check your learning CH 11, 19, 20, 21, 22, 23, 24
. Which action should the nurse take when counseling a teenaged client who has decided to relinquish her baby for adoption?
A. Question her about her feelings regarding adoption B. Tell her she can always change her mind about adoption C. Affirm her decision while acknowledge her maturity in making it D. Ask her if anyone is coercing her into the decision to relinquish her baby C
Foremilk
Thirst-quenching milk
List the characteristics that predispose newborns to heat loss.
This skin; blood vessels near the surface; little insulating subcutaneous white fate; heat readily transferred from internal organs to skin; greater ratio of surface area to body mass.
A new mother anxiously summons the nurse to her room because the baby has sneezed twice. A brief assessment shows nothing unusual. The appropriate teaching is that: A. This may indicate overstimulation, and the infant may need quiet time B. Multiple sneezes are characteristic of the second period of reactivity C. The baby may be developing a cold, so the healthcare provider should be notified D. Sneezing may indicate sensitivity to the drugs given to the mother during birth
A
A new mother wants to breastfeed but plans occasional formula feedings. The nurse should reach her to: A. Avoid using bottles for 3 to 4 weeks to establish her milk supply, if possible B. Make a clear choice to feed by one method to avoid nipple confusion C. Limit formula feeding to once each day until her milk supply is well established. D Alternate formula and nursing to allow the infant to become accustomed to both
A
A nursing student has been caring for a woman and her newborn all morning. The student takes the infant to the nursery for screening tests before discharge. When the infant is returned to the mother, the correct procedure is to: A. Have the mother read her printed band number and verity that it matches the infant's band number B. Ask the mother to state her name and the name of her infant C. Call out the mother's full name before leaving the infant with her D. Explain the screening tests and give the infant to the mother
A
Choose the correct parent teaching about cord care. A. Fold the diaper below the cord to speed drying B. Expect the cord to detach in no more than 7 days C. Scrub the area with soap each day D. Skin near the cord site may be red until it detaches
A
Parents of a 6-week-old infant are afraid to pick him up if he cries because they do not want to spoil him. The appropriate teaching is that: A. Infants this young cannot be spoiled by holding in response to crying B. They should not worry about crying if he has recently fed well C. Holding the infant for more than 15 minutes at a time usually avoids spoiling D. Not holding him will reduce the stimulation that often causes crying
A
A breastfeeding mother is reluctant to take prescribed analgesic because she does not want to pass it to the baby. The nurse should teach her that: A. Medications prescribed for postpartum discomfort are safe for use in lactation B. She should feed less often so that she can limit transfer of medication to the baby C. It is important to avoid all nonessential medications during nursing, including analgesics D. Formula feeding as long as she needs analgesics may be best for the baby
A
A client has delivered twins. The first twin was stillborn, and the second is in the intensive care nursery, recovering quickly from respiratory distress. The client is crying softly and says, "I wish my baby could have lived." What is the most therapeutic response?
A. "I have a friend who lost a twin and she's doing just fine now." B. "How soon do you plan to have another baby?" C. "I am so sorry about your loss. Would you like to talk about it?" D. "Don't be sad. At least you have one healthy baby." C
A client has just acknowledged that she is 20 weeks pregnant and confides to the nurse that she has a daily heroin habit. The nurse discusses treatment options for the client. Which client statement requires follow-up?
A. "My plan is to visit the outpatient clinic daily for treatment." B. "My baby will not have to go through withdrawal when I take methadone." C. "I will see my health care provider at least every 2 weeks." D. "With oral methadone, my baby and I are at decreased risk of infection." B
The nurse notes that the infant's feet are turned inward. The appropriate initial nursing action is to:
A. Apply a splint or harness to the feet and lower legs B. Notify the healthcare provider immediately C. Explain to the parents that this can be corrected with surgery D. Determine whether the feet can be moved to a normal position D
The foramen ovale closes because the:
A. Arterial pressures in the lungs are higher than in the body. B. Presence of slight hypoxia and acidosis causes constriction. C. Blood flow through it is redirected through the liver. D. Pressure in the left atrium is higher than in the right. D
While performing an admission assessment on a term newborn, the nurse notes poor muscle tone and slight jitteriness. There are no other findings. The appropriate nursing action is to:
A. Assess the infant's blood glucose level B. Wrap the infant tightly in blankets C. Check the chart for narcotics given in labor D. Give supplemental oxygen by face mask A
When weighing an infant, the nurse places a covering on the scale tray to:
A. Avoid causing multiple Moro reflexes when weighing B. Ensure that conductive heat loss from the infant is minimal C. Compensate for negative weight balance to ensure correct weight D. Avoid contaminating the scale with body substances B
. Signs of infection in the newborn are often subtle because:
A. Body temperature rises slowly in response to pathogens. B. Passive antibodies from the mother fight infection early. C. Immunoglobulins mask early signs of infection. D. Leukocyte response and inflammatory signs are immature. D
Describe each of these hand positions for breastfeeding.
A. C position—The mother cups the breast in her palm with her thumb on top and fingers underneath and behind the areola B. U position—In the U position, the mother places her index and middle fingers above and beneath the areola to guide her nipple to the infant
Describe changes in the composition and appearance of colostrum, transitional milk, and mature milk
A. Colostrum—Colostrum is produced during lactogenesis I. It is a thick, yellow substance that is rich in immunoglobulins, especially IgA. It has laxative effects and is high in protein, some vitamins, and minerals. It is lower in carbohydrates, fat, lactose, and some vitamins than mature milk. B. Transitional milk—Transitional milk is produced during lactogenesis II. It is lower in immunoglobulins and proteins but higher in lactose, fat, and calories than colostrum. The vitamin content is similar to that of mature milk. C. Mature milk—Mature milk replaces transitional milk during lactogenesis III. It is bluish and provides 20 cal/oz. Immunoglobulins are provided in mature milk throughout lactation.
What should the mother be taught about the storage of breast milk?
A. Containers—Glass or rigid polypropylene plastic containers with tight caps B. Length of time to be stored in refrigerator and freezer—Milk can be stored in the refrigerator for 72 hours; it can be kept in a deep freeze for 6 to 12 months C. Thawing frozen milk—Do not microwave. Thaw in the refrigerator or by holding under running water.
Describe normal assessments of full-term genitalia.
A. Female: Labia majora darker than surrounding skin and completely covering the clitoris and labia minora; white mucus discharge or pseudomenstruation; hymenal or vaginal tags; urinary meatus and vagina present. B. Male: Pendulous scrotum that is darker than surrounding skin and covered with rugae; testes palpable in the scrotal sac; meatus centered at the tip of the glans penis; prepuce covering the glans and adherent to it.
Explain what a new mother should be taught about each of these aspects of formula feeding.
A. Frequency—Feed the infant every 3 to 4 hours, following the infant's hunger cures instead of a rigid schedule. B. Microwaving formula—Do not microwave formula, because it might have hot spots that would burn the infant. C. Propping the bottle—Do not prop the bottle. Propping can cause aspiration of formula, and it increases the incidence of ear infections and dental caries (when the primary teeth erupt). D. Feeding leftover formula—Discard all remaining formula after 1 hour of use.
The nurse can help prevent many cases of jaundice in the breastfed infant by:
A. Giving the infant extra water between each nursing session. B. Teaching the mother the importance of frequent and adequate nursing. C. Placing the infant under phototherapy light prophylactically. D. Advising the mother about suitable formulas to use if jaundice occurs. B
The best location for an infant's glucose determination is the:
A. Great toe of either foot B. Nondominant heel C. Midline of the heel D. Lateral surface of the heel D
An infant weighting 4394g (9lb 11oz) was born vaginally. The labor nurse reports that there was a should dystocia at birth but the Apgar scores were 8 at 1 minute and 9 at 5 minutes. The nurse should do a focus assessment for:
A. Hip dysplasia B. Head molding C. Clavicle fracture D. Cephalohematoma C
A hungry infant is crying vigorously. The best initial intervention is to:
A. Immediately give formula until the infant is satisfied. B. Place the infant in a quiet, dark area, wrapped tightly. C. Console the infant before the mother tries to feed it. D. Instruct parents to engage the infant in eye-to-eye contact. C
Explain newborn classifications of gestational age and birth weight.
A. Late preterm—Born between 34.0 and 36.6 weeks of gestation B. Preterm—born before the 38th week of gestation begins C. Low birth weight—birth weight 2500 g (5 lb, 8 oz) or less D. Very low birth weight—birth weight 1500 g (3 lb, 5 oz) or less E. Extremely low birth weight—birth weight 1000 g (2 lb, 3 oz) or less F. Fetal growth restricted—birth weight and growth less than expected for duration of gestation
The infant of a diabetic mother is prone to hypoglycemia because:
A. Liver conversion of glycogen to glucose is sluggish B. Excess subcutaneous fat interferes with the use of insulin. C. High insulin production rapidly metabolizes glucose. D. Vulnerability to infections increases metabolic stress C
The primary purpose of surfactant is to:
A. Maintain normal blood glucose levels. B. Keep lung alveoli partly open between breaths. C. Inhibit excess erythrocyte production. D. Stimulate passage of the first meconium stool. B
Brown fat is used to:
A. Maintain temperature. B. Facilitate digestion. C. Metabolize glucose. D. Conjugate bilirubin. A
Becoming cold can lead to respiratory distress primarily because the infant
A. May need more oxygen than he or she can supply to generate heat. B. Breathes more slowly and shallowly when hypothermic. C. Reopens fetal shunts when the body temperature reaches 36.1C (97 F). D. Cannot supply enough glucose to provide fuel for respirations. A
When performing an admission assessment on a term newborn, the nurse notes that the lung sounds are slightly moist. The skin color is pink expect for acrocyanosis. Pulse is 156 beats per minute (bpm), and respirations are 55 breaths per minutes and unlabored. The appropriate nursing action is to:
A. Notify the healthcare provider of the abnormal lung sounds B. Continue to observe the infant's respiratory status C. Recheck the high respiratory and pulse rates in 30 minutes D. Keep the infant in the newborn nursery until stable B
The primary difference between physiologic and nonphysiologic jaundice is the:
A. Number of fetal erythrocytes that are broken down. B. Type of feeding method chosen by the mother. C. Location of the yellow areas on the newborn's skin. D. Time of onset and rate of rise in bilirubin levels. D
Describe differences between nutritive and non-nutritive suckling. How does infant swallowing sound?
A. Nutritive—Nutritive suckling is evidenced by smooth, continuous movement, with occasional pauses to rest. Swallowing may follow each suck or after two or three sucks. B. Non-nutritive—Non-nutritive sucking produces fluttery or choppy motions without the sound of swallowing. C. Swallowing—Infant swallowing has a soft "ka" or "ah" sound.
To elicit the Babinski reflex, the nurse should:
A. Place a finger at the base of the infant's toes and press gently B. Begin at the middle toe and stroke down the center of the foot C. Stroke the lateral sole from the heel up and across the ball of the foot D. Stroke across the dorsal aspect of the toes to the center of the foot C
What type of heat loss can occur in each situation?
A. Placing the newborn on a cold, unpadded surface: Conduction B. Using a cold stethoscope to listen to breath sounds: Conduction C. Placing the infant's crib by a window on a snowy day: Radiation D. Partially drying the infant's hair after a bath: Evaporation E. Placing the infant's crib near an air conditioner vent: Convection F. Forgetting to turn on the radiant warmer before placing the infant under it: Conduction
How does each of these problems result in jaundice? What is the usual treatment for each?
A. Poor intake Inadequate intake of colostrum or formula causes retention of meconium, which is high in bilirubin. High levels of beta-glucuronidase in the intestine deconjugate bilirubin in the meconium, adding to the load on the liver. Poor intake reduces the lactating mother's milk supply, worsening the problem. Nursing measures and teaching to stimulate the infant to feed better and, in the breastfeeding mother, increase milk production are appropriate treatment. B. True breast milk jaundice True breast milk jaundice is characterized by rising bilirubin lvels later than the first 3-5 days after birth that usually peak at 5-10 mg/dL. Jaundice can last several months. Treatment may include frequent feedings, phototherapy, formula, supplementation.
List methods to prevent and treat engorgement.
A. Prevention—Early and frequent nursing (every 2 to 3 hours) for adequate length of time during the day and night help prevent engorgement. Avoiding formula or water supplements causes the infant to eat more often than if formula is used. B. Treatment—Treatment includes feeding every 1 ½ to 2 hours; cold applications between feedings; heat applications shortly before feeding; massage to speed milk release; softening the areola by using a pump or expressing milk to begin flow or pressing gently on the areola to move swelling back. Give medication for discomfort; advise the mother to wear a well-fitting (but not tight) bra 24 hours a day.
Describe the purposes of prolactin and oxytocin in breastfeeding. What can enhance or interfere with their secretion?
A. Prolactin—Prolactin stimulates the breast to produce milk. It is enhanced by suckling and removal of milk from the breasts. It is inhibited by estrogen, progesterone, and human chorionic somatomammotropin during pregnancy and by inadequate removal of milk after nursing begins. B. Oxytocin—Oxytocin causes the milk ejection reflex. It is enhanced by comfort, thinking about the infant, and the stimulation of suckling. It is inhibited by discomfort or inadequate suckling.
Describe use and precautions associated with each type of formula
A. Ready to use—Open the bottle and add a cap for single-serving containers. For multiple-serving cans, was the top of the can and can opener just before opening and shake the can. Pour into washed bottles and cap. Do not dilute. Refrigerate an open can and discard any remaining milk after 48 hours. B. Concentrated liquid—Dilute the concentrated liquid with an equal part of water. Do not overdilute or underdilute. Fill clean bottles with diluted formula as in ready to feed. C. Powdered—Dilute formula in a clean bottle exactly as directed, usually one scoop for each 2 oz of water. Mix well. As the concentrated liquid formula, do not overdilute of underdilute. Cover opened cans of powder and use within 4 weeks of opening.
An infant's gestational age assessment reveals that she is a SGA. This means that:
A. She was born before 37 weeks of gestation B. Her weight falls between the 10th and 90th percentiles C. She has a low birth weight in relation to her length D. Her size is smaller than expected for her gestation D
Describe differences in breast fullness.
A. Soft—Feel like a cheek B. Filling—Slightly firmer than a cheek C. Engorged—Hard, shiny, tender, taut tissue
When assessing a 2-day-old newborn, the nurse notes that the infant's skin color is yellowish to the level of the umbilicus. The most important action is to:
A. Teach the mother to nurse the infant as least every 2 to 3 hours B. Explain that jaundice is common and will resolve without treatment C. Ask the mother whether she has been feeding the infant supplemental formula D. Notify the healthcare provider of the early intense jaundice D
Which of the following is an example of healthy grieving?
A. The parents do not mention the baby in conversation with family members B. The mother exhibits an absence of crying or expression of feelings C. While holding the baby the mother says to her husband, "He has your eyes and nose." D. The mother asks that the baby be taken away from the delivery area quickly C
Explain the possible significance of each neonatal assessment
A. Two-vessel umbilical cord: Associated with other anomalies such as kidney defects; assess the infant carefully. B. Simian crease or line: Single palmar crease that often occurs in infants who have chromosomal abnormalities such as Down syndrome, but may be normal. C. Unequal gluteal creases: Suggests that one leg is shorter than the other; often associated with developmental hip dysplasia. D. Hair tuft on lower spine: May indicate spina bifida occulta or failure of one or more vertebrae to close fully. E. Ears below the level of the outer canthi of the eyes: Associated with chromosomal disorders. F. Drooping of one side of the mouth: Indicates facial nerve injury during birth resulting in paralysis.
Classify each of these newborn physical characteristics as preterm, term, or postmature. Some characteristics will have more than one answer.
A. Underdeveloped flexor muscles—Preterm B. Abundant hair on the head—Term or preterm C. Loose skin—Postmature D. Little or no lanugo—Postmature E. Poor muscle tone—Preterm F. Long fingernails—Postmature G. Visible blood vessels on the abdomen—Preterm H. Long, thin body—Postmature I. Creases coving the entire sole—Term or postmature J. Alert and wide-eyed—Postmature K. Little subcutaneous fat—Preterm or postmature L. Dry and peeling skin—Term or postmature M. Frog-leg position—Preterm N. Meconium staining—Postmature O. Abundant vernix caseosa—Preterm P. Barely perceptible areola—Preterm Q. Soft, flexible ears—Preterm R. Labia majora covering clitoris and labia minora—Term or postmature
Choose the nursing observation that is most important if the nurse notes a two-vessel umbilical cord.
A. Urine output B. Onset of jaundice C. Respiratory rate D. Heart rhythm A
. Explain why these medications are typically given to newborns. Which is required by state law?
A. Vitamin K: Necessary for normal blood coagulation, is given because the infant's gastrointestinal tract is sterile at birth and temporarily lacks the microorganisms that will make this vitamin B. Erythromycin eye ointment: Required by state law to prevent gonorrhea acquired in the mother's birth canal C. Hepatitis B immunization: Given to promote the infant's manufacture of antibodies against this viral infection of the liver.
What should the mother be taught about burping the infant?
A. When to burp—For breastfeeding, burp when non-nutritive suckling begins and change to the other breasts. For formula feeding, burp after approximately 0.5 ounce of formula in the early days and then midway in the feeding when the infant's intake increases. B. Removing the infant from breast—Break suction before removing the infant from the breast by inserting a finger between the infant's gums.
Milk ejection reflex
Allows milk to let down
What added assessments and interventions should the nurse perform if an infant has a subnormal temperature?
Assess for and correct sources of heat loss, such as wet clothing, drafts, or exposed skin. Place the infant skin to skin with the mother or wrap the flexed infant snugly in warm blankets. Apply a hat and a shirt, and use another shirt with the sleeves over the legs. A radian warmer, regulated by a skin probe, may be needed for very low temperatures. Have the mother breastfeed or feed the infant formula if it is near feeding time. Teach parents about maintaining the infant's temperature, particularly if their actions have contributed to the low temperature.
What precautions can parents take to reduce the risk of sudden infant death syndrome (SIDS)?
Avoid allowing the infant to sleep in a prone position, overheating the infant, or letting the infant sleep with another person; provide a firm sleeping surface; allow no loose blankets, pillows, or stuffed toys in the infant's bed; avoid smoking during or after pregnancy.
A new mother is worried because her 2-day-old baby is taking only 0.5 to 1.5 oz of formula at most feedings. The nurse should teach her that: A. her baby should be taking 3 to 4 oz at each feeding by the next day B. The amount that the baby is taking at each feeding is normal at this time C. The baby might take more if she tries using a different formula D. The nipple may be too firm for the baby to suck easily and should be changed
B
A new mother should be taught to support her baby's head when holding the infant because: A. Doing so will promote better eye contact and bonding. B. The baby's muscles are too weak to support his or her own head C. It allows better guidance of the head toward the breast D. Less regurgitation of gastric contents will occur
B
A new mother wants to nurse her infant only 5 minutes at each breast to avoid sore nipples. Choose the appropriate teaching. A. Keeping early feedings short lessens nipple trauma and help toughen nipples B. Very short feedings reduce hindmilk and may interfere with the infant's weight gain C. Limiting time at the breast does not reduce sore nipples but does reduce engorgement D. Delay in the transition from colostrum to true milk will result from this practice
B
At a home visit 3 days after birth, the nurse notes that the infant is swaddled tightly and the room is very warm. Appropriate parent teaching is that: A. Cold stress will be prevented if the parents continue to dress their baby warmly B. The infant can be dressed as they would dress, with the addition of a receiving blanket C. Swaddling the infant tightly in a warm room can decrease the severity of colic D. Adding a hat and loosening the blankets would be appropriate dress
B
The nurse should teach the parents to position the infant's hospital crib: A. Next to the windows to be exposed to the sun B. Near the mother's bed, on the side opposite of the door C. At the foot of the bed so the mother can get out of bed easily D. Near the door of the bathroom, next to the sink
B
To care for the uncircumcised penis, parents should be taught to: A. Retract the foreskin with each diaper change B. Wash under the foreskin as far as it will retract when the child is older C. Use an emollient cream to hasten foreskin separation D. Avoid putting soap on the foreskin before separation
B
List components in breast milk that help prevent infant infections, and describe the purpose of those components.
Bifidus factor promotes the growth of Lactobacillus bifidus, which increases acidity in the gastrointestinal tract. Leukocytes (macrophages) secrete lysozyme, which acts against gram-positive and enteric bacteria. Lactoferrin inhibits the growth of iron-dependent bacteria. Immunoglobulins, particularly IgA, help protect against gastrointestinal infections
What are the primary nursing observations after circumcision?
Bleeding, urination, and infection
Mastitis
Breast inflammation
Determine what advantages the breastfed infant receives that the formula-fed infant does not receive regarding the following components Enzymes
Breast milk contain enzymes that aid in digestion. The amount of pancreatic amylase necessary for digestion of carbohydrates is low in the newborn but present in breast milk. Breast milk also contains lipase to increase fat digestion.
How does brown fat help the newborn maintain body temperature? Under what circumstances can newborns have inadequate fat and why?
Brown fat is metabolized to generate heat, which is transferred to the blood vessels running through it and then circulated to the rest of the body. Infants who may have inadequate brown fat include preterm infants who may not have accumulated brown fat and those with intrauterine growth restriction whose stores were depleted
. The nurse notes an infant sleeping on her or his back in the crib in the mother's room. The nurse should: A. Turn the infant to the side to avoid aspiration from regurgitation B. Suggest that the mother hold the infant to enhance bonding C. Commend the mother for positioning the infant correctly D. Explain the importance of the prone position for sleep
C
. Which statement is true about colic? A. It generally occurs in the early morning hours B. It is more common in infants who are fed by formula C. Infants with colic eat and gain weight appropriately D. It is almost always caused by parental stress
C
A breastfeeding mother is encouraged to nurse her infant 30 minutes after birth. The infant is awake, licks her nipple, and makes occasional suckling efforts but does not latch on. The mother says, "Maybe I should just bottle-feed him, since he doesn't want to nurse." The best reply should emphasize that: A. Formula feeding is usually much easier than breastfeeding B. The infant's actions suggest that her nipples may be too firm C. Breast milk production is stimulated by these early actions D. She will be unable to establish lactation unless the baby nurses early
C
If a car is equipped with airbags, the newborn's safety seat should always be positioned: A. Forward-facing in the back seat B. Forward-facing in the front seat C. Rear-facing in the back seat D. Rear-facing in the front seat
C
Which is true about breastfeeding? A. Immigrant women are more likely than women born in this country to breastfeed B. African-American women have the highest rates of breastfeeding C. Some women do not feed their infants colostrum because they think that it is spoiled D. American-born women are the most likely to combine breastfeeding and formula feeding
C
Do infants of mothers with hepatitis B need any additional medication? Why?
Mothers who are positive for hepatitis B (carriers) may transmit the organism to their infant at birth. The first dose of a series of three doses of the vaccine is given within 12 hours of birth to infants of mothers who are hepatitis carriers. These infants also receive hepatitis B immune globulin within 12 hours to provide passive antibody protection until the infant manufactures his or her own active antibodies to the virus.
A woman has had a baby at 29 weeks of gestation. She tells the nurse that she cannot breastfeed because the baby is so small. The nurse should tell her that: A. She will be able to establish lactation when the baby is strong enough to nurse B. Special formulas are actually better than breast milk for preterm infants C. Infections are more likely to occur if the infant takes stored breast milk D. She can use a breast pump to maintain lactation until nursing is possible
D
Choose the normal circumcision assessment. A. Plastibell positioned well down the shaft of the penis B. Oozing of blood from the site after a Gomco circumcision C. Delay in urination for 12 to 16 hours after the procedure D. Development of a dry yellow crust on the circumcision site
D
For the cross-cradle hold, the mother holds the infant's head: A. At the antecubital space, with the infant's body along her arm and holding the breast with the other hand on the other side B. In the hand on the side of the breast being used, with the infant's body along her side and holding her breast with the other hand C. And body close to her, facing the breast, as the mother lies on her side. Pillows help position the mother and infant D. In the hand opposite from the breast being used, with the infant's body across her lap and holding the breast with the other hand
D
The best way to cure miliaria is to: A. Apply cream with a zine oxide base B. Clean the area with mild soap and water C. Change the formula to a soy-based one D. Take measures to cool the infant
D
The correct site for injection of hepatitis B immunization for a newborn is the: A. Subcutaneous tissue of the thigh B. Dorsogluteal muscle C. Deltoid muscle D. Vastus lateralis muscle
D
The maximum length of time the formula should be kept in a refrigerator after preparation is: A. 12 hours B. 24 hours C. 36 hours D. 48 hours
D
How can you tell whether the infant needs more of the areola in the mouth? How much areola should be inside?
The infant's cheeks will show dimpling, and he or she will make smacking or clicking sounds if more of the areola should be in the mouth. The infant's lips should be 2.5 to 3.8 cm (1 to 1 ½ inches) from the base of the nipple if there is enough of the areola in the mouth.
How would you answer a mother who wants to start feeding her 2-month-old infant rice cereal?
Early feeding of solids replaces milk, which is easily digested, with a food that is not taken or digested well. The extrusion reflex (pushing objects ways from the mouth) makes feeding of solids difficult until the age of 4-6 months. Early feeding will not help the infant sleep through the night.
How does frequent breastfeeding help resolve jaundice?
Frequent breastfeeding enhances milk production in the mother and stimulates peristalsis in the infant, which increases the number of stools and thus helps the body excrete bilirubin.
Hindmilk
Higher-fat milk
When should parents seek immediate medical care for their infant?
If signs of dyspnea occur (sustained respiratory rate >60 breaths per minute or <30 breaths per minute, retractions, cyanosis, or extreme pallor) or the infant is hard to arouse, parents should see their pediatrician or visit an emergency department. Sudden respiratory distress in a well infant may indicate aspiration, and parents should summon paramedics.
Explain to parents why it is important for their jaundiced infant to eat frequently and adequately.
Infants who do not eat well will be slower in passing stools in which bilirubin is eliminated. When feces remain in the intestines, an enzyme (beta-glucuronidase) that was important during fetal life may change the bilirubin back to a form (unconjugated) that cannot be eliminated in the stools. The bilirubin may be absorbed back into the bloodstream, and the liver will have added work in changing it back to a form in which it can be excreted.
List signs that suggest neonatal hypoglycemia
Jitteriness Poor muscle tone Sweating Respiratory signs (dyspnea, apnea, cyanosis, tachypnea, grunting) Low temperature Poor suck High-pitched cry Lethargy Seizures Eventually coma Some show no signs of hypoglycemia
Determine what advantages the breastfed infant receives that the formula-fed infant does not receive regarding the following components Carbohydrates
Lactose is the major carbohydrate in breast milk. It improves absorption of calcium and provides energy for brain growth. Other carbohydrates in breast milk increase intestinal acidity and impede growth of pathogens.
Determine what advantages the breastfed infant receives that the formula-fed infant does not receive regarding the following components Vitamins
Levels of vitamins A, E, and C are high in breast milk
List five general signs of newborn infection?
Low temperature, lethargy, poor feeding, periods of apnea without obvious cause; any unexplained change in behavior; drainage from the eyes, cord, or circumcision
How would you explain the prophylactic neonatal vitamin K injection to new parents?
Newborns may have a problem with bleeding because they have a temporary lack of vitamin K, which is necessary for clotting. One injection of vitamin K given shortly after birth provides the newborn with vitamin K until the intestines are able to make it.
When does jaundice become nonphysiologic rather than physiologic?
Nonphysiologic or pathologic jaundice may occur in the first 24 hours of life. It rises more rapidly and to higher levels than expected or stays elevated longer than expected
Determine what advantages the breastfed infant receives that the formula-fed infant does not receive regarding the following components Minerals
The level of iron in breast milk is absorbed five times as well and breastfed infants are rarely deficient in iron.
How can flattening of the back of the head be prevented?
Placing the infant on the abdomen when awake and supervised and supine at alternating ends of the crib for sleep will help prevent flattening of the head. The infant should not spend prolonged time in the infant or car seats where pressure is put on the back of the head.
What should parents be taught about safety when the infant sleeps?
Position the infant on the back for sleep, not in a prone position. Do not place pillows or soft stuffed toys in the crib. The infant should not sleep with another person or on a soft surface.
Colostrum
Precedes true milk
Determine what advantages the breastfed infant receives that the formula-fed infant does not receive regarding the following components Fats
Provides 50% of calories in breast milk. Fat in breast milk is more easily digested. Hindmilk is higher in fat than foremilk, which produces satiety and helps the infant gain weight. Triglycerides form the majority of fat content. Cholesterol and essential fatty acids are also present. These nutrients are important for vision and for the growth of the brain and the nervous system.
Describe useful techniques to teach the mother if the infant seems to have trouble breathing while nursing.
The mother can bring the infant to a more horizontal position and nearer to her body. She should not indent the breast tissue, because this could interfere with milk flow or change the position of the nipple in the infant's mouth and lead to sore nipples.
List at least five problems common to late preterm infants.
Respiratory disorders, inadequate thermoregulation, hypoglycemia, hyperbilirubinemia, feeding difficulties, acidosis, infection, neurodevelopmental disorders, rehospitalization after discharge
What care can help the mother who has flat or inverted nipples? Are any precautions needed?
Rolling flat nipples stimulates them to become more erect. Pumping breasts for a few minutes before nursing or using a breast shield draw inverted nipples out so that the infant can grasp them. The use of breast shells is late pregnancy or between feeding to help draw nipples is controversial. Stretching or other manipulation of the nipples is unnecessary and should be avoided during pregnancy because it may cause uterine contraction
In which maternal conditions is breastfeeding not advised?
Serious infections such as untreated tuberculosis, HIV infection, galactosemia, and maternal chemotherapy. Maternal substance abuse is usually also contraindication to breastfeeding, although some women taking methadone or buprenorphine may be allowed to breastfeed. Mothers who have infectious conditions or who take medications unsafe for the infant also should not breastfeed.
List at least five signs that suggest neonatal respiratory distress.
Tachypnea (sustained) Retractions that continue after the first hour Nasal flaring after the first hour Cyanosis involving the lips, tongue, and trunk (central cyanosis) Grunting Seesaw respirations Asymmetry of chest expansion
How long should a mother breastfeed?
The American Academy of Pediatrics and American Dietetic Association recommend breast milk only for infants during the first 6 months. Although solid foods are added at approximately 6 months, the recommendation is for breastfeeding to continue for at least 1 year. However, the decision of how long to breastfeed is up to the mother
Why is it particularly important that the infant's head be dried promptly?
The head makes up a large part of the newborn's body and thus is a large surface for heat loss. Damp hair presents a continuing source of evaporative heat loss
The correct order for suctioning an infant's airway with the bulb syringe is to suction the _____mouth____________ first and the ________nose____________ second. Why?
The infant might gasp when the nose is suctioned, drawing any secretions that are in the mouth in the airway.
An infant's axillary temperature is 35.9 C (96.6 F). The priority nursing action is to: A. Recheck the infant's temperature rectally B. Have the mother breastfeed the infant C. Place the infant in a radiant warmer D. Chart the normal axillary temperature
c
