Newborn Transitions & Complications

When a preterm infant is receiving an intravenous infusion containing calcium gluconate, the nurse would assess this infant for: Seizures Bradycardia Dysrhythmias Tetany

Bradycardia

A preterm infant has a yellow skin color and a rising bilirubin level. The nurse is aware that this infant is at risk for: Skin breakdown Renal failure Brain damage Congestive heart failure

Brain damage The higher the bilirubin level and the deeper the jaundice, the greater the risk for neurological damage.

All of these statements about physiologic jaundice are true except: Neonatal jaundice is common, but kernicterus is rare The appearance of jaundice during the first 24 hours or beyond day 7 indicates a pathologic process. Because jaundice may not appear before discharge, parents need instruction on how to assess it and when to call for medical help. Breastfed babies have a lower incidence of jaundice

Breastfed babies have a lower incidence of jaundice. A. Incorrect: Neonatal jaundice occurs in 60% of newborns; the complication called kernicterus is rare. B. Incorrect: Jaundice in the first 24 hours or that persists past day 7 is cause for medical concern. C. Incorrect: Parents need to know how to assess jaundice. D. Correct: Breastfeeding is associated with an increased incidence of jaundice.

One reason the brain is vulnerable to nutritional deficiencies and trauma in early infancy is the: Incompletely developed neuromuscular system Primitive reflex system Presence of various sleep-wake states Cerebellum growth spurt

Cerebellum growth spurt

The nurse clarifies that a fetus has enough surfactant to breathe on its own at the age of ____________________ weeks. 18 20 24 30

24

With regard to the respiratory development of the newborn, nurses should be aware that: The first gasping breath is an exaggerated respiratory reaction within 1 minute of birth. Newborns must expel the fluid at uterine life from the respiratory system within a few minutes of birth. Newborns are instinctive mouth breathers. Seesaw respirations are no cause for concern in the first hour after birth.

The first gasping breath is an exaggerated respiratory reaction within 1 minute of birth.

A 3-month-old baby who was born at 25 weeks has been exposed to prolonged oxygen therapy. Due to oxygen therapy, the nurse explains to the parents, their infant is at a greater risk for: Visual impairment. Hypercalcemia. Cerebral palsy. Sensitive gag reflex.

Visual impairment.

In caring for the premature newborn, the nurse must assess hydration status continually. Assessment parameters should include: Select all that apply. Volume of urine output. Weight. Blood pH. Head circumference. Bowel sounds.

Volume of urine output. Weight.

A woman gave birth to a healthy 7-pound, 13-ounce infant girl. The nurse suggests that the woman place the infant to her breast within 15 minutes after birth. The nurse knows that breastfeeding is effective during the first 30 minutes after birth because this is the: Transition period First period of reactivity Organizational stage Second period of reactivity

First period of reactivity

The apnea monitor indicates that a preterm infant is having an apneic episode. The appropriate nursing action in this situation is to: Administer oxygen via nasal cannula Gently rub the infant's feet or back Ventilate with an Ambu bag Perform nasopharyngeal suctioning

Gently rub the infant's feet or back

The pregnant patient at 41 weeks is scheduled for labor induction. She asks the nurse whether induction is really necessary. What response by the nurse is best? "Babies can develop postmaturity syndrome, which increases their chances of having complications after birth." "When infants are born 2 or more weeks after their due date, they have meconium in the amniotic fluid." "Sometimes the placenta ages excessively, and we want to take care of that problem before it happens." "The doctor wants to be proactive in preventing any problems with your baby if he gets any bigger."

"Babies can develop postmaturity syndrome, which increases their chances of having complications after birth."

The mother of a premature newborn questions why a gavage feeding catheter is placed in the mouth of the newborn and not in the nose. The nurse's best response is: "Most newborns are nose breathers." "The tube will elicit the sucking reflex." "A smaller catheter is preferred for feedings." "Most newborns are mouth breathers."

"Most newborns are nose breathers."

The patient with blood type O Rh-negative has given birth to an infant with blood type O Rh-positive. The infant has become visibly jaundiced at 12 hours of age. The mother asks why this is happening. The best response by the nurse is: "The RhoGAM you received at 28 weeks' gestation did not prevent alloimmunization." "Your body has made antibodies against the baby's blood that are destroying her red blood cells." "The red blood cells of your baby are breaking down because you both have type O blood." "Your baby's liver is too immature to eliminate the red blood cells that are no longer needed."

"Your body has made antibodies against the baby's blood that are destroying her red blood cells." Rationale 1: Although this statement is true, the term "alloimmunization" is not likely to be understood by the patient. It is better to explain what is happening using more understandable terminology. R ationale 2: This explanation is accurate and easy for the patient to understand. Rationale 3: Mother and baby's both having type O blood is not a problem. ABO incompatibility occurs if mother is O and baby is A or B. Rationale 4: The infant's liver is indeed too immature to eliminate red blood cells, but the hemolysis from the maternal antibodies is the cause of the jaundice.

The nurse is assessing a newborn diagnosed with physiologic jaundice. Which findings would the nurse expect? Select all that apply. Jaundice present within the first 24 hours of life Appearance of jaundice symptoms after 24 hours of life Yellowish coloration of the sclera of the eyes Cephalhematoma or excessive bruising Cyanosis

Appearance of jaundice symptoms after 24 hours of life. Yellowish coloration of the sclera of the eyes. Rationale 1: Pathologic jaundice occurs within the first 24 hours of life. Rationale 2: Physiologic or neonatal jaundice appears after 24 hours of life. Rationale 3: Jaundice is a yellowish coloration of the skin and sclera of the eyes that develops from the deposit of yellow pigment bilirubin in lipid- or fat-containing tissues. Rationale 4: These are risk factors for pathologic jaundice. Rationale 5: Jaundice is not associated with cyanosis.

Which nursing interventions are appropriate when caring for the newborn undergoing phototherapy? Select all that apply. Cover the newborn's eyes at all times, even when not under the lights. Close the newborn's eyelids before applying eye patches. Inspect the eyes each shift for conjunctivitis, drainage, and corneal abrasions. Keep the baby swaddled in a blanket to prevent heat loss. Reposition the baby every 2 hours.

Close the newborn's eyelids before applying eye patches. Inspect the eyes each shift for conjunctivitis, drainage, and corneal abrasions. Reposition the baby every 2 hours. Rationale 1: Removing the baby from under the phototherapy lights and removing eye patches during feedings provide visual stimulation and facilitate attachment behaviors. Rationale 2: This prevents corneal abrasions. Rationale 3: This intervention prevents or facilitates prompt treatment of purulent conjunctivitis and abrasions due to irritation from eye patches. Rationale 4: The nurse should apply minimal coverage-diaper area only-to provide maximum exposure to phototherapy lights. Rationale 5: Repositioning allows equal exposure of all skin areas and prevents pressure areas.

The nurse assesses the gestational age of a newborn and informs the parents that the newborn is premature. All of the following assessment findings are congruent with prematurity except: Cry is weak and feeble. Clitoris and labia minora are prominent. Strong sucking reflex. Lanugo is plentiful.

Cry is weak and feeble.

A 2-day-old newborn is asleep, and the nurse assesses the apical pulse to be 88 beats/min. What would be the most appropriate nursing action based on this assessment finding? Call the physician. Administer oxygen Document the finding. Place the newborn under the radiant warmer.

Document the finding.

A 7 pound 14 ounce girl was born to an insulin-dependent type II diabetic mother 2 hours ago. The infant's blood sugar is 47 mg/dl. The best nursing action is to: Recheck the blood sugar in 4 hours. Begin an IV of 10% dextrose. Feed the baby 1 ounce of formula. Document the findings in the chart.

Document the findings in the chart. Rationale 1: Infants of diabetic mothers should be fed frequently, and should have their blood sugar assessed frequently. Four hours is too long a time frame. Rationale 2: A blood sugar reading of 47 mg/dl is considered normal for a neonate. No IV is needed. Rationale 3: Feeding would be appropriate if the infant's blood sugar were below 45 mg/dl, but this infant's reading is 47. Rationale 4: A blood sugar level of 47 mg/dl is a normal finding; documentation is an appropriate action.

The nurse is caring for an infant born at 43 weeks. A physical assessment would reveal: Dry, peeling skin Minimal hair on the head Short, rough nails Abundant lanugo on the body

Dry, peeling skin Loss of vernix caseosa leaves the skin dry, causing peeling.

The nurse is caring for the newborn of a drug-addicted mother. Which assessment findings would be typical for this newborn? Select all that apply. Hyperirritability Decreased muscle tone Exaggerated reflexes Depressed respiratory effort Transient tachypnea

Hyperirritability Exaggerated reflexes Transient tachypnea

The nurse recognizes symptoms of cold stress in a preterm infant as: Tremors and weak cry Plasma glucose level <40 mg/dl Warm skin with low core temperature Increased respiratory rate and periods of apnea

Increased respiratory rate and periods of apnea. Signs of cold stress include increased respiratory rate with periods of apnea, decreased skin temperature, bradycardia, mottling of skin, and lethargy.

A nurse is caring for a newborn on a ventilator who has respiratory distress syndrome (RDS). The nurse informs the parents that the newborn is improving. Which data support the nurse's assessment? Decreased urine output Pulmonary vascular resistance increases. Increased PCO2 Increased urination

Increased urination Rationale 1: As fluid moves out of the lungs and into the bloodstream, alveoli open and kidney perfusion increases, thereby increasing urine output. Rationale 2: Pulmonary vascular resistance increases with hypoxia. Rationale 3: Increased PCO2 results from alveolar hypoventilation. Rationale 4: Increased urination could be an indication that the newborn's condition is improving.

The nurse prepares to admit to the nursery a newborn whose mother had meconium-stained amniotic fluid. The nurse knows this newborn might require: Initial resuscitation. Vigorous stimulation at birth. Phototherapy immediately. An initial feeding of iron-enriched formula.

Initial resuscitation. Rationale 1: Newborns who have aspirated meconium might require resuscitation to establish adequate respiratory effort. Rationale 2: Stimulation at birth should be avoided to minimize respiratory movements. Rationale 3: Phototherapy is not required immediately. Typically, bilirubin levels rise after the first 24 hours of life. Rationale 4: Oral feedings may be withheld until respirations are normal. The newborn might require intravenous fluids.

The nurse assessing a newborn knows that the most critical physiologic change required of the newborn is: Closure of fetal shunts in the circulatory system Full function of the immune defense system at birth Maintenance of a stable temperature Initiation and maintenance of respirations

Initiation and maintenance of respirations

When caring for the newborn after a vaginal delivery, the nurse needs to be able to identify the respiratory changes that occur during the transition of the fetus to extrauterine life. Which factors does the nurse recognize as contributing to the changes in the newborn's lung function after birth? Select all that apply. Adequate lung development and production of surfactant Marked decrease in pulmonary circulation Inspiratory gasp triggered by the elevation in PCO2 and decrease in pH and PO2 Stimulation of skin nerve endings due to chilling Chemical stimulator associated with transient asphyxia of the fetus

Inspiratory gasp triggered by the elevation in PCO2 and decrease in pH and PO2 Stimulation of skin nerve endings due to chilling Chemical stimulator associated with transient asphyxia of the fetus

All of these statements describe the first phase of the transition period except: It lasts no longer than 30 minutes. It is marked by spontaneous tremors, crying, and head movements. It includes the passage of meconium. It may involve the infant suddenly sleeping briefly.

It may involve the infant suddenly sleeping briefly.

The transition period between intrauterine and extrauterine existence for the newborn: Consists of four phases, two reactive and two of decreased responses Lasts from birth to day 28 of life Applies to full-term births only Varies by socioeconomic status and the mother s age

Lasts from birth to day 28 of life. A. Incorrect: The transition period has three phases: first reactivity, decreased response, and second reactivity. B. Correct: Changes begin right after birth; the cutoff time when the transition is considered over (although the baby keeps changing) is 28 days. C. Incorrect: All newborns experience this transition regardless of age or type of birth. D. Incorrect: Although stress can cause variation in the phases, the mother's age and wealth do not disturb the pattern.

The nurse is caring for a newborn with jaundice. The parents question why the newborn is not under phototherapy lights. The nurse explains that the fiber optic blanket is beneficial because: Select all that apply. Lights can stay on all the time. The eyes do not need to be covered. The lights will need to be removed for feedings. Newborns do not get overheated. Weight loss is not a complication of this system.

Lights can stay on all the time. The eyes do not need to be covered. Newborns do not get overheated. Weight loss is not a complication of this system. Rationale 1: Being able to keep the halogen lights on all the time is an important advantage. Rationale 2: The eyes do not have to be covered with this system. Rationale 3: The lights can stay on all the time. Rationale 4: One benefit of the fiber optic blanket is that the newborn is not overheated. Rationale 5: Weight loss is not a complication of this system.

The nurse is caring for an infant born at 35 weeks of gestation. A physical characteristic that the nurse might expect this infant to exhibit is: Thin, long extremities Large genitals for its size Lanugo on the back and abdomen Loose, transparent skin

Loose, transparent skin The growth and development of the fetus are abruptly halted by a preterm birth. One of the characteristics of the preterm infant is skin that is loose and transparent.

To prevent possible retinopathy in a preterm infant requiring oxygen therapy, the nurse will: Monitor arterial oxygen levels with a pulse oximeter Position with the head slightly lower than the body Administer low concentrations of oxygen Keep the infant s eyes covered at all times

Monitor arterial oxygen levels with a pulse oximeter. Use of a pulse oximeter to carefully monitor arterial blood gases in high-risk infants continues to be a priority in the NICU.

Which fetal/neonatal risk factors would lead the nurse to anticipate a potential need to resuscitate a newborn? Select all that apply. Nonreassuring fetal heart rate pattern/sustained bradycardia Fetal scalp/capillary blood sample pH greater than 7.25 History of meconium in amniotic fluid Prematurity Significant intrapartum bleeding

Nonreassuring fetal heart rate pattern/sustained bradycardia. History of meconium in amniotic fluid. Prematurity Significant intrapartum bleeding

The nurse is caring for the newborn of a diabetic mother whose blood glucose level is 39 mg/dl. What should the nurse include in the plan of care for this newborn? Offer early feedings with formula or breast milk. Provide glucose water exclusively. Evaluate blood glucose levels at 12 hours after birth. Assess for hypothermia.

Offer early feedings with formula or breast milk.

The nurse is caring for the newborn of a diabetic mother. Which of the following should be included in the nurse's plan of care for this newborn? Offer more frequent feedings. Administer an intravenous infusion of glucose. Assess for hypercalcemia. Assess for hyperbilirubinemia immediately after birth.

Offer more frequent feedings. Rationale 1: Newborns of diabetic mothers can require more frequent feedings. Rationale 2: If the newborn's blood sugar level falls below 45 mg/dl, and if normal levels cannot be maintained by early feedings of formula or breast milk, the newborn might require intravenous infusions of D10W, along with oral feedings, to maintain normoglycemia. Rationale 3: The newborn should be assessed for hypocalcemia. Rationale 4: Hyperbilirubinemia can occur 48-72 hours after birth.

The nurse explains that a 4-day-old infant born at 33 weeks of gestation may need to be fed by gavage during the first few days of life because the infant: Often has a very weak or absent sucking or swallowing reflex Is unable to digest food properly Refuses to take formula by mouth Needs a larger quantity of formula at each feeding

Often has a very weak or absent sucking or swallowing reflex. When the preterm infant's sucking and swallowing reflexes are immature, gavage feedings can be used to promote nutrition.

What marks on a baby s skin may indicate an underlying problem that requires notification of a physician? Mongolian spots on the back Telangiectatic nevi on the nose or nape of the neck Petechiae scattered over the infant s body Erythema toxicum anywhere on the body

Petechiae scattered over the infant s body. A. Incorrect: Mongolian spots are bluish black spots that resemble bruises but that fade gradually over months and have no clinical significance. B. Incorrect: Telangiectatic nevi (stork bites, angel kisses) fade by the second year and have no clinical significance. C. Correct: Petechiae (bruises) scattered over the infant's body should be reported to the pediatrician, because they may indicate underlying problems. D. Incorrect: Erythema toxicum is an appalling-looking rash, but it has no clinical significance and requires no treatment.

When assessing a preterm infant, the nurse observes nasal flaring, sternal retractions, and expiratory grunting. These findings are indicative of: Respiratory distress syndrome Postmaturity syndrome Apneic episode Cold stress

Respiratory distress syndrome Insufficient amounts of surfactant predispose the preterm infant to respiratory distress. The signs manifested by the infant are indicative of respiratory distress.

A nurse explains to new parents that their newborn has developed respiratory distress syndrome (RDS). The nurse bases this assessment on all of the following data except: Grunting respirations. Nasal flaring. Respiratory rate of 40 during sleep. Chest retractions.

Respiratory rate of 40 during sleep. Rationale 1: Grunting with respirations is a characteristic of RDS. Rationale 2: Nasal flaring is a characteristic of RDS. Rationale 3: A respiratory rate of 40 during sleep is normal. Rationale 4: Significant chest retractions are characteristic of RDS.

During life in utero, oxygenation of the fetus occurs through transplacental gas exchange. When birth occurs, four factors combine to stimulate the respiratory center in the medulla. The initiation of respiration then follows. Which is NOT one of these essential factors? Chemical Mechanical Thermal Psychologic

Psychologic A. Incorrect: Chemical factors are essential for the initiation of breathing. During labor decreased levels of oxygen and increased levels of carbon dioxide seem to have a cumulative effect that is involved in the initiation of breathing. Clamping of the cord may also contribute to the start of respirations. Prostaglandins are known to inhibit breathing. Clamping of the cord results in a drop in the level of prostaglandins. B. Incorrect: Mechanical factors also are necessary to initiate respirations. As the infant passes through the birth canal, the chest is compressed. With birth, the chest is relaxed, which allows for negative intrathoracic pressure that encourages air to flow into the lungs. C. Incorrect: The profound change in temperature between intrauterine and extrauterine life stimulates receptors in the skin to communicate with the receptors in the medulla. This also contributes to the initiation of breathing. D. Correct: This is not a factor in the initiation of breathing, rather it is sensory factors that contribute. These factors include handling by the provider, drying by the nurse, lights, smells, and sounds.

With regard to the gastrointestinal (GI) system of the newborn, nurses should be aware that: The newborn s cheeks are full because of normal fluid retention. The nipple of the bottle or breast must be placed well inside the baby s mouth, because teeth have been developing in utero, and one or more may even be through. Regurgitation during the first day or two can be reduced by burping the infant and by slightly elevating the baby s head Bacteria already are present in the infant s GI tract at birth, because they traveled through the placenta

Regurgitation during the first day or two can be reduced by burping the infant and by slightly elevating the baby s head A. Incorrect: The newborn's cheeks are full because of well-developed sucking pads. B. Incorrect: Teeth do develop in utero, but the nipple is placed deep because the baby cannot move food from the lips to the pharynx. C. Correct: Avoiding overfeeding can also reduce regurgitation. D. Incorrect: Bacteria are not present at birth, but they soon enter through various orifices.

The nurse is caring for an infant who was delivered in a car on the way to the hospital and who has developed cold stress. Which finding requires immediate intervention? Vasoconstriction and pallor Blood glucose level of 45 Room-temperature IV running Positioned under radiant warmer

Room-temperature IV running. Rationale 1: Vasoconstriction is the first physiologic response to a lowering temperature; it causes pallor. Rationale 2: This is an adequate blood sugar in a neonate. A level lower than 40 indicates hypoglycemic. Rationale 3: IV fluids should be warmed prior to administration and wrapped in a blanket or other insulating material to keep them warm. Room-temperature IV fluids will increase the cold stress. Rationale 4: Radiant warmers are used to gradually increase the neonate's temperature.

A NICU nurse plans care for a preterm newborn that will provide opportunities for development. Which interventions support development in a preterm newborn in a NICU? Select all that apply. Schedule care throughout the day. Silence alarms quickly. Place a blanket over the top portion of the incubator. Do not offer a pacifier. Dim the lights.

Silence alarms quickly. Place a blanket over the top portion of the incubator. Dim the lights.

With regard to the functioning of the renal system in newborns, nurses should be aware that: The pediatrician should be notified if the newborn has not voided in 24 hours. Breastfed infants likely will void more often during the first days after birth. Brick dust or blood on a diaper is always cause to notify the physician. Weight loss from fluid loss and other normal factors should be made up in 4 to 7 days.

The pediatrician should be notified if the newborn has not voided in 24 hours. A. A newborn who has not voided in 24 hours may have any of a number of problems, some of which deserve the attention of the pediatrician. B. Incorrect: Formula-fed infants tend to void more frequently in the first 3 days; breastfed infants void less during this time because the mother's breast milk has not come in yet. C. Incorrect: "Brick dust" may be uric acid crystals; blood spotting could be due to withdrawal of maternal hormones (pseudomenstruation) or a circumcision. The physician must be notified only if there is no apparent cause of bleeding. D. Incorrect: Weight loss from fluid loss might take 14 days to regain.

The nurse is assessing a 2-hour-old newborn delivered by cesarean at 38 weeks. The amniotic fluid was clear. The mother had preeclampsia. The newborn has a respiratory rate of 80, is grunting, and has nasal flaring. What is the most likely cause of this infant's condition? Meconium aspiration syndrome Transient tachypnea of the newborn Respiratory distress syndrome Prematurity of the neonate

Transient tachypnea of the newborn. Rationale 1: There was no meconium in the amniotic fluid, which rules out meconium aspiration syndrome. Rationale 2: The infant is term and was born by cesarean, and is most likely experiencing transient tachypnea of the newborn. Rationale 3: The infant is not premature and therefore is not likely to be experiencing respiratory distress syndrome. Rationale 4: The infant is not premature.

The nurse is caring for an infant of a diabetic mother. Which potential complications would the nurse consider in planning care for this newborn? Select all that apply. Tremors Hyperglycemia Hyperbilirubinemia Respiratory distress syndrome Birth trauma

Tremors Hyperbilirubinemia Respiratory distress syndrome Birth trauma

What infant response to cool environmental conditions is either NOT effective or NOT available to them? Constriction of peripheral blood vessels Metabolism of brown fat Increased respiratory rates Unflexing from the normal position

Unflexing from the normal position A. Incorrect: The newborn's body is able to constrict the peripheral blood vessels to reduce heat loss. B. Incorrect: Burning brown fat generates heat. C. Incorrect: The respiratory rate may rise to stimulate muscular activity, which generates heat. D. Correct: The newborn's flexed position guards against heat loss, because it reduces the amount of body surface exposed to the environment.

The nurse is assessing a drug-dependent newborn. Which symptom would require further assessment by the nurse? Occasional watery stools Spitting up after feeding Unrelieved irritability Positive Babinski's reflex

Unrelieved irritability Rationale 1: An occasional watery stool can be associated with the normal newborn. Rationale 2: Spitting up after some feedings can be associated with the normal newborn. Rationale 3: Unrelieved irritability can be an indicator of drug withdrawal. Rationale 4: A positive Babinski's reflex can be associated with the normal newborn.

The nurse is caring for a newborn 30 minutes after birth. After assessing respiratory function, the nurse would report which findings as abnormal? Select all that apply. respiratory rate of 66 beats per minute periodic breathing with pauses of 25 seconds synchronous chest and abdomen movements grunting on expiration nasal Flaring

periodic breathing with pauses of 25 seconds grunting on expiration nasal Flaring