OB PrepU Chapter 24: Nursing Management of the Newborn at Risk: Acquired and Congenital Newborn Conditions
Rescue treatment with surfactant administration for an infant with established respiratory distress syndrome (RDS) who requires mechanical ventilation is administered within how many hours after birth? 1 hour and repeated in 2 hours 1 hour and repeated in 4 hours 2 hours and repeated in 4 hours 2 hours and repeated in 6 hours
2 hours and repeated in 4 hours Explanation: Rescue treatment with surfactant administration is indicated for newborns with established RDS who require mechanical ventilation and supplemental oxygen. It is typically given within 2 hours after birth and repeated again at 4 hours. The earlier the surfactant is administered, the better the effect on gas exchange.
A nurse makes a home visit to a new mother and her 5-day-old newborn. Assessment of the newborn reveals slight yellowing of the skin on the face and forehead and slowed skin turgor. The mother tells the nurse that she's been having trouble breastfeeding the newborn. "My baby's been feeding about every 4 to 5 hours." Additional assessment reveals about 3 wet diapers per day and 1 to 2 stools per day. Which action by the nurse would be the priority? Call the provider to obtain a prescription for a bilirubin level. Arrange for home phototherapy. Evaluate the mother's technique for breastfeeding. Measure the newborn's abdominal girth.
Call the provider to obtain a prescription for a bilirubin level. Explanation: The assessment findings and report from the mother suggest late-onset breastfeeding jaundice. The nurse should report the findings to the provider and obtain a prescription for a bilirubin level. Once the results are obtained, then the decision for home phototherapy can be made. Although it would be helpful to evaluate the mother's breastfeeding technique to promote enhanced breastfeeding, the priority is to confirm hyperbilirubinemia and institute measures to lower the bilirubin level. Measuring the newborn's abdominal girth would be unnecessary.
At birth, a newborn is diagnosed with brachial plexus palsy. The parent asks how the nurse knows the newborn's positioning of the arm is a result of the palsy and not just a preferred position. Which neonatal reflex should the nurse explain to the parent? Moro stepping rooting Babinski
Moro Explanation: When a newborn has brachial plexus palsy, there will be asymmetry of the Moro reflex. The stepping reflex assesses movement of the legs. The rooting reflex is used to stimulate sucking and feeding. A positive Babinski sign indicates neurologic immaturity.
The nurse is caring for an intrapartum mother whose fetus has asymmetrical intrauterine growth restriction (IUGR) after the 24th week of gestation. Which nursing action is best? Provide emotional support to the mother and support person as the neonate has anomalies. Regular assessment of the fetal monitor tracings and preparation for a cesarean birth, if needed. Anticipate a precipitous delivery since the neonate is small-for-gestational-age. Use regular assessment techniques as an uncomplicated delivery is anticipated.
Regular assessment of the fetal monitor tracings and preparation for a cesarean birth, if needed. Explanation: The fetus with asymmetrical intrauterine growth restriction is compromised in some manner; thus, regular assessment of the fetal monitor tracings can indicate if the fetus is in distress (a common occurrence). If the fetus is in distress due to the work of birth, be prepared for a cesarean section. Neither a congenital anomaly nor a precipitous delivery is always present with IUGR. Since there is a complication causing IUGR, a complicated delivery is anticipated.
Which measure would the nurse expect to be included in the plan of care for an infant of a mother with diabetes who has a serum calcium level of 6.2 mg/dl (1.55 mmol/l)? administration of calcium gluconate initiation of phototherapy infusions of intravenous glucose initiation of oral feedings
administration of calcium gluconate Explanation: Serum calcium levels less than 7 mg/dl (1.75 mmol/l) indicate the need for supplementation with oral or IV calcium gluconate. Phototherapy would be used if the infant develops hyperbilirubinemia. Intravenous glucose solutions would be used to stabilize the infant's blood glucose levels and prevent hypoglycemia. Feedings help to control glucose levels, reduce hematocrit, and promote bilirubin excretion.
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 placing light 6 inches above the newborn's bassinet delay of feeding until bilirubin levels are normal gentle shaking of the baby
application of eye dressings to the infant Explanation: Continuous exposure to bright lights by phototherapy may be harmful to a newborn's retina, so the infant's eyes must always be covered while under bilirubin lights. Eye dressings or cotton balls can be firmly secured in place by an infant mask. The lights are placed 12 to 30 inches above the newborn's bassinet or incubator. Bilirubin is removed from the body by being incorporated into feces. Therefore, the sooner bowel elimination begins, the sooner bilirubin removal begins. Early feeding by either breast milk or formula, therefore, stimulates bowel peristalsis and helps to accomplish this. Gently shaking the infant is a method of stimulating breathing in an infant experiencing apnea.
The nurse is caring for a pregnant woman who is struggling with controlling gestational diabetes mellitus. What effect does the nurse predict this situation may have on the fetus? have a serious birth defect grow to an unusually large size suffer from symmetrical intrauterine growth restriction suffer from asymmetrical intrauterine growth restriction
grow to an unusually large size Maternal diabetes is the most widely known contributing factor to large-for-gestational-age newborns. LGA babies are frequently born to mothers with diabetes and poor glucose control. Continued high blood glucose levels in the mother lead to an increase in insulin production in the fetus. Increased insulin levels act as a fetal growth hormone causing macrosomia, an unusually large newborn with a birth weight of greater than 4,500 grams (9 pounds, 14 ounces). The incidence of birth defects in newborns born of a mother with gestational diabetes is not greatly increased. IUGR is not a typical outcome of uncontrolled gestational diabetes. It is more likely that the newborn will be large-for-gestational-age.
A neonate undergoing phototherapy treatment must be monitored for which adverse effect? hyperglycemia increased insensible water loss severe decrease in platelet count increased GI transit time
increased insensible water loss Increased insensible water loss is due to absorbed photon energy from the lights. Hyperglycemia isn't a characteristic effect of phototherapy treatment. Phototherapy may cause a mild decrease in platelet count. GI transit time may decrease with the use of phototherapy.
The nurse should carefully monitor which neonate for hyperbilirubinemia? neonate of African descent neonate of an Rh-positive mother neonate with ABO incompatibility neonate with Apgar scores 9 and 10 at 1 and 5 minutes
neonate with ABO incompatibility Explanation: The mother's blood type, which is different from the neonate's, has an impact on the neonate's bilirubin level due to the antigen antibody reaction. Neonates of African descent tend to have lower mean levels of bilirubin. Chinese, Japanese, Korean, and Greek neonates tend to have higher incidences of hyperbilirubinemia. Neonates of Rh-negative, not Rh-positive, mothers tend to have hyperbilirubinemia. Low Apgar scores may indicate a risk for hyperbilirubinemia; 9 and 10 associate with normal adjustment to extrauterine life.
Which sign appears early in a neonate with respiratory distress syndrome? bilateral crackles pale gray skin color tachypnea more than 60 breaths/minute poor capillary filling time (3 to 4 seconds)
tachypnea more than 60 breaths/minute Explanation: Tachypnea and expiratory grunting occur early in respiratory distress syndrome to help improve oxygenation. Poor capillary filling time, a later manifestation, occurs if signs and symptoms aren't treated. Crackles occur as the respiratory distress progressively worsens. A pale gray skin color obscures earlier cyanosis as respiratory distress symptoms persist and worsen.
At the breech forceps birth of a 32 weeks' gestation neonate, the nurse notes oligohydramnios with green thick amniotic fluid. The maternal history reveals a mother of Hispanic ethnicity with marked hypertension, who admits to using cocaine daily. Which factor(s) may contribute to meconium aspiration syndrome (MAS)? Select all that apply. the preterm pregnancy the forceps breech birth maternal cocaine use maternal hypertension Hispanic ethnicity oligohydramnios present
the forceps breech birth maternal cocaine use maternal hypertension oligohydramnios present The predisposing factors for meconium aspiration syndrome include postterm pregnancy and breech presentation with forceps. Ethnicity (Pacific Islander, Indigenous Australian, Black African) is a factor. Postterm neonates are at risk for MAS, but preterm neonates are not. Exposure to drugs during pregnancy, especially tobacco and cocaine, predispose the neonate to MAS. Maternal hypertension and oligohydramnios also contribute to MAS.
