newborns be placed on their backs to sleep to reduce the risk of: