OB: Chapter 24 Nursing Management of the Newborn at Risk: Acquired and Congenital Newborn Conditions

The nurse is caring for a newborn client newly diagnosed with dysplasia of the hip. Which response by the nurse educates the parents on the correct plan of treatment for this diagnosis?

"Treatment will begin immediately." Dysplasia of the hip is a congenital newborn condition that requires immediate intervention. The development of the acetabulum of the hip is defective, and it may or may not be dislocated. Treatment of the defect and dislocated hips involves positioning the hip into a flexed, abducted (externally rotated) position to attempt to press the femur into the acetabulum. This involves splints and halters as the first line of treatment. Treatment should not be delayed. Surgery and casts are typically not used as the first line of treatment.

In caring for the child with esophageal atresia, the nurse recognizes the priority assessment is which?

Assessment for respiratory distress. Children with esophageal atresia have periods of respiratory distress with choking and cyanosis. This is a priority assessment as the implications include the highest risk. Excessive bleeding, cardiac status for anomolies, and feeding difficulties are not concerns in the child with esophageal atresia.

A newborn at 33 weeks' gestation has an Apgar score of 5 at 10 minutes of life. Which nursing action is a priority?

Begin resuscitation measures. Determine the Apgar score at 1 and 5 minutes; if less than 7 at 5 minutes, repeat the assessment at 10 minutes of age. If the initial assessment is poor, begin resuscitation measures until the Apgar score is above 7. The Ballard score would not be performed at this time. Reviewing the L & D records or repeating the Apgar are not priorities.

In the infant diagnosed with spina bifida with myelomeningocele, the infant will likely have:

a partial to complete paralysis in the lower extremities. In spina bifida with myelomeningocele, there is a protrusion of the spinal cord and the meninges, with nerve roots embedded in the wall of the cyst. The effects of this defect vary in severity from sensory loss or partial paralysis below the lesion to complete flaccid paralysis of all muscles below the lesion.

What is the term for a small collection of blood that forms underneath the skull as a result of birth trauma?

cephalhematoma Vernix caseosa is a thick white substance found on a newborn. Erythema toxicum is a newborn rash. Caput succedaneum is molding or edema.

The nurse assesses an infant. Which finding may indicate heart failure?

diminished peripheral pulses After birth, the nurse should carefully assess the newborn's cardiovascular and respiratory systems, looking for signs and symptoms of respiratory distress, cyanosis, or congestive heart failure that might indicate a cardiac anomaly. Assess rate, rhythm, and heart sounds, reporting any abnormalities immediately. Note any signs of heart failure, including edema, diminished peripheral pulses, hepatomegaly, tachycardia, diaphoresis, respiratory distress with tachypnea, peripheral pallor, and irritability. Capillary refill time and the color of the infant's hands and feet are important to note, but do not indicate possible heart failure and neither does the blood glucose level.

A nurse is assigned to care for a high-risk newborn with a periventricular-intraventricular hemorrhage (PVH-IVH) in the home environment after discharge. For which condition should the nurse monitor the infant?

hydrocephalus A significant number of newborns with PVH-INH will incur brain injury, leading to complications that may include hydrocephalus. The nurse should monitor for the incidence of hydrocephalus in this high-risk newborn. Urinary tract infection is not condition that persists after discharge. Spina bifida is most often noted at birth and would not to need to be assessed for by the nurse. Formula intolerance is not specific to high-risk newborns.

For which condition would the nurse commonly assess in an infant following surgery for a myelomeningocele?

hydrocephalus Surgery includes removing a portion of the meninges; without the surface to absorb cerebral spinal fluid, hydrocephalus can result.

When planning preoperative care for a newborn with a cleft lip and palate, a major need for which the nurse would plan interventions is:

nutrition. An infant with a cleft lip is unable to suck effectively, so obtaining adequate nutrition is a major concern

The prenatal health nurse is conducting an educational session focusing on alcohol use during pregnancy. The nurse feels the session was a success when a participant makes which statement?

"Alcohol use could cause my baby to be cognitively challenged." Disorders included in the grouping fetal alcohol spectrum disorders are alcohol-related neurodevelopmental disorders (ARND). Children with ARND primarily display intellectual disabilities related to behavior and learning. Fetal alcohol syndrome is one of the most common known causes of cognitive challenge. Counsel girls and women to avoid any alcohol use during pregnancy. Participating in programs for at-risk groups, including adolescents, especially about the serious effects of substance abuse, especially alcohol, during pregnancy.

A nursing instructor is teaching about newborn congenital disorders and realizes that the student needs further instruction after making which statement?

"All congenital disorders can be diagnosed at birth." All congenital disorders are not diagnosed at birth. Hydrocephalus is one such disorder that may be diagnosed at birth but also may not be diagnosed until after a few weeks or months. It is also true that congenital defects may be caused by both genetics and environmental factors.

The nurse is doing teaching with the caregivers of an infant diagnosed with hypospadias. Which statement made by the caregivers is accurate regarding hypospadias?

"Being able to most likely correct this in one stage rather than several is reassuring." Surgical repair is often accomplished in one stage and is often done as outpatient surgery. Surgical repair is desirable between the ages of 6-18 months, before body image and castration anxiety become problems. Urination is not affected, but the boy cannot void while standing in the normal male fashion. These newborns should not be circumcised because the foreskin is used in the repair.

A client who gave birth 2 hours ago expresses concern about her baby developing jaundice. Which response from the nurse would be best?

"I understand your concern because as many as 50% of babies can develop jaundice." As many as 50% of term newborns will develop physiologic jaundice. Physiologic jaundice occurs after the first 24 hours of life and is not pathologic. Pathologic jaundice will develop within the first 24 hours of life.

A nurse is explaining to the parents the preoperative care for their infant born with bladder exstrophy. The parents ask, "What will happen to the bladder while waiting for the surgery?" What is the nurse's best response?

"The bladder will covered in a sterile plastic bag to keep it moist." In the preoperative period, the infant care is focused on protecting the exstrophied bladder and preventing infection. The infant is kept in a supine position, and the bladder is kept moist and covered with a sterile plastic bag. Change soiled diapers immediately to prevent contamination of the bladder with feces. Sponge-bathe the infant only rather than immersing him or her in water to prevent pathogens in the bath water from entering the bladder. Consult the ostomy nurse if necessary.

A group of nursing students is discussing hydrocephalus. Which statement made by the students related to the noncommunicating type of congenital hydrocephalus is the most accurate?

"There is an obstruction that keeps cerebrospinal fluid from passing between the ventricles and the spinal cord." In the noncommunicating type of congenital hydrocephalus, an obstruction occurs, and CSF is not able to pass between the ventricles and the spinal cord. The blockage causes increased pressure on the brain or spinal cord. In the communicating type of hydrocephalus, no obstruction of the free flow of CSF exists between the ventricles and the spinal theca; rather, the condition is caused by defective absorption of CSF. There is no concern of decreased production of CSF and no opening between the ventricles and spinal cord in hydrocephalus

A newborn boy is diagnosed with esophageal atresia and tracheoesophageal fistula. After the nurse provides preoperative teaching, which statement indicates that the parents need additional teaching?

"We can probably start feeding him with the bottle about a day after the surgery." Preoperatively, the newborn is at risk for pneumonitis due to aspiration of food and secretions. Antibiotics are typically given until the anastomosis is proven intact and patent. Oral feedings are usually started within a week after surgery once the esophageal anastomosis is proven to be intact and patent. Proper position with elevation of the head is important for the newborn with esophageal atresia and tracheoesophageal fistula because he is at risk for aspiration of food and secretions. Using a pacifier to provide nonnutritive sucking helps to meet the newborn's need to suck.

At a preconception counseling class, a client expresses concern and wonders how Healthy People 2020 will improve maternal infant outcomes. Which responses by the nurse are appropriate? Select all that apply.

Healthy People 2020 will reduce the rate of fetal and infant deaths. Healthy People 2020 will decrease the number of all infant deaths (within 1 year). Healthy People 2020 will decrease the number of neonatal deaths (within the first year). Healthy People 2020 will foster early and consistent prenatal care. One of the leading health indicators as identified by Healthy People 2020 refers to decreasing the number of infant deaths. Acquired and congenital conditions account for a significant percentage of infant deaths.

A male newborn is born with hypospadias. The nurse doing the newborn physical assessment notes that the penis is also curved downward. What information would the nurse provide the parents for this infant?

His ability to void and have an erection in adulthood may be impaired and surgery is needed. Hypospadias is a relatively common malformation of the male genital organ. It is an abnormal positioning of the urinary meatus on the underside of the penis. It is often accompanied by a downward bowing of the penis (chordee), which can lead to urination and erection problems in adulthood. There are no maneuvers that will improve the penis curvature, surgery is definitely warranted and needed, and infants with hypospadius are never circumcised because the foreskin may be needed for later repairs.

Which nursing measure is most effective in reducing newborn infections?

Maintain medical asepsis while providing care. Nurses possess the education and assessment tools to decrease the incidence of and reduce the impact of newborn infections. Nurses should implement measures for prevention and early recognition, including maintaining medical and surgical asepsis for all providing care. Nurses should outline and carry out measures to prevent hospital-acquired infections, such as thorough hand-washing hygiene for all staff.

A ventilated 33 weeks' gestation newborn in the neonatal intensive care unit (NICU) receives surfactant therapy. Which would the nurse expect to assess as a positive response to this therapy?

Oxygen saturation levels are at 98%. Rescue treatment is indicated for newborns with established RDS who require mechanical ventilation and supplemental oxygen. The earlier the surfactant is administered, the better the effect on gas exchange with an aim to have the O2 saturation level of 98%. Glucose level assessment does not correlate with this therapy. The HR of 60 bpm is an abnormal finding and not a positive result of the therapy. The PaCO2 indicates respiratory acidosis

A nurse is caring for a newborn client after birth who is diagnosed with myelomeningocele. Which nursing intervention would protect the newborn from injury?

Place the newborn in a prone or lateral position. The nurse should place the newborn in a prone or lateral position to keep pressure off the spinal sac and avoid newborn injury. Parents should be allowed to hold the stable infant with assistance. The spinal sac should be kept covered and moist until surgery to avoid rupture. Collecting urine decreases the risk of urine stasis, which is sometimes common in spinal defects

A nurse is caring for a newborn with a repaired cleft lip. What intervention can the nurse provide to facilitate drainage of mucus and secretions to prevent aspiration?

Position the child on the side. To facilitate drainage of mucus and secretions, the nurse should position the infant on the side, never on the abdomen, after a cleft lip repair.

A nurse is assigned to care for a newborn with esophageal atresia. What preoperative nursing care is the priority for this newborn?

Prevent aspiration by elevating the head of the bed, and insert an NG tube to low suction. The preoperative nursing care focuses on preventing aspiration by elevating the head of the bed and insertion of an NG tube to low suction to prevent aspiration. Documenting the amount and color of drainage is not needed with the NG tube in place. An infant with esophageal atresia is NPO and fed nothing until after repairing the defect. Administering antibiotics and total parenteral nutrition is a postoperative nursing intervention when caring for a newborn with esophageal atresia.

An infant is suspected of having persistent pulmonary hypertension of the newborn (PPHM). What intervention implemented by the nurse would be most beneficial in treating this client?

Provide oxygen by oxygen hood or ventilator. The nurse should administer oxygen to the infant in whatever manner needed to help maintain the infant's oxygen levels. Anticonvulsants are not necessary in treating this disorder. The infant's physical environment should be warm, not cool, and stimulation should be limited for these clients.

An infant has just been born with a cleft lip and palate. The birthing room suddenly becomes very quiet, and the birth team seem somber. The health care provider is busy examining the newborn, but the mother is obviously aware that something is not right. What should the nurse do?

Say to the parents, "Your son has been born with a cleft lip and palate. This condition is highly treatable by surgery, however, and he is otherwise in excellent health." Nurses need to be familiar with the most frequently encountered physical or developmental anomalies which are present at birth so, as the person who at that moment in the birth process is most available for client education, they can explain the problem to parents. It is a good rule to explain to parents what the disorder consists of and what the usual prognosis is before showing the baby to them as parents may find it hard to look at an infant with a cleft lip or palate or exposed abdominal contents, for example, and listen at the same time.

A nurse is caring for a newborn with jaundice undergoing phototherapy. What intervention is appropriate when caring for the newborn?

Shield the newborn's eyes The nurse should shield the newborn's eyes and cover the genitals to protect these areas from becoming irritated or burned when using direct lights and to ensure exposure of the greatest surface area. The nurse should place the newborn under the lights or on the fiberoptic blanket, exposing as much skin as possible. Breast or bottle feedings should be encouraged every 2 to 3 hours. Loose, green, and frequent stools indicate the presence of unconjugated bilirubin in the feces. This is normal; therefore, there is no need for therapy to be discontinued. Lack of frequent green stools is a cause for concern.

A newborn with newly diagnosed hemolytic jaundice is being treated with phototherapy. Which actions should the nurse take? Select all that apply.

Shield the newborn's genitals and eyes during phototherapy sessions. Encourage the mother to breastfeed (8 to 12 feedings per day). Supplement breast milk with formula. Expose as much of the newborn's skin as possible. For the newborn receiving phototherapy, place the newborn under the lights or on the fiber-optic blanket, exposing as much skin as possible. Cover the newborn's genitals and shield the eyes to protect these areas from becoming irritated or burned when using direct lights. Assess the intensity of the light source to prevent burns and excoriation. Turn the newborn every 2 hours to maximize the area of exposure, removing the newborn from the lights only for feedings. Maintain a neutral thermal environment to decrease energy expenditure, and assess the newborn's neurologic status frequently. Research is finding that intermittent versus continuous phototherapy is as efficacious to lower bilirubin levels. Assess the newborn's temperature every 3 to 4 hours as indicated. Monitor fluid intake and output closely.

A 6-week gestation client asks the nurse what foods she should eat to help prevent neural tube disorders in her growing baby. The nurse would recommend which foods?

Spinach, oranges, and beans Folic acid assists in preventing the incidence of neural tube disorders. These foods include green, leafy vegetables, citrus fruits, beans, and fortified breads, cereals, rice, and pasta. Milk, yogurt, and cheese are high in calcium. Bananas, avocados, and coconut are high in potassium. Pork, beans, and poultry are high in iron.

The nurse is developing a plan of care for a neonate experiencing symptoms of drug withdrawal. What should be included in this plan?

Swaddle the infant between feedings. Supportive interventions to promote comfort include swaddling, low lighting, gentle handling, quiet environment with minimal stimulation, use of soft voices, pacifiers to promote "self-soothing," frequent small feedings, and vertical rocking, which will soothe the newborn's neurological system.

The nurse is caring for a newborn with respiratory distress syndrome (RDS). Which explanation best explains this disorder?

The infant's lungs are immature and deficient in surfactant. In RDS, the premature infant's lungs are deficient in surfactant and thus collapse after each breath, greatly increasing the work of breathing. The immature liver in the preterm infant cannot manage all the bilirubin produced by hemolysis (destruction of red blood cells with the release of hemoglobin), making the infant prone to jaundice and high blood bilirubin levels. Intraventricular hemorrhage (IVH) is a complication of preterm birth in which there is bleeding into the brain's ventricles. Retinopathy of prematurity (ROP) is a form of retinopathy (degenerative disease of the retina) commonly associated with the preterm newborn.

A nurse is assigned to care for a newborn with hyperbilirubinemia. The newborn is relatively large in size and shows signs of listlessness. What most likely occurred?

The infant's mother probably had diabetes. The nurse should know that the infant's mother more than likely was a diabetic. The large size of the infant born to a diabetic mother is secondary to exposure to high levels of maternal glucose crossing the placenta into the fetal circulation. Common problems among infants of diabetic mothers include macrosomia, respiratory distress syndrome, birth trauma, hypoglycemia, hypocalcemia and hypomagnesemia, polycythemia, hyperbilirubinemia, and congenital anomalies. Listlessness is also a common symptom noted in these infants. Infants born to clients who have abused alcohol, infants who have experienced birth traumas, or infants whose mothers have had long labors are not known to exhibit these particular characteristics, although these conditions do not produce very positive pregnancy outcomes. Infants with fetal alcohol syndrome or alcohol exposure during pregnancy do not usually have hypoglycemia problems.

A nurse is assessing a newly admitted newborn who is 2 hours old. Which assessment findings would concern the nurse? Select all that apply.

The newborn has visible bilateral nasal flaring. The newborn has visible chest retractions The signs and symptoms of respiratory distress include tachypnea, periodic breathing, apnea, retractions, nasal flaring, grunting, pallor, and cyanosis. These findings require interventions. The blue hands and feet, apical pulse rate, and minimal response to voices are all appropriate for a newborn who is two hours old.

The nurse is caring for a newborn with hemolytic disease of the newborn who is receiving phototherapy. Which nursing intervention would be the most appropriate for the nurse to do?

The nurse turns the newborn every 3 or 4 hours. The nurse should turn the newborn every 3 or 4 hours to rotate the area of exposure. Do not turn off the lights except to feed and to change the diaper. The infant is nude to maximize the skin surface area exposed to the light. Remove the patches every four hours to cleanse the eyes and examine for irritation, inflammation, and/or dryness. Clean and change the patches daily.

The nurse is reinforcing discharge teaching with the mother of an infant who is being discharged prior to having a required blood test done. The nurse explains to this mother that she needs to bring the newborn back to check the infant's phenylalanine level. Which statement is most accurate related to this blood test?

The test is done after the newborn has ingested protein. As soon as the newborn with phenylketonuria begins to take milk, phenylalanine builds up in the blood serum to as much as 20 times the normal level. This build-up occurs so quickly that increased levels of phenylalanine appear in the blood after only one or two days of ingestion of milk.

The neonatal intensive care nurse is assessing a new admission and suspects the newborn to have meconium aspiration syndrome. Which assessment finding would correlate with the nurse's suspicion?

a barrel-shaped chest with an increased anterior-posterior chest diameter Observe the newborn with MAS for a barrel-shaped chest with an increased anterior-posterior chest diameter, prolonged tachypnea, progression of respiratory distress, intercostal retractions, end-expiratory grunting, and cyanosis. Arterial blood gas analysis will indicate metabolic acidosis with a low blood pH, decreased PaO2, and increased PaCO2. The arterial blood gas values listed are normal as well as the vital signs. Acrocynosis is a normal expectation of a newborn immediately after birth.

A nurse is caring for a neonate of 25 weeks' gestation who is at risk for intraventricular hemorrhage (IVH). Which assessment finding should be reported immediately?

a sudden drop in hemoglobin The signs and symptoms of IVH include a sudden decrease in hematocrit, a severe and sudden unexplained deterioration of vital signs, bulging fontanels, changes in activity level, and sudden lethargy. The diagnosis is confirmed by cranial ultrasonography. Pink skin with blue extremities is not a critical sign of IVH, nor is the routine calculation of intake and output a critical assessment for IVH.

As the nurse examines the birth records, which newborn would the nurse expect to monitor closely for respiratory distress syndrome (RDS)?

a term male newborn, born by a repeat cesarean birth, whose mother has diabetes mellitus It is necessary to review the maternal history for risk factors associated with RDS. Risk factors in the term infant placing the infant at most risk include a cesarean birth in the absence of preceding labor, male gender, and maternal diabetes, which produces high levels of insulin which inhibit surfactant production. The other infant situations would not be the priority.

When providing care to a newborn with necrotizing enterocolitis (NEC), the nurse would need to report which finding immediately?

abdomen appearing red and shiny An abdomen that appears red and shiny in a newborn with NEC indicates peritonitis and must be reported immediately. A decrease in abdominal girth, stools negative for blood, and active bowel sounds suggest that the condition is resolving.

A nurse is reading a journal article about birth defects and finds that some birth defects are preventable. Which risk factor would the nurse expect to find as being cited as the current leading preventable cause of birth defects?

alcohol Alcohol is now recognized as the leading preventable cause of birth defects and developmental disorders in the United States. Smoking, recreational drugs, and obesity are also contributing factors.

Assessment reveals that a young mother has several risk factors for giving birth to an infant with a neural tube defect. Which laboratory test would the nurse expect to be used to monitor the fetus for this birth defect?

alpha-fetoprotein levels In pregnancies in which the fetus has neural tube defect, the level of alpha-fetoprotein in the amniotic fluid and maternal serum is elevated. By monitoring this level throughout the pregnancy, it is possible to be aware of this defect before the birth. Genetic studies, folic acid levels, and cultures for infections are not utilized to detect neural tube defects.

After birth, an infant experiences meconium aspiration. What does the nurse anticipate the primary care provider prescribing prophylactically to prevent pneumonia?

antibiotics Prophylactic antibiotics may prevent development of pneumonia.

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 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 (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.

A preterm newborn is noted to be cyanotic. Which laboratory test will the nurse prepare the infant for to determine if the cyanosis is due to respiratory or circulatory problems?

arterial blood gases Arterial blood gases are obtained to determine the oxygenation levels and to help differentiate lung disease from heart disease. Chest X-rays will help identify cardiac size, shape, and position. An echocardiogram will evaluate the heart anatomy and flow defects. An angiography will be conducted to prepare for cardiac surgery, if needed.

What are the causes of retinopathy of the preterm newborn? Select all that apply.

assistive ventilation with high oxygen content fragility of blood vessels in the eyes in response to changes on oxygenation. shock Retinopathy of the preterm newborn typically develops in both the eyes secondary to an injury such as hyperoxemia resulting from prolonged assistive ventilation and high oxygen exposure, fragility of retinal blood vessels in response to changes in oxygentaion, and shock. Alkalosis does not contribute to this problem- acidosis does.

What objective data gathered by the nurse could indicate a diagnosis of developmental dysplasia of the hip? Select all that apply.

asymmetry of the gluteal skin folds limited abduction of the affected hip apparent shortening of the femur Signs that are useful after age 1 month are asymmetry of the gluteal skin folds, limited abduction of the affected hip, and apparent shortening of the femur.

The parents are upset their newborn has a cleft lip. When describing the treatment, the nurse should mention that surgical repair can be done:

between the age of 6 to 12 weeks. Treatment of cleft lip is surgical repair between the ages of 6 to 12 weeks. It is important to repair this anomaly as soon as possible to facilitate bonding between the newborn and the parents and to improve nutritional status.

The nurse suspects a preterm newborn receiving enteral feedings of having necrotizing enterocolitis (NEC). What assessment finding best correlates with this diagnosis?

bloody stools NEC assessment includes assessing the newborn's health history and physical examination as well as laboratory and diagnostic testing. The onset of NEC is demonstrated by the development of feeding intolerance, abdominal distention, and bloody stools in a preterm infant receiving enteral feedings. As the disease worsens, the infant develops signs and symptoms of septic shock with RDS, temperature instability, lethargy, hypotension, and oliguria.

Periventricular hemorrhage is suspected in a newborn of 30 weeks' gestation. The nurse would anticipate preparing the newborn for which diagnostic tool to confirm the diagnosis?

cranial ultrasound The diagnostic tool of choice to detect periventricular hemorrhage is a cranial ultrasound. Arterial blood gases would be helpful in evaluating for metabolic acidosis. Blood glucose levels provide information about the newborn's glucose stability. Chest X-ray would provide no information related to bleeding in the brain.

The nurse is caring for an infant born to a mother who abused cocaine during her pregnancy. The nurse would likely notice that this infant:

cries when touched. Developmental delays occur in young children of substance abusers. Infants of cocaine abusers do not like to be touched or held and avoid the caregiver's gaze, which contributes to bonding delays. Infants of cocaine abusers are often restless and below average weight when born.

The nurse is feeding a 2-day-old in the nursery when the infant begins choking and becomes cyanotic. Frothy sputum is observed coming from the mouth. What congenital malformation does the nurse understand these symptoms indicate?

esophageal atresia Any mucus or fluid that a newborn with esophageal atresial swallows enters the blind pouch of the esophagus. The pouch fills and overflows, usually resulting in aspiration into the trachea. The newborn with this disorder has frothing, excessive drooling, and periods of respiratory distress with choking and cyanosis.

A nurse in the newborn nursery has noticed that an infant is frothing and appears to have excessive drooling. Further assessment reveals that the baby has episodes of respiratory distress with choking and cyanosis. What disorder should the nurse suspect based on these findings?

esophageal atresia Any swallowed mucus or fluid enters the blind pouch of the esophagus when a newborn suffers from esophageal atresia. The newborn with this disorder will have frothing, excessive drooling, and periods of respiratory distress with choking and cyanosis. If this happens no feedings should be given until the newborn has been examined.

The nurse is assessing a newborn suspected of having meconium aspiration syndrome. What sign or symptom would be most suggestive of this condition?

expiratory grunting Expiratory grunting, a barrel-shaped chest with an increased anterior-posterior chest diameter, prolonged tachypnea, progression from mild-to-severe respiratory distress, intercostal retractions, cyanosis, surfactant dysfunction, airway obstruction, hypoxia, and chemical pneumonitis with inflammation of pulmonary tissues are seen in a newborn with meconium aspiration syndrome. A high-pitched cry may be noted in periventricular hemorrhage/intraventricular hemorrhage. Bile-stained emesis occurs in necrotizing enterocolitis. Intermittent tachypnea can be indicative of transient tachypnea of the newborn or any mild respiratory distress problem.

A nurse is assessing a newborn for jaundice. The nurse would first notice jaundice at which area?

face Neonatal jaundice first becomes visible in the face and forehead. Identification is aided by pressure on the skin, since blanching reveals the underlying color. Jaundice then gradually becomes visible on the trunk and extremities.

The newborn nursery nurse suspects a newborn of having neonatal abstinence syndrome. What assessment findings would most correlate with the diagnosis?

frequent yawning and sneezing Manifestations of neonatal abstinence syndrome include: CNS dysfunction such as hyperactive reflexes resulting in exaggerated Babinski and Moro reflexes; hypertonic muscle tone and constant movement; metabolic, vasomotor, and respiratory disturbances with frequent yawning and sneezing; gastrointestinal dysfunction, including poor feeding; and frantic sucking or rooting. Acrocyanosis is a normal newborn finding which is cyanotic discoloration of the extremities.

The nurse is caring for a newborn who was small for gestational age and has been determined to have the condition intrauterine growth restriction (IUGR). It is most likely that the mother of this newborn:

has a history of abnormal blood glucose levels. Uncontrolled maternal diabetes can be a contributing factor for the infant with intrauterine growth restriction. Smoking during pregnancy could be a contributing factor, but being a previous smoker would not affect this pregnancy. Inadequate maternal nutrition is a contributing factor, but because this mother was on a food stamp program she was more likely to have had adequate nutrition during pregnancy. Previous pregnancies with a history of IUGR or other poor pregnancy outcomes would be a possible contributing factor, but not normal pregnancies.

The nurse is caring for a newborn of a substance-abusing mother who is withdrawing from alcohol. Which finding would the nurse likely see in this newborn?

hyperactive and irritable The newborn that is withdrawing from alcohol typically is hyperactive, irritable, has trouble sleeping, and may have tremors or seizures. Characteristics of FAS include low birth weight, and small height and head circumference. This newborn is prone to respiratory difficulties, hypoglycemia, hypocalcemia, and hyperbilirubinemia.

In addition to newborns of diabetic mothers being at risk for hypoglycemia, these newborns are also at risk for which condition?

hypocalcemia The newborn of the diabetic mother is at risk for hypocalcemia, hypomagnesemia, polycythemia with hyperviscosity, and hyperbilirubinemia. Potassium concerns are not a risk for these newborns.

Over the course of an eight-hour shift of postoperative care for a child who has had ventriculoatrial shunt placement, the nurse notes that the child's cry has become increasingly shrill and the child has projectile vomiting. The nurse would notify the primary care provider immediately because of the possibility that the child might be experiencing:

increased intracranial pressure. Symptoms of increased intracranial pressure (IICP) may include irritability, restlessness, personality change, high-pitched cry, ataxia, projectile vomiting, failure to thrive, seizures, severe headache, changes in level of consciousness, and papilledema. At least every 2-4 hours, the nurse should monitor the newborn's level of consciousness, check the pupils for equality and reaction, monitor the neurologic status, and observe for a shrill cry, lethargy, or irritability.

A preterm newborn is noted to have hypotonia, apnea, bradycardia, a bulging fontanelle, cyanosis, and increased head circumference. These signs indicate the newborn has which complication?

intraventricular hemorrhage (IVH) Signs that may accompany IVH include hypotonia, apnea, bradycardia, a full (or bulging) fontanelle, cyanosis, and increased head circumference.

In the infant with developmental dysplasia of the hip (DDH), which sign would likely be noted?

limited abduction of the affected hip The infant with DDH usually has limited abduction of the affected hip. They have asymmetry of the gluteal skin folds and shortening of the femur. Adduction is not a concern.

Which finding is common in the child who has a ventricular septal defect?

loud, harsh murmur Children with ventricular septal defects have a characteristic loud, harsh murmur. Fatigue and dyspnea, delayed growth and development, and a bounding pulse are seen in the child with patent ductus arteriosus

A newborn is diagnosed with respiratory distress syndrome (RDS). While assessing the newborn, the nurse realizes that which maternal factor would most place the infant at risk for RDS?

maternal gestational diabetes Prolonged rupture of membranes, gestational or chronic maternal hypertension, maternal narcotic addiction, and the use of prenatal corticosteroids reduces the newborn's risk for RDS because of the physiologic stress imposed on the fetus. Chronic stress experienced by the fetus in utero accelerates the production of surfactant before 35 weeks' gestation and thus reduces the incidence of RDS at birth. Maternal diabetes produces high levels of insulin that inhibits surfactant production thus placing the newborn more at risk for developing RDS.

A nurse is caring for a newborn whose chest X-ray reveals marked hyperaeration mixed with areas of atelectasis. The infant's arterial blood gas analysis indicates metabolic acidosis. For which dangerous condition should the nurse prepare when providing care to this newborn?

meconium aspiration syndrome The nurse should assess for meconium aspiration syndrome in the newborn. Meconium aspiration involves patchy, fluffy infiltrates unevenly distributed throughout the lungs and marked hyperaeration mixed with areas of atelectasis that can be seen through chest X-rays. Direct visualization of the vocal cords for meconium staining using a laryngoscope can confirm aspiration. Lung auscultation typically reveals coarse crackles and rhonchi. Arterial blood gas analysis will indicate metabolic acidosis with a low blood pH, decreased PaO2, and increased PaCO2. Newborns with choanal atresia, diaphragmatic hernia, and pneumonia do not exhibit to exhibit these manifestations.

The perinatal nurse is assessing a large-for-gestational age infant born by breech birth and notes that the infant is irritable and does not move the right arm. For what would the nurse assess?

midclavicular fracture Midclavicular fractures most often occur during births of newborns with macrosomia. The newborn is irritable and does not move the arm on the affected side either spontaneously or when the Moro reflex is elicited. A brachial plexus injury usually presents with the extremity adducted and internally rotated with absent shoulder movement. Phrenic nerve palsy is not associated with birth injuries and is caused by lesions along the phrenic nerve. The newborn does not demonstrate signs of cranial nerve trauma, which would be evident in the face.

A premature infant in the neonatal intensive care unit exhibits worsening respiratory distress and is noted to have abdominal distention, absent bowel sounds, and frequent diarrhea stools that are positive for hemoccult. What diagnosis would be most likely to correlate with the symptoms?

necrotizing enterocolitis Observations for the developemnt of NEC in the preamture newborn may include feeding intolerance with abdominal distention tenderness and bloody or hemoccult-positive stools. Diarrhea is present with NEC and worsening of respiratory distress. Decreased or absent bowel sounds are noted. Rotavirus causes inflammation of a child's stomach and digestive tract, usually triggering vomiting, diarrhea, and fever and not seen in a preterm infant. Garamycin-resistant bacteria is usually seen in older adults.

A newborn is found to have hemolytic disease. Which combination would be found related to the blood types of this newborn and the parents of the newborn?

newborn who is type A, mother who is type O Hemolytic disease today is principally the result of ABO incompatibility. The most common incompatibility in the newborn occurs between a woman with type O blood and an infant with type A or B blood.

It would be best to place an infant with a myelomeningocele in which position prior to surgery?

on the stomach (prone) Placing the infant prone prevents direct trauma to the lesion and reduces the chance that feces will contaminate the lesion.

The nurse is changing the diaper on a newborn and notices that there is a musty smell to the infant's urine. This finding is a characteristic sign of which disorder?

phenylketonuria There is a characteristic musty smell to the urine in the child with phenylketonuria. None of the other disorders affect the urine or the smell of the urine.

A 30 weeks' gestation neonate born with low Apgar scores is in the neonatal intensive care unit with respiratory distress syndrome and underwent an exchange transfusion for anemia. Which factors place the neonate at risk for necrotizing enterocolitis? Select all that apply

preterm birth respiratory distress syndrome low Apgar scores exchange transfusion The predisposing factors for the development of necrotizing enterocolitis include preterm labor, respiratory distress syndrome, exchange transfusion, and low birth weight. Low Apgar scores, hypothermia, and hypoglycemia are also risk factors.

A nurse is working with a child who has spina bifida. Which nursing goal for this child would have the highest priority?

preventing infection The highest priority nursing goal is preventing infection because of the vulnerability of the myelomeningocele sac. Promoting comfort is important but not as high a priority because the child does not usually have severe pain with this diagnosis. Reducing anxiety and teaching are lower priorities; physical is a higher priority than psychosocial.

The nurse is caring for a baby born to a mother with a history of alcohol abuse. For what characteristics should the nurse observe to determine if the newborn has fetal alcohol syndrome? Select all that apply.

reduced ocular growth short palpebral fissures flattened nasal bridge The newborn withdrawing from alcohol typically is hyperactive and irritable, has trouble sleeping, and may have tremors or seizures. Characteristics of fetal alcohol syndrome (FAS) include low birth weight, small height and head circumference, short palpebral fissures, reduced ocular growth, and a flattened nasal bridge.

When assessing a newborn, the nurse determines that the newborn is most likely experiencing respiratory distress syndrome (RDS) based on which finding?

see-saw respirations Typically the newborn with RDS demonstrates signs and symptoms of severe respiratory distress at birth or within a few hours of birth. Fine, inspiratory crackles are noted on auscultation of a newborn with RDS. See-saw respirations are characteristic of RDS. A newborn with RDS typically demonstrates generalized cyanosis.

What treatment can the nurse anticipate assisting with for a newborn with congenital talipes equinovarus?

serial casting Treatment for congenital talipes equinovarus starts during the neonatal period. Correction can usually be accomplished by manipulation and bandaging or by application of a cast. Casts are changed frequently to provide gradual, atraumatic correction—every few days for the first several weeks.

Which newborn would the nurse suspect to be most at risk for cognitive challenge due to the mother's actions during pregnancy?

the child of a client who admits to drinking a liter of alcohol daily during the pregnancy Fetal alcohol syndrome is one of the most common known causes of cognitive challenge. The newborn is also at risk for fetal alcohol spectrum disorder and other alcohol-related birth defects. The other illicit drugs are not linked to mental retardation but have many other teratogenic effects on the fetus/newborn. Marijuana has not shown to have teratogenic effects on the fetus.

A nurse working in the newborn observational unit is assigned four newborns closely being monitored. Which newborn is at greatest risk of developing respiratory distress syndrome?

the male preterm infant born by cesarean birth with cold stress The most common factor is a premature birth with additional factors of cesarean births and cold stress. Vaginal births and a parental history of asthma do not correlate with RDS. A positive Babinski reflex is normal in newborns and children up to 2 years old. Maternal hypertension with a term birth as well do not correlate.

Following birth, the newborn's independent circulatory system is established. If there is an abnormal opening between the chambers in the heart, which cardiac defect may occur?

ventricular septal defect A ventricular septal defect is the most common intracardiac defect. It consists of an abnormal opening in the septum between the two ventricles.

An infant develops hydrocephalus at 2 weeks of age. Which finding would the nurse expect to assess?

white sclera showing above the pupils As accumulating cerebrospinal fluid puts pressure on the posterior surface of the eye globes, they tip downward; white sclera shows above the pupils.