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

A 3-day-old neonate needs phototherapy for hyperbilirubinemia. Nursery care of a neonate receiving phototherapy includes which treatment? A) Eye patches to prevent retinal damage B) Temperature monitored every 6 hours during phototherapy C) Mask over mouth D) Tube feedings

A) Eye patches to prevent retinal damage The neonate's eyes must be covered with eye patches to prevent damage. The neonate can be removed from the lights and held for feeding. The mouth of the neonate doesn't need to be covered during phototherapy. The neonate's temperature should be monitored at least every 2 to 4 hours because of the risk of hyperthermia with phototherapy.

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? A) "Treatment will start once your child can bear weight." B) "Treatment will begin immediately." C) "Treatment will consist of surgery when your child weighs about 10 pounds." D) "Treatment will include bilateral casts at 1 month of age."

B) "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.

Which nursing measure is most effective in reducing newborn infections? A) Place newborns in an isolette. B) Maintain medical asepsis while providing care. C) Promote early discharge of all newborns. D) Limit the number of newborns in newborn nurseries.

B) 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.

The nurse is caring for a newborn who has transient tachypnea of the newborn. In discussing the contributing factors for this disorder, which statement is most accurate? A) This disorder may be seen with advanced gestational age. B) This disorder is often seen in newborns born by cesarean birth. C) This disorder is associated with fetal distress during labor. D) This disorder usually occurs when the mother has a history of hypertension.

B) This disorder is often seen in newborns born by cesarean birth. TTN commonly occurs in newborns born by cesarean birth. The newborn does not experience the compression of the thoracic cavity that occurs with passage through the birth canal, so he or she retains some fluid in the lungs that usually squeezes out as the thoracic area is compressed during a vaginal birth. Meconium aspiration syndrome is associated with fetal distress during labor, a maternal history of diabetes or hypertension, difficult birth, and advanced gestational age.

Which measure would the nurse expect to be included in the plan of care for an infant of a diabetic mother who has a serum calcium level of 6.2 mg/dL? A) infusions of intravenous glucose B) administration of calcium gluconate C) initiation of phototherapy D) initiation of oral feedings

B) administration of calcium gluconate Serum calcium levels less than 7 mg/dL indicate the need for supplementation with oral or IV calcium gluconate. Phototherapy would be used if the newborn develops hyperbilirubinemia. Intravenous glucose solutions would be used to stabilize the newborn's blood glucose levels and prevent hypoglycemia. Feedings help to control glucose levels, reduce hematocrit, and promote bilirubin excretion.

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: A) weighed above average when born. B) has facial deformities. C) cries when touched. D) sleeps for long periods of time.

C) 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 assessing a newborn suspected of having meconium aspiration syndrome. What sign or symptom would be most suggestive of this condition? A) intermittent tachypnea B) bile-stained emesis C) expiratory grunting D) high-pitched, shrill cry

C) 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.

When assessing a newborn, the nurse determines that the newborn is most likely experiencing respiratory distress syndrome (RDS) based on which finding? A) respiratory distress occurring by 6 hours of age B) slightly diminished breath sounds C) see-saw respirations D) peripheral cyanosis

C) 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.

A neonatal intensive care nurse is caring for a preterm newborn diagnosed with transient tachypnea who is NPO and receiving intravenous fluid therapy. When would the nurse expect the newborn to begin oral feedings? A) When intake and output correlate. B) When serum glucose is 30 mg/dL (1.7 mmol). C) When the oxygen saturation level is at 92%. D) When the respiratory rate is 44 BPM.

D) When the respiratory rate is 44 BPM. Nursing management of transient tachypnea of the newborn (TTN) is supportive with the administration of intravenous (IV) fluids and/or gavage feedings until the respiratory rate decreases enough to allow safe oral feeding. RR of 44 bpm is normal. The O2 sat level is too low to start oral feedings. The glucose levels indicates hypoglycemia. Intake and output measurements do not indicate the newborn will manage oral feedings.

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: A) was on a food stamp program during pregnancy. B) smoked until 4 years ago. C) has been pregnancy 3 previous times. D) has a history of abnormal blood glucose levels.

D) 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.