Ch. 26- Nursing Care of a Family With a High-Risk Newborn

A newborn's condition is not improving after intubation. What assessment by the nurse would identify a possible problem?

*Auscultate breath sounds.* Auscultate for bilateral breath sounds. If breath sounds are absent on one side, the endotracheal (ET) tube is malpositioned and needs to be repositioned. Retractions are consistent with respiratory distress and the need for resuscitation. A blood gas might confirm inadequate ventilation but would not identify the problem.

A newborn is receiving bag and mask ventilation and cardiac compression. The resuscitation is paused, and the nurse reassesses the infant. The infant's heart rate is 70 bpm with irregular gasping respirations. What is the appropriate action in this situation?

*Continue bag and mask ventilation only.* The infant is exhibiting respiratory distress and needs continued bag and mask resuscitation. The heart rate is greater than 60 bpm, so cardiac compressions are not needed.

The parents of a preterm newborn being cared for in the neonatal intensive care unit (NICU) are coming to visit for the first time. The newborn is receiving mechanical ventilation, intravenous fluids and medications and is being monitored electronically by various devices. Which action by the nurse would be most appropriate?

*Encourage the parents to touch their preterm newborn.* The NICU environment can be overwhelming. Therefore, the nurse should address their reactions and explain all the equipment being used. On entering the NICU, the nurse should encourage the parents to touch, interact, and hold their newborn. Doing so helps to acquaint the parents with their newborn, promotes self-confidence, and fosters parent-newborn attachment. The parents should be allowed to stay for as long as they feel comfortable. Reassurance, although helpful, may be false reassurance at this time. Discussing discharge care can be done later once the newborn's status improves and plans for discharge are initiated.

At the birth of a high-risk newborn, what is the nurse's priority action to prevent cerebral hypoxia?

*Maintain adequate respirations.* At birth, maintaining adequate respirations is the priority to prevent cerebral hypoxia. Cerebral perfusion and cardiac activity are dependent on adequate respiratory effort. Thermoregulation is important at birth, but it does not prevent cerebral hypoxia.

A 35-year-old client has just given birth to a healthy newborn during her 43rd week of gestation. What should the nurse expect when assessing the condition of the newborn?

*meconium aspiration in utero or at birth* Infants born after 42 weeks of pregnancy are postterm. These infants are at a higher risk of swallowing or aspirating meconium in utero or after birth. As soon as the infant is born, the nurse usually suctions out the secretions and fluids in the newborn's mouth and throat before the first breath to avoid aspiration of meconium and amniotic fluid into the lungs. Seizures, respiratory distress, cyanosis, and shrill cry are signs and symptoms of infants with intracranial hemorrhage. Intracranial hemorrhage can be a dangerous birth injury that is primarily a problem for preterm newborns, not postterm neonates. Yellow appearance of the newborn's skin is usually seen in infants with jaundice. Tremors, irritability, high-pitched or weak cry, and eye rolling are seen in infants with hypoglycemia.

How does the nurse position the infant experiencing respiratory difficulty?

*on the back with the head elevated 15 degrees* Positioning the infant on the back allows bilateral lung expansion. Elevating the head 15 degrees enhances movement of the diaphragm. Positioning the infant on the side or on the stomach restricts lung expansion.

A nurse is caring for a preterm newborn who has developed rapid, irregular respirations with periods of apnea. Which additional assessment finding should the nurse identify as an indication of respiratory distress syndrome (RDS)?

*sternal retraction* The nurse should identify sternal retraction as a sign of respiratory distress syndrome in the preterm newborn. Deep inspiration is not seen during respiratory distress; rather, a shallow and rapid respiration is seen. There is an inspiratory lag, instead of an expiratory lag, during respiratory distress. There is a grunting heard when the air is breathed out, which is during expiration and not during inspiration.

A nurse initiates bag and mask ventilation with an anesthesia bag on a newborn with no spontaneous respiratory effort. What controls the pressure of breaths delivered by an anesthesia bag?

*the pressure the nurse uses when the hand squeezes against the bag* The pressure exerted by the nurse's hand squeezing the bag controls the pressure delivered by an anesthesia bag. An ambu or resusci bag has a blow-off value that limits the pressure administered.

The preterm neonate has been in an incubator and is in medically stable condition and gaining weight. The nurse is preparing the neonate for transfer to an open cot. What will the nurse include in the care plan for this process? Select all that apply.

Dress the neonate in a sleeper and hat. Decrease incubator temperature gradually until room temperature is reached. Assess the neonate's temperature every 30 minutes during the transition. The nurse should dress the neonate because the neonate will be in an open cot (sleeper, hat, light blanket); the nurse should also gradually decrease the incubator temperature every 30 minutes until room temperature is reached. The nurse should also assess the neonate's temperature every 30 minutes during the transition. The incubator should not be moved to a sunny window, because this action can increase incubator temperature and will not show the neonate's tolerance of the transition. Bathing can cause cold stress and should be avoided until after the transition is complete and the neonate shows signs of thermoregulation

The nurse assesses an infant's body temperature as 97.1°F (36.2°C) during an extended resuscitation at birth. What consequence of this temperature would the nurse anticipate? Select all that apply.

Fetal shunts remain open. Anaerobic glycolysis occurs. Pulmonary perfusion decreases. Metabolism increases. When the infant's body temperature is low, the fetal shunts remain open, anaerobic glycolysis occurs, pulmonary perfusion decreases, and metabolism increases. Immune function is not a consequence of body temperature.

Which condition may cause intrauterine asphyxia? Select all that apply.

cord compression placental abruption (abruptio placentae) intrauterine growth restriction (IUGR) Conditions such as cord compression, placental abruption, and intrauterine growth restriction alter uteroplacental blood flow and may cause intrauterine asphyxia. Gestational diabetes may cause fetal hyperinsulinemia, and group B strep infection may cause intrauterine infection or PROM/preterm labor.

A preterm infant receives surfactant by lung lavage. Which interventions should the nurse perform immediately? Select all that apply.

placing the infant in an upright position not suctioning the airway Following lung lavage, the infant needs to be placed in an upright position to facilitate dispersion of the surfactant. The airway is not suctioned for as long as safely possible to prevent removal of the surfactant.