CH. 21 : The Newborn at Risk: Congenital Disorders
The nurse is caring for an infant diagnosed with a ventricular septal defect. Which assessment findings does the nurse anticipate? A harsh murmur Fatigue Slow weight gain Cyanosis
A harsh murmur Explanation: The infant diagnosed with a ventricular septal defect exhibits a characteristic loud, harsh murmur. Otherwise, the child may be asymptomatic. There is no cyanosis as blood does not shunt to the left due to pressure gradients. Normal activity and growth and development are anticipated.
Which assessment findings are most prominent in the infant with Tetralogy of Fallot and significant pulmonary stenosis? Irregular heart rate, fatigue, pink tinged skin Poor weight gain, nausea, decreased muscle tone Dyspnea on limited exertion, fatigue, cyanosis Dry mucous membranes, poor urine output
Dyspnea on limited exertion, fatigue, cyanosis Explanation: The infant with Tetralogy of Fallot and significant pulmonary stenosis exhibits prominent signs of dyspnea, fatigue and cyanosis. Other symptoms include feeding difficulties and poor weight gain, retarded growth and development and breathlessness. Irregular heartrate, dry mucous membranes, nausea and decreased muscle tone may be present in some form but are not the prominent signs.
A 5-month-old is having a cleft lip/palate repair. What games could the nurse play with the child to provide comfort and diversion postoperatively while the baby is in elbow restraints? A board game Peek-a-boo Arts and crafts Blowing a pinwheel
Peek-a-boo Explanation: Playing peek-a-boo and other infant games will help to comfort and entertain the infant in restraints; however, "patty cake" does not work well with an infant in elbow restraints. Blowing a pinwheel will stress the suture line.
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? Place a wedge under the child's crib. Position the child on the side. Place the child on the back. Place the child on the abdomen.
Position the child on the side. Explanation: 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.
Why is the preterm newborn at greater risk than a term newborn for intraventricular hemorrhage (IVH)? Select all that apply. Poor ability to autoregulate cerebral pressure Overstimulation or brisk, abrupt movements Premature and very fragile capillary system surrounding the brain Inability to metabolize excessive RBCs Greater likelihood of trauma during delivery because of the newborn's size
Premature and very fragile capillary system surrounding the brain Poor ability to autoregulate cerebral pressure Overstimulation or brisk, abrupt movements Explanation: Preterm infants have a very fragile capillary system that can be damaged easily by overstimulation and brisk or abrupt movements. They also have a decreased ability to autoregulate cerebral pressure, leading to an increased likelihood of IVH. They are able to metabolize RBCs. They are less likely than an LGA newborn to experience trauma during delivery.
A late preterm newborn is born at: Between 32 and 34 weeks Between 32 and 36 weeks Between 34 and 36 weeks Between 34 and 37 weeks
The late preterm newborn is born between 34 and 37 weeks. This is an important classification of newborns because their care may differ from that provided to other preterm infants.
Spina bifida with myelomeningocele
The neonate shown was born with spina bifida myelomeningocele, which is a sac containing the spinal cord and meninges with nerves roots embedded in the wall. Spina bifida occulta is a bony defect that occurs without soft tissue involvement. These neonates are asymptomatic and present no problems. A neonate with spina bifida with a meningocele would have spinal meninges protrude through a bony defect forming a sac. There is no condition as spina bifida major.
The nurse is caring for a preterm neonate and has chosen the following goal: improvement of the neonate's respiratory function. Which expected outcome is most appropriate for the first week? The neonate will have 99% oxygen saturation. The neonate will sleep without apnea periods. The neonate will maintain a temperature under 99.5°F (37.5°C). The neonate will not use accessory muscles when breathing.
The neonate will not use accessory muscles when breathing. Explanation: The goal most appropriate for the first week of life is to not use accessory muscles or grunting when breathing. This signifies an improvement in the respiratory status. A 99% oxygen saturation rate is too high for the neonate. Maintaining the temperature and sleeping without apnea are acceptable goals but not most reflective of improvement in the respiratory status.
The nurse is performing a cardiac assessment on a newborn and hears a loud, harsh murmur associated with a systolic thrill. What congenital heart defect does the nurse suspect? Coarctation of the aorta Patent ductus arteriosus Atrial septal defect Ventricular septal defect
Ventricular septal defect Explanation: Small, isolated defects are usually asymptomatic and often are discovered during a routine physical examination. A characteristic loud, harsh murmur associated with a systolic thrill occasionally is heard on examination.
A nurse is performing a newborn assessment and notes the blood pressures in the upper extremities are higher than the lower extremities. The nurse should suspect which congenital newborn abnormality? coarctation of the aorta ventricular septal defect truncus arteriosus patent ductus arteriosus
coarctation of the aorta Explanation: In congenital heart defects, coarctation of the aorta occurs when there is a narrow or constricted area of the aorta. This causes blood pressures to be higher in the upper extremities and lower in the lower extremities. Patent ductus arteriosus refers to an open patent foramen ovale after birth, and a ventricular septal defect is an opening in the ventricle. Both of these latter disorders cause increased pulmonary flow in the heart. Truncus arteriosus means there is one main branch for all vessels coming off the top of the heart.
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? cleft lip hydrocephalus inguinal hernia esophageal atresia
esophageal atresia Explanation: 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.
Congenital myelomeningocele is commonly associated with which condition? hydrocephalus microcephaly absence of the cranial vault cranial suture overlap
hydrocephalus Explanation: A myelomeningocele is commonly associated with hydrocephalus or excessive cerebrospinal fluid (CSF) within the cranial cavity. Microcephaly is associated with maternal exposure to cytomegalovirus (CMV) or rubella. Anencephaly is a different type of neural tube defect. Cranial suture overlap may occur with vaginal birth, but it is not associated with myelomeningocele.
When planning preoperative care for a newborn with a cleft lip and palate, the nurse would plan interventions for which major need? nutrition prevention of oral infection prevention of pneumonia visual stimulation
nutrition Explanation: An infant with a cleft lip is unable to suck effectively, so obtaining adequate nutrition is a major concern.
It would be best to place an infant with a myelomeningocele in which position prior to surgery? on the left side with the head dependent semi-Fowler in an infant chair supine with the head elevated on the stomach (prone)
on the stomach (prone) Explanation: Placing the infant prone prevents direct trauma to the lesion and reduces the chance that feces will contaminate the lesion.
The nurse is caring for neonates in the neonatal intensive care unit (NICU). In reviewing the records of the neonates, the nurse notes that one of the infants has a common congenital heart defect. She recognizes that the most common of the congenital heart defects is: ductus venosus. hypoplastic left heart. atrial septal defect. ventricular septal defect. coarctation of the aorta.
ventricular septal defect. Explanation: Ventricular septal defect is the most common congenital heart defect.
A nurse is caring for a child with complex esophageal atresia who will be undergoing surgery for repair. What comment by the parents indicates further teaching is required? "After this surgery is done tomorrow, my baby will be able to eat and drink." "Intravenous fluids are going to be needed so that the baby won't get dehydrated." "They will be placing a tube in the stomach during surgery." "The baby will have tubes in the chest to drain chest fluids."
"After this surgery is done tomorrow, my baby will be able to eat and drink." Explanation: The newborn will need IV fluids to maintain optimal hydration. The first stage of surgery may involve a gastrostomy and a method of draining the proximal esophageal pouch. A chest tube is inserted to drain chest fluids. If the repair is complex, surgery may need to be done in stages.
A patient comes to the clinic because she had positive home pregnancy test results. She tells the nurse that she has a brother with spina bifida and is concerned that her child may be born the same way. When does the nurse tell the patient is the best time to perform tests for neural tube defects? 9 to 10 weeks' gestation 11 to 12 weeks' gestation 6 to 8 weeks' gestation 13 to 15 weeks' gestation
13 to 15 weeks' gestation Explanation: Elevated maternal alpha-fetoprotein (AFP) levels followed by ultrasonographic examination of the fetus may show an incomplete neural tube. An elevated AFP level in the maternal serum or amniotic fluid indicates the probability of central nervous system abnormalities. The best time to perform these tests is between 13 and 15 weeks' gestation, when peak levels are reached.
Which clinical manifestation is seen in the child with hydrocephalus? Partial to complete paralysis in the lower extremities An extremely large and rapidly growing head A membrane between the rectum and the anus A protruding sac that contains abdominal contents
An extremely large and rapidly growing head Explanation: An excessively large head at birth is suggestive of hydrocephalus. Rapid head growth with widening cranial sutures is also strongly suggestive and may be the first manifestation of this condition.
Which health care provider assessment technique does the nurse anticipate being used to determine developmental dysplasia of the hip (DDH) on a newborn? Assessing leg kicks for extension Full range of motion of the hip Visual inspection of the hip Barlow sign and Ortolani click
Barlow sign and Ortolani click Explanation: The nurse anticipates that a Barlow sign and Ortolani assessment will be done by an experienced health care provider when the newborn is in the nursery. This includes range of motion of the hip. Leg kicks and visual inspection are not helpful in determining congenital hip dysplasia.
Newborns born to a mother with diabetes are at risk for which of the following? Hyperglycemia, intrauterine hypoxia, hemolytic disease of the newborn, and hyperviscosity of the blood Hypoglycemia, delayed fetal lung maturity, respiratory distress, and shoulder dystocia Hyperglycemia, meconium aspiration syndrome, cerebral ischemia, and polycythemia Hypoglycemia, polycythemia, respiratory distress, and hyperviscosity of the blood
Hypoglycemia, delayed fetal lung maturity, respiratory distress, and shoulder dystocia Explanation: Maternal diabetes can lead to a delay in fetal lung maturity, resulting in respiratory distress. Newborns are also susceptible to hypoglycemia because they have been producing a higher level of insulin in utero as a result of high maternal glucose levels. They are at increased risk for LGA and subsequent shoulder dystocia.
During cardiac surgery the body temperature is reduced to decrease the effects of the surgery on the brain and other body organs. This process is referred to as inducing which of the following? Hypoactivity Hypotension Hypokalemia Hypothermia
Hypothermia Explanation: Inducing hypothermia consists of reducing the body temperature to between 68°F and 78.8°F (20°C to 26°C). It is a useful technique that helps to make early surgery possible and increases the time that the circulation may be stopped without causing brain damage.
The parent reports that the health care provider said that the infant had a hernia but she can't remember which type. When recalling what the health care provider said, the parent said that a surgeon will repair it soon and there is no problem with the testes. Which hernia type is anticipated? Hiatal hernia Inguinal hernia Umbilical hernia Diaphragmatic hernia
Inguinal hernia Explanation: An inguinal hernia occurs primarily in males and allows the intestine to slip into the inguinal canal, resulting in swelling. If the intestine becomes trapped and circulation is impaired, surgery is indicated within a short period of time. The diaphragmatic hernia has implications with the respiratory system. An umbilical hernia typically spontaneously closes by age 3. A hiatal hernia produces digestive issues.
Which types of play are most appropriate for the 3-month-old who is in an orthopedic cast? Puzzles and cars Colorful books and crayons Baskets and soft balls Mobiles and rattles
Mobiles and rattles Explanation: Infants who are in an orthopedic cast must have stimulation by contact and play. They have limited ability to move. The best type of play for this age is a mobile that they can look at or a hand toy such as a rattle. The infant is unable to play with baskets and soft balls or books and crayons. The infants can hear musical instruments.
The nursing student is describing a protrusion of the spinal cord and the meninges. The nursing instructor realizes that the student is correctly describing which neural tube defect? Spinal cyst Myelomeningocele Spina bifida occulta Meningocele
Myelomeningocele Explanation: Myelomeningocele is a defect in the the neural tube that includes the spinal cord and the meninges in a cyst. Spina bifid a occult does not have a cyst, meningocele does not include the spinal cord and a spinal cyst does not include the spinal cord or the meninges.
A mother is inspecting her newborn and notices the baby has a sixth finger. The nurse would explain that this condition is called: syndactyly. genu varum. webbing. polydactyly.
polydactyly. Explanation: Polydactyly is the presence of one or more additional fingers or toes. Syndactyly is when two fingers or toes are fused. Webbing is the result of fusing of two fingers or toes. Genu varum is a knee disorder.
A newborn has ambiguous genitalia. The parents are quite emotional and do not know what to do, or if they should raise the child as a boy or girl. What is the best advice for the nurse to offer at this time? "It is important to make the decision based on your desire to have either a girl or boy." "Research shows that it is best for anatomical structure to determine the sex of rearing." "It is not that important right now. You have lots of time to make that decision." "Surgery can be done to correct anomalies, so that's the important thing to consider."
"Research shows that it is best for anatomical structure to determine the sex of rearing." Explanation: Regardless of the cause, it is important to establish the genetic sex and the sex of rearing as early as possible so that surgical correction of the anomalies may occur before the child begins to function in a sex-related social role. Authorities believe that the newborn's anatomical structure, rather than the genetic sex, should determine the sex of rearing. Parents may feel guilt, anxiety, and confusion about their child's condition and need understanding and support to help them cope with this emergency.
The nurse is caring for a newborn client newly diagnosed with developmental dysplasia of the hip. Which response by the nurse educates the parents on the correct plan of treatment for this diagnosis? "Treatment will consist of surgery when your child weighs about 10 pounds." "Treatment will start once your child can bear weight." "Treatment will include bilateral casts at 1 month of age." "Treatment will begin immediately."
"Treatment will begin immediately." Explanation: Developmental dysplasia of the hip (DDH) 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.
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? "He'll need antibiotics for a bit after the surgery to prevent infection." "We can probably start feeding him with the bottle about a day after the surgery." "The head of his bed will be elevated to prevent him from aspirating." "We can give him a pacifier to help satisfy his need to suck."
"We can probably start feeding him with the bottle about a day after the surgery." Explanation: 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.
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? "The head of his bed will be elevated to prevent him from aspirating." "We can probably start feeding him with the bottle about a day after the surgery." "He'll need antibiotics for a bit after the surgery to prevent infection." "We can give him a pacifier to help satisfy his need to suck."
"We can probably start feeding him with the bottle about a day after the surgery." Explanation: 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.
A new mother is concerned because she fears that her infant's head is larger than normal. What would be the nurse's best response? A large head at birth in itself is not indicative of hydrocephalus, but we will keep a check on it. It will become even larger as the baby grows. A large head at birth suggests hydrocephalus. If we do not drain the excessive fluid building up the child will have a problem raising the head when older.
A large head at birth in itself is not indicative of hydrocephalus, but we will keep a check on it. Explanation: An excessively large head at birth suggests hydrocephalus. An apparently large head in itself, however, is not necessarily significant. Normally every newborn's head is measured at birth and the rate of growth is checked at subsequent examinations. It should be measured more frequently if found to be enlarged at birth or if it appears to be enlarging. The other responses are not therapeutic for a mother already worried about her newborn.
The nurse is reviewing the medical record of the antepartum client with an abnormal alpha-fetoprotein test. The mother is distraught and states, "How bad can it be?" The nurse is correct to describe which? A type of spina bifida The absence of a kidney A cleft lip and palate A cardiac deficit
A type of spina bifida Explanation: The alpha-fetoprotein test is an indicator of a neural tube defect indicating a form of spina bifida. Spina bifida is a bony defect that occurs is various forms and can produce a varied level of disability (ranging from no disability to paralysis). This test is not an indicator of a cardiac deficit, a cleft lip and palate, or a kidney disorder.
Immediately after birth, the nurse is caring for a newborn with a myelomeningocele. What intervention should the nurse provide to prevent drying out of the sac to avoid damage? Apply a sterile dressing moistened in a warm, sterile saline solution. Cover the sac with petroleum jelly and a dry sterile dressing. Cover the sac with a water-soluble lubricant and a dry sterile dressing. Allow the sac to dry out to "toughen" it.
Apply a sterile dressing moistened in a warm, sterile saline solution. Explanation: Until surgery is performed, the sac must be covered with a sterile dressing moistened in a warm, sterile solution (often saline). The nurse should change this dressing every 2 hours and not allow it to dry to avoid damage to the covering of the sac.
Immediately after birth, the nurse is caring for a newborn with a myelomeningocele. What intervention should the nurse provide to prevent drying out of the sac to avoid damage? Cover the sac with petroleum jelly and a dry sterile dressing. Cover the sac with a water-soluble lubricant and a dry sterile dressing. Apply a sterile dressing moistened in a warm, sterile saline solution. Allow the sac to dry out to "toughen" it.
Apply a sterile dressing moistened in a warm, sterile saline solution. Explanation: Until surgery is performed, the sac must be covered with a sterile dressing moistened in a warm, sterile solution (often saline). The nurse should change this dressing every 2 hours and not allow it to dry to avoid damage to the covering of the sac.
Which assessment findings are most prominent in the infant with Tetralogy of Fallot and significant pulmonary stenosis? Poor weight gain, nausea, decreased muscle tone Dyspnea on limited exertion, fatigue, cyanosis Irregular heart rate, fatigue, pink tinged skin Dry mucous membranes, poor urine output
Dyspnea on limited exertion, fatigue, cyanosis Explanation: The infant with Tetralogy of Fallot and significant pulmonary stenosis exhibits prominent signs of dyspnea, fatigue and cyanosis. Other symptoms include feeding difficulties and poor weight gain, retarded growth and development and breathlessness. Irregular heartrate, dry mucous membranes, nausea and decreased muscle tone may be present in some form but are not the prominent signs.
Which nursing suggestion is most helpful in preventing symptoms from a 3-month-old's hiatal hernia? Add cereal to the feeding Feed in an upright position Use a hypoallergenic formula Increase the amount of feeding
Feed in an upright position Explanation: The nursing suggestion which is most helpful is to feed the infant in an upright position and maintain that position after the feeding. The upright posture is a noninvasive, easy suggestion to try without a health care provider's order. An increased amount of feeding may aggravate the symptoms. Adding cereal to the feeding and use of a hypoallergenic formula would need approval from the health care provider.
From which pair of metabolic disorders must the nurse instruct the parents to eliminate breast and cow's milk from the diet? Congenital hypothyroidism and phenylketonuria Galactosemia and phenylketonuria Turner syndrome and maple syrup urine disease Maple syrup urine disease and galactosemia
Galactosemia and phenylketonuria Explanation: Both phenylketonuria and galactosemia are hereditary disorders in which the body cannot have milk. Maple syrup urine disease is an inborn error of metabolism of the branched chain amino acid. Congenital hypothryroidism is an error with the thyroid gland.
A nurse is caring for a newborn client who is diagnosed with myelomeningocele. Which nursing intervention would protect the newborn from injury? Place the newborn in a prone or lateral position. Delay the parents from holding the newborn. Place a urine collection bag on newborn for the continuous leakage. Place petroleum jelly gauze on the spinal sac to keep it moist.
Place the newborn in a prone or lateral position. Explanation: 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 pregnant woman at 41 weeks' gestation is scheduled for labor induction. What does the nurse monitor after the birth of the baby? BUN and creatinine levels Serial blood glucose levels Surfactant levels AST levels
Serial blood glucose levels Explanation: The nurse should monitor serial blood glucose levels. The newborn may require intravenous glucose infusions to stabilize the glucose level.
The nurse is assessing a neonate.From the assessment, the nurse notes that there is paralysis of the lower extremities. For which condition does the nurse anticpate performing care? Spina bifida major Spina bifida with meningocele Spina bifida occulta Spina bifida with myelomeningocele
Spina bifida with myelomeningocele Explanation: The neonate shown was born with spina bifida myelomeningocele, which is a sac containing the spinal cord and meninges with nerves roots embedded in the wall. Spina bifida occulta is a bony defect that occurs without soft tissue involvement. These neonates are asymptomatic and present no problems. A neonate with spina bifida with a meningocele would have spinal meninges protrude through a bony defect forming a sac. There is no condition as spina bifida major.
5 When examining a newborn for developmental dysplasia of the hip (DDH), which motion would the newborn's hip be unable to accomplish? extension abduction rotation adduction
abduction Explanation: Infants with shallow acetabulums are unable to abduct their hips.
A pregnant client asks the nurse at what point in pregnancy the fetal heart is most susceptible to damage during development. The nurse correctly explains the period as: during the second trimester when the heart begins to beat. during the last trimester when the fetus is growing rapidly. during the first 8 weeks of pregnancy when it is forming. between the 10th and 16th weeks when the central nervous system is developing.
during the first 8 weeks of pregnancy when it is forming. Explanation: The fetal heart develops between the third and eighth week of pregnancy. Teratogenic effects would be most detrimental during this time.
A nursing student has read that cleft lip is diagnosed at birth based on inspection of physical appearance and that cleft palate is diagnosed in which way? ultrasound feeling the palate with a gloved finger or using a tongue blade X-ray blood work
feeling the palate with a gloved finger or using a tongue blade Explanation: Diagnosis of cleft palate is made at birth with the close inspection of the newborn's palate. To be certain that a cleft palate is not missed, the examiner must insert a gloved finger into the newborn's mouth to feel the palate to determine that it is intact. The other tests cannot confirm a cleft palate.
A nurse is providing preoperative care to a female newborn client with the congenital abnormality myelomeningocele. Which intervention is the priority? promoting newborn nutrition maximizing newborn motor function preserving newborn GI function preventing infection
preventing infection Explanation: A congenital condition of the newborn with a spinal deformity puts the newborn at risk for infection. A myelomeningocele is a fluid-filled sac on the spine that includes part of the spinal cord defect and the meninges. This cyst on the outside of the newborn requires surgical intervention. Although nutrition, GI function, and motor function are all important to the health of the newborn, the spinal and meninges defect puts the newborn at high risk for infection.
The nurse is providing education to the parents of an infant who was just diagnosed with transposition of the great arteries. The parents ask, "Which vessels were involved?" The nurse is correct to educate about: the inferior vena cava and pulmonary vein. the pulmonary vein and pulmonary artery. the aorta and pulmonary artery. the superior and inferior vena cava.
the aorta and pulmonary artery. Explanation: The nurse is correct to educate that in the congenital condition known as transposition of the great arteries, it is the aorta and the pulmonary artery that are reversed. In this condition, the aorta rises from the right ventricle and the pulmonary artery arises from the left. The other options are incorrect.
The nurse is caring for a newborn with hydrocephalus. To protect the newborn from injury in the postoperative period, the nurse should position the head: in Trendelenburg position. turned toward the operative site. supported on a pillow. turned away from the operative site.
turned away from the operative site. Explanation: In the early postoperative period, the infant's head should be placed turned away from the operative site to promote comfort until the physician instructs otherwise. Trendelenberg would facilitate additional fluid accumulation, infants should not be placed on pillows and if turned toward the operative site additional pain and fluid accumulation would result.