Ch. 23 Nursing Care of NB w/ special needs

What percentage of neonates requires some type of assistance to transition to extrauterine life?

10% Most newborns transition to extrauterine life smoothly. About 10% of newborns need some type of assistance at birth.

A nurse is assessing a term newborn and finds the blood glucose level is 23 mg/dl. The newborn has a weak cry, is irritable, and exhibits bradycardia. Which intervention is most appropriate?

Administer dextrose intravenously The infant is demonstrating signs and symptoms of significant hypoglycemia. IV dextrose should be administered to the term newborn intravenously when the blood glucose level is less than 40 mg per dL, and the newborn is symptomatic for hypoglycemia. Administration of IV glucose assists in stabilizing blood glucose levels. Providing oral glucose feedings or placing the infant on a radiant warmer will not help maintain the glucose level. Monitoring the infant's hematocrit level is not a priority and not related to the problem at hand.

The nurse observes a neonate delivered at 28 weeks' gestation. Which finding would the nurse expect to see?

The pinna of the ear is soft and flat and stays folded. The ear has a soft pinna that's flat and stays folded. Pale skin with no vessels showing through and 7 to 10 mm of breast tissue are characteristic of a neonate at 40 weeks' gestation. Creases on the anterior two-thirds of the sole are characteristic of a neonate at 36 weeks' gestation.

With the administration of oxygen, a preterm infant's Pa02 level is monitored carefully. It is important to keep this level under which value to help prevent retinopathy of prematurity?

100 mm Hg Retinal capillaries can be damaged by excessive oxygen levels. Keeping the Pa02 level under 100 mm Hg helps prevent this.

Assessment of a newborn at 40 weeks' gestation reveals that he is a low birth weight newborn. Which of the following weights would the nurse identify as being low birth weight?

2400 g A birth weight of less than 2500 g is categorized as a low birth weight in infants. The normal birth weight of term infants ranges from 3000-4000 g. Hence infants with a birth weight of 3500 g or 4500 g will not be categorized as low birth weight infants. Infants having birth weights lower than 1500g are termed as very low birth weight infants, and not merely low birth weight.

All infants need to be observed for hypoglycemia during the newborn period. Based on the facts obtained from pregnancy histories, which infant would be most likely to develop hypoglycemia?

An infant who had difficulty establishing respirations at birth

When reviewing the medical record of a newborn who is large for gestational age (LGA), which of the following factors would the nurse identify as having increased the newborn's risk for being LGA?

Maternal pregravid obesity The nurse should identify maternal pregravid obesity as a risk factor for the development of LGA newborns. The other risk factors for the development of LGA newborns include fetal exposure to high estrogen, excess weight gain during pregnancy, gestational diabetes and high maternal birth weight.

Which intervention should a nurse implement to promote thermal regulation in a preterm newborn?

Observe for clinical signs of cold stress such as weak cry The nurse should observe for clinical signs of cold stress, such as respiratory distress, central cyanosis, hypoglycemia, lethargy, weak cry, abdominal distention, apnea, bradycardia, and acidosis. The temperature of the radiant warmer should not be set at a fixed level and should be adjusted to the newborn's temperature. The nurse does not need the check the blood pressure of the infant every 2 hours. The infant's temperature should be measured more often than every 8 hours.

The small-for-gestational-age neonate is at increased risk for which complication during the transitional period?

Polycythemia probably due to chronic fetal hypoxia The small-for-gestational-age neonate is at risk for developing polycythemia during the transitional period in an attempt to decrease hypoxia. This neonate is also at increased risk for developing hypoglycemia and hypothermia due to decreased glycogen stores

The nurse enters the room and notices that the infant is in the crib against the window. What type of heat loss may this infant suffer?

Radiation Radiation heat loss results from the transfer of heat in an environment from warmer to cooler objects that are not in direct contact with each other.

When caring for a preterm infant, what intervention will best address the sensorimotor needs of the infant?

Rocking and massaging When preterm infants receive sensorimotor interventions such as rocking, massaging, holding, or sleeping on waterbeds, they gain weight faster, progress in feeding abilities more quickly, and show improved interactive behavior. Interventions such as swaddling and positioning, use of minimal amount of tape, and use of distraction through objects are related to pain management.

A nurse is caring for a baby girl born at 34 weeks' gestation. Which of the following features should the nurse identify as those of a preterm newborn?

Shiny heels and palms A preterm newborn has shiny heels and palms with few creases. The eyelids of the preterm newborn are edematous, and not paper-thin. The external genitalia in the preterm baby girl appear large with widely spaced labia, and not closely approximated. Vernix is scant in post-term newborns and is excessive in premature infants.

The nurse is performing a newborn assessment and the infant's lab work reveals a heelstick Hct of 66. What is the best response to this finding?

The hematocrit needs to be repeated as a venous stick to see what the central hematocrit level is. A hematocrit above 65% is considered elevated and polycythemia is diagnosed. However, to get an accurate venous reading, a central venous hematocrit needs to be drawn to verify the value. Drawing the blood in 8 hours does not address the problem at present and the infant does not need a partial exchange transfusion immediately. Healthcare providers will decide if this is needed after monitoring the infant for symptoms and following the central Hct levels

The nurse is caring for a client in the early stages of labor. What maternal history factors will alert the nurse to plan for the possibility of a small-for-gestational-age (SGA) newborn?

• Maternal Smoking during pregnancy • Asthma exacerbations during pregnancy • Drug abuse The nurse should be alert to the possibility of an SGA newborn if the history of the mother reveals smoking, chronic medical conditions (such as asthma), and drug abuse. Additional maternal factors that increase the risk for an SGA newborn include hypertension, genetic disorders, and multiple gestations.

Which of the following would the nurse expect to find in a newborn who is considered small for gestational age?

• Sunken abdomen • Poor muscle tone over buttocks • Dry or thin umbilical cord A small-for-gestational-age newborn typically has a sunken abdomen, wide skull sutures, decreased subcutaneous fat stores, poor muscle tone over buttocks and cheeks, and a thin umbilical cord.