OB: Ch. 17 Newborn Transitioning

A nursing student correctly chooses which stage of behavioral adaptation in the infant to reinforce teaching about feeding, positioning for feeding, and diaper-changing techniques?

second period of reactivity The second period of reactivity is the best time to teach about feeding, positioning for feeding, and diaper-changing techniques. It is also a good time for the parents to interact with the infant as well as examine the infant and ask questions.

The nurse is preparing a teaching plan for new parents about why newborns experience heat loss. Which information about newborns would the nurse include?

limited voluntary muscle activity Newborns have limited voluntary muscle activity or movement to produce heat. They have thin skin with blood vessels close to the surface. They cannot shiver to generate heat. They have limited stores of metabolic substances such as glucose and glycogen.

A nurse is observing the interaction between a new mother and her neonate. The nurse notes that the neonate moves his head and eyes to focus on the mother's voice and smile. The nurse interprets this as which behavioral response?

orientation The neonate is demonstrating orientation, the neonate's ability to respond to auditory and visual stimuli, as demonstrated by the movement of head and eyes to focus on that stimuli. Habituation is the newborn's ability to process and respond to visual and auditory stimuli. Habituation is the ability to block out external stimuli after the newborn has become accustomed to the activity. Motor maturity depends on gestational age and involves evaluation of posture, tone, coordination, and movements. These activities enable newborns to control and coordinate movement. When stimulated, newborns with good motor organization demonstrate movements that are rhythmic and spontaneous. Self-quieting ability (also called self-soothing) refers to newborns' ability to quiet and comfort themselves. pg 580

A newborn in the nursery has a temperature of 97.4° F (36.3° C). What may happen first, if the infant continues to be cold stressed?

respiratory distress An infant who has an episode of cold stress is as risk for distress in the respiratory system. The infant needs to be warmed and monitored. If the infant is not warmed then hypoglycemia, seizures, and cardiovascular distress can occur, but they will not happen before the infant has respiratory distress.

A mother is upset because her newborn has lost 6 ounces since birth 2 days ago. The nurse informs the mother that it is normal for a newborn to lose which percentage of their birth weight within the first week of life?

5% to 10% of their birth weight Adequate digestion and absorption are essential for newborn growth and development. Normally, term newborns lose 5% to 10% of their birth weight as a result of insufficient caloric intake within the first week after birth. pg 576

What should the nurse consider when checking results of blood work done on a newborn?

Leukocytosis is usually present. The site of the blood sample matters. For instance, capillary blood has higher levels of HGB and HCT compared to venous blood. Leukocytosis (elevated white blood cells) is present as a result of birth trauma soon after birth. The newborn's platelet and aggregation ability are the same as adults.

What should the nurse expect for a full-term newborn's weight during the first few days of life?

There is a loss of 5% to 10% of birth weight in formula-fed and breastfed newborns. The nurse should expect the newborn who is breastfed or formula-fed to lose 5% to 10% of birth weight in the first few days of life. pg 576

A nurse is teaching newborn care to students. The nurse correctly identifies which mechanism as the predominant form of heat loss in the newborn?

radiation, convection, and conduction Heat loss in the newborn occurs primarily through radiation, convection, and conduction because of the newborn's large ratio of body surface to weight and because of the marked difference between core and skin temperatures. Nonshivering thermogenesis is a mechanism of heat production in the newborn. Lack of brown adipose tissue contributes to heat loss, particularly in premature infants, but it is not the predominant form of heat loss. Peripheral vasoconstriction is a method to increase heat production pg 570

A mother points out to the nurse that following three meconium stools, her newborn has had a bright green stool. The nurse would explain to her that:

this is a normal finding. Newborn stools typically pass through a pattern of meconium, green transitional, and then yellow. pg 577

When assessing the newborn's umbilical cord, what should the nurse expect to find?

two smaller arteries and one larger vein When inspecting the vessels in the umbilical cord, the nurse should expect to encounter one larger vein and two smaller arteries. In 0.5% of births (3.5% of twin births), there is only one umbilical artery, which can be linked to cardiac or chromosomal abnormalities.

The nurse describes the changes in stool that a new mother would see when feeding her newborn formula. Which description best indicates what the mother would observe after several days?

yellow-green, pasty, unpleasant-smelling stool The stool of formula-fed newborns varies depending on the type of formula ingested, but it typically is yellow, yellow-green, or greenish, loose, pasty, or formed with an unpleasant odor. Greenish-black tarry stool denotes meconium. Thin, yellowish, seedy brown stool characterizes the transitional stool that occurs after meconium. Sour-smelling yellowish-gold stool that is loose and stringy to pasty in consistency is typical of a breastfed newborn stool.

While teaching a newborn nutrition class to a group of pregnant women, the nurse encourages breastfeeding because it is a major source of which immunoglobulin?

IgA The newborn largely depends on three immunoglobulins for defense: IgG, IgA, and IgM. A major source of IgA is human breast milk, so breastfeeding is believed to have significant immunologic advantages over formula feeding. IgG is the only immunoglobulin that crosses the placenta.

The nurse is teaching new parents the best way to prevent hypothermia. Which mechanism would the nurse include when explaining about the newborn's primary method of heat production?

nonshivering thermogenesis The newborn's primary method of heat production is through nonshivering thermogenesis, a process in which brown fat (adipose tissue) is oxidized in response to cold exposure. When the newborn is in a cold environment, the blood flow is increased through the brown fat, which warms the blood and in turn helps warm the infant.

A nursing instructor is teaching about changes the newborn must make to survive outside of the uterus. The instructor realizes that further teaching is needed when a student makes which statement?

"When the baby is ready to leave the uterus, it takes its first breath." Changes in circulation begin immediately at birth as the fetus separates from the placenta. When the umbilical cord is clamped, the first breath is taken and the lungs begin to function.

A newborn's primary method of heat production is through nonshivering thermogenesis. This process oxidizes which substance in response to cold exposure?

brown fat The newborn's primary method of heat production is through nonshivering thermogenesis, a process in which brown fat (adipose tissue) is oxidized in response to cold exposure. The brown color is derived from the fat's rich supply of blood vessels and nerve endings.

The heart rate of the newborn in the first few minutes after birth will be in which range?

120 to 180 bpm During the first few minutes after birth, the newborn's heart rate is approximately 120 to 180 bpm. Thereafter, it begins to decrease to an average of 120 to 130 bpm pg 565

A new mother asks the nurse what her neonate can actually see. When responding to the mother, the nurse integrates knowledge that newborns typically can focus on objects at which distance?

8 to 10 inches (20 to 25 cm) Newborns have ability to focus only on close objects (8 to 10 inches away [20 to 25 cm]) with a visual acuity of 20/140; they can track objects in midline or beyond (90 inches [229 cm]). This is the least mature sense at birth.

Why should a nurse monitor a newborn after cesarean birth more closely than after a vaginal birth?

The baby will have more fluid in its lungs, making respiratory adaptation more challenging. During a vaginal birth the infant is squeezed by the uterine contractions. The infant who is born via cesarean birth without labor first does not have the mechanical removal of the fluid from the lungs. This places the infant at increased risk for respiratory compromise, so there is a need to more closely assess a newborn after birth pg 569

Which statement is true regarding fetal and newborn senses?

The rooting reflex is an example that the newborn has a sense of touch. Newborns experience pain, have vision, and can discriminate between tastes. The rooting reflex is an example of a newborn's sense of touch. The fetus can hear in utero.

A nurse in a normal newborn nursery receives a report on four infants. Baby A is reported as being 16 hours old, vital signs within normal limits (WNL), bilirubin 3.5 mg/dL rooming in with mother; baby B is 8 hours old, vital signs WNL, bilirubin 3 mg/dL, returning to nursery for night; baby C is 19 hours old, vital signs WNL, bilirubin 4 mg/dL, rooming in with mother; baby D is 4 hours old, vital signs WNL, bilirubin 2 mg/dL, returning to nursery for night. Which baby would the nurse assess first?

baby C Hyperbilirubinemia, high levels of unconjugated bilirubin in the bloodstream (serum levels of four to six mg/dL and greater), can lead to jaundice, a yellow staining of the skin.

Which is not a cause of jaundice in the newborn?

bilirubin hyperexcretion Overexcretion of bilirubin would not cause jaundice. Bilirubin overproduction, decreased bilirbuin conjugation, and impaired bilirubin excretion would cause hyperbilirubinemia, which leads to jaundice.

A nurse is assessing a newborn during the first 24 hours after birth. Which findings would the nurse recognize as normal?

body temperature of 97.9° to 99.7° F (36.5° to 37.5° C) On average, a newborn's temperature ranges from 97.9° to 99.7° F (36.5° to 37.5° C).

A nurse is providing care to a 3-hour-old neonate. The nurse ensures that her hands are warm prior to touching the neonate to prevent heat loss by which mechanism?

conduction Heat loss by conduction can occur when the nurse touches the newborn with cold hands. Conduction involves the transfer of heat from one object to another when the two objects are in direct contact with one another. Convection involves the flow of heat from the body surface to cooler surrounding air or to air circulating over a body surface. Radiation involves the loss of body heat to cooler, solid surfaces that are in proximity but not direct contact with the newborn. Evaporation involves the loss of heat when a liquid is converted to a vapor.

A nursing student will pick which value as a correct laboratory value for a newborn?

hemoglobin (HBG) 17 to 20 g/dL The normal laboratory values for a newborn include HGB 17 to 20g/dL, HCT 52% to 63%, platelets 100,000 to 300,000µL , RBCs 5.1 to 5.8, and WBCs 10 to 30,000/mm³3.

The nurse is providing teaching to a new mother who is breastfeeding. The mother demonstrates understanding of teaching when she identifies which characteristics as being true of the stool of breastfed newborns? Select all that apply.

yellowish gold color stringy to pasty consistency The stools of a breastfed newborn are yellowish gold in color. They are not firm in shape or solid. The smell is usually sour. A formula-fed infant's stools are formed in consistency, whereas a breastfed infant's stools are stringy to pasty in consistency. pg 577

The nurse is aware that the infant's circulatory dynamics during transition can be greatly affected by which action?

late clamping of the umbilical cord after 3 minutes Early (before 30 to 40 seconds) or late (after 3 minutes) clamping of the umbilical cord changes circulatory dynamics during transition. Recent studies indicate that the benefits of delayed cord clamping include improving the newborn's cardiopulmonary adaptation, preventing iron-deficient anemia in full-term newborns without increasing hypervolemia-related risks and increased iron stores, increasing blood pressure, improving oxygen transport, and increasing red blood cell flow (McAdams, 2014). Although a tailored approach is required in the case of cord clamping, current available data suggests that delayed cord clamping offers the newborn many benefits physiologically which include at least a 30 percent increase in blood volume for term infants and a 50 percent increase in preterm infants; improvement of systemic blood pressure; increase in the cerebral oxygen index; higher hemoglobin levels at 24 to 48 hours of age and increased serum iron levels at 4 to 6 months.

A nurse is preparing a refresher program for a group of staff nurses returning to work in the neonatal nursery. As part of the program, the nurse will describe the process of nonshivering thermogensis as the neonate's primary mechanism for producing heat. Place the steps below in the order that the nurse would use to describe this process. All options must be used.

release of norepineprhine breakdown of triglycerides increase in cardiac output warming of blood When the newborn experiences a cold environment, norepinephrine is released. This in turn stimulates brown fat metabolism by breaking down triglycerides. Cardiac output increases, increasing blood flow through the brown fat tissue. Subsequently, this blood becomes warmed as a result of the increased metabolic activity of the brown fat.

How long is the neonatal period for a newborn?

28 The neonatal period is the first 28 days of life. pg. 564

A nurse is explaining to new parents how a newborn adapts to extrauterine life. When discussing the physiologic changes that occur, the nurse would explain that this transition usually takes the first:

6 to 10 hours of life. The infant must make many changes to survive outside the uterus. Immediately after birth, respiratory gas exchange, along with circulatory modifications must occur. During this time, the infant also experiences complex changes in major organ systems. The transition usually takes place within the first 6 to 10 hours of life; however, some adaptations take weeks to attain full maturity.

When teaching a class of new parents about the needs of their newborn, the nurse explains that the newborn's voiding is a good indicator that he or she is getting enough fluids. The nurse determines that the teaching was successful when the parents state which number of voiding per day as a good indicator of adequate fluids?

6 to 8 From birth to about 3 months of age, the newborn's kidneys are unable to concentrate urine and they will urinate frequently. Approximately 6 to 8 voidings per day is average and indicates adequate fluid intake.

A nurse is caring for an infant with an elevated bilirubin level who is under phototherapy. What evaluation data would best indicate that the newborn's jaundice is improving?

Bilirubin level went from 15 to 11 The newborn has physiologic jaundice, which is related to decreased bilirubin conjugation. Newborns have relatively immature livers and cannot conjugate (break down) bilirubin as fast as needed. Bilirubin overproduction is responsible for causing jaundice. A serum bilirubin is the best way to determine whether the jaundice is improving. The other listed methods will not address the needed information. pg 575

A nurse teaches new parents that the bestway to help prevent infections in the newborn is which method?

Breastfeed. A major source of IgA, which helps in immunity, is human breast milk. Thus, breastfeeding is believed to have significant immunological advantages over formula. The other options such as keeping them in for a month and keeping them warm will not help prevent infections. Keeping the child away from people who have an infection might stop them from getting that infection. Doing so will not help build up the infant's immunity.

The nurse explains to the parents of a 2-day-old newborn that decreased life span of neonatal red blood cells has contributed to which complication?

Hyperbilirubinemia Neonatal red blood cells have a life span of 80 to 100 days and normally have a higher count at birth. This combination leads to an increased hemolysis. Complications of this process include hyperbilirubinemia.

A nurse working in the neonatal nursery anticipates the primary care provider to prescribe which medication for a premature newborn having difficulty breathing?

surfactant Surfactant is a protein that keeps small air sacs in the lungs from collapsing. Its use was introduced in 1990 and continues today, especially for premature babies and those who have respiratory distress syndrome. The other medications are not given to help premature babies breathe. pg 568

A client gives birth to a baby at a local health care facility. The nurse observes that the infant is fussy and begins to move her hands to her mouth and suck on her hand and fingers. How should the nurse interpret these findings?

The infant is attempting self-consoling maneuvers. The hand-to-mouth movement of the baby indicates the self-quieting and consoling ability of a newborn. The other options are states of behavior of a newborn but are not applicable to this situation. pg 581

The nurse is teaching a new mother about the changes in her newborn's gastrointestinal tract. The nurse determines that additional teaching is needed when the mother makes which statement?

"His stomach can hold approximately 10 ounces." A newborn's stomach capacity is approximately 30 to 90 mL or 1 to 3 ounces. The gut is sterile at birth but changes rapidly depending on what feeding is received. Colonization of the gut is dependent on oral intake; oral intake is required for the production of vitamin K. The cardiac sphincter which leads into the stomach and nervous control of the stomach are immature.

A preterm infant is experiencing cold stress after birth. For which symptom should the nurse assess to best validate the problem?

apnea Preterm newborns are at a greater risk for cold stress than term or postterm newborns. Cold stress can cause hypoglycemia, increased respiratory distress and apnea, and metabolic acidosis. Preterm infants lack the ability to shiver in response to cold stress. pg 573

A newborn's axillary temperature is 97.6° F (36.4° C). He has a cap on his head. His T-shirt is damp with spit-up milk. His blanket is laid over him, and several children are in the room running around his bassinet. The room is comfortably warm, and the bassinet is beside the mother's bed away from the window and doors. What are the most likely mechanisms of heat loss for this newborn?

convection and evaporation Conductive heat loss occurs when the newborn's skin touches a cold surface, causing body heat to transfer to the colder object. Heat loss by convection happens when air currents blow over the newborn's body. Evaporative heat loss happens when the newborn's skin is wet. As the moisture evaporates from the body surface, the newborn loses body heat along with the moisture. Heat loss also occurs by radiation to a cold object that is close to, but not touching, the newborn.

The nurse is explaining to new parents that a potential complication of a cesarean birth is transient tachypnea. The nurse explains that this is due to which occurrence?

lack of thoracic compressions during birth A baby born by cesarean birth does not have the same benefit of the birth canal squeeze as does the newborn born by vaginal birth. This may result in the fluid in the lungs being removed too slowly or incompletely. Research findings support the need for thoracic compression to assist with the removal of the fluid and facilitate adequate breathing in the newborn.

The mother has given birth to a premature infant at 30 weeks. To ensure the alveoli can function properly, the infant needs to be evaluated for:

surfactant. Surfactant is a surface tension-reducing lipoprotein found in the newborn's lungs that prevents alveolar collapse at the end of expiration and loss of lung volume. Surfactant provides the lung stability needed for gas exchange. Oxygen, hematocrit, and blood flow are unrelated.

A mother is concerned because her newborn daughter has lost 8 ounces within 3 days after birth. What response by the nurse correctly addresses this concern?

"This is a normal and expected finding." The infant has a 5% to 10% loss of birth weight during the first few days of life as the body loses excess fluid and has limited food intake. The nurse would not tell the new mother that her infant needs to be checked for an illness; this is inappropriate because if the infant were ill, there would be other symptoms besides weight loss. Weight loss in a newborn is a normal finding. A new breastfeeding mother should not supplement feedings with formula.

A nurse is making a home visit to a new mother with a 5-day-old newborn. The mother tells the nurse that the baby is fussy and she does not know how to calm her. Which suggestions would be most appropriate for the nurse to make? Select all that apply.

"Try swaddling her nice and snuggly." "Try shushing her loudly." "Encourage her to suck." Recent research outlines five things (the five "S") that parents can do to calm a fussy infant: swaddling tightly; using the side/stomach position on the lap of the caretaker; shushing loudly or continuous white noise; swinging using any rhythmic movement; and sucking (Karp, 2014). pg 581

A nurse is assessing a newborn's temperature. Which reading would the nurse document as normal?

37.0° C (98.6° F) On average a newborn's temperature ranges from 36.5° C to 37.5° C (97.9° F to 99.7° F).

Which intervention would be the best way for the nurse to prevent heat loss in a newborn while bathing?

Bathe the baby under a radiant warmer. Bathing a newborn under a radiant warmer helps to prevent heat loss. To minimize the effects of cold stress during the bath, the nurse should also prewarm blankets, dry the child completely to prevent heat loss from evaporation, encourage skin-to-skin contact with the mother, promote early breastfeeding, used heated and humidified oxygen, and defer bathing until the newborn is medically stable. Limiting the length of time spent bathing the baby is secondary to maintaining the baby's body temperature. Having warm water is also important but is irrelevant if the baby is not kept warm under a warmer.

A nurse is caring for a 3-hour-old newborn boy. The nurse makes the initial assessment and finds the following: respiratory rate 30 bpm, BP 60/40 mm/Hg, heart rate 155 bpm, axillary temperature 98.2° F (36.8° C). The nurse assesses that the newborn is in a state of quiet alert. What should the nurse do?

Document the data. The normal respiratory rate is 30 to 60 breaths per minute and should be counted for a full minute when the infant is quiet. A newborn starts with a low blood pressure (60/40 mm Hg) and a high pulse (120 to 160 bpm). Normal temperature range is between 97.7 ° F (36.5 ° C) and 99.5 ° F (37.5 ° C).

What is the best rationale for trying to decrease the incidence of cold stress in the neonate?

If the neonate becomes cold stressed, it will eventually develop respiratory distress If cold stressed the infant eventually will develop respiratory distress; oxygen requirements rise, even before noting a change in temperature, glucose use increases, acids are released into the bloodstream and surfactant production decreases bringing on metabolic acidosis. A flexed position, not an extended position keeps the neonate warm.

A nursing student is preparing a class for new mothers about adaptations they can expect in their newborns. Which information about newborn vision should the student include in the presentation?

Newborns have the ability to focus only on objects in close proximity. In regards to vision the newborn has the ability to focus on objects only in close proximity (8 to 30 cm away) and tracks objects in midline or beyond. Vision is the least mature sense at birth. pg 579

A nurse is caring for a 5-hour-old newborn. The primary care provider has asked the nurse to maintain the newborn's temperature between 97.7° F and 99.5° F (36.5° C and 37.5° C). Which nursing intervention would be the best approach to maintaining the temperature within the recommended range?

Place the newborn skin-to-skin with the mother. The nurse should place the newborn skin-to-skin with mother. This is the best way to help maintain the newborn's temperature as well as promoting breastfeeding and bonding between the mother and newborn. The nurse can weigh the infant as long as a warmed cover is placed on the scale. The stethoscope should be warmed before it makes contact with the infant's skin, rather than using the stethoscope over the garment because it may obscure the reading. The newborn's crib should not be placed close to the outer walls in the room to prevent heat loss through radiation.

At birth there are multiple changes in the cardiac and respiratory systems. What is one of the changes to occur at birth in the cardiovascular system?

Pressure changes occur and result in closure of the ductus arteriosus. The ductus arteriosus is one of the openings through which there was fetal circulation. At birth, or within the first few days, this closes and the heart becomes the source of movement of blood to and from the lungs. The exchange of oxygen in the lungs is not a function of the cardiovascular system; it is a function of the respiratory system. Again, the removal of fluid from the alveoli is not a function of the cardiovascular system. The oxygen content of the blood increases; it does not decrease.

The nurse is assessing an infant's reflexes. While eliciting a rooting reflex, the infant strongly sucks on the nurse's finger. How does the nurse interpret this finding?

The rooting reflex was tested incorrectly. Gently stroking the newborn's cheek brings out the rooting reflex. The newborn would demonstrate this reflex by turning toward the touch with an open mouth. This infant demonstrates a positive suck reflex but does not display the rooting reflex because the test was performed incorrectly. pg 580

A 12-hour-old infant is receiving IV fluids for polycythemia. For which complication should a nurse monitor this client?

fluid overload The possibility of fluid overload is increased and must be considered by a nurse when administering IV therapy to a newborn. IV therapy does not significantly increase heart rate or change blood pressure, as well as the level of consciousness, unless fluid overload occurs

The nurse is describing fetal circulation to new parents and how the circulation changes after birth. The nurse describes a structure that allows the pulmonary circulation to be bypassed, but that shortly after birth this structure should close. Which structure is the nurse describing?

ductus arteriosus During fetal life, the ductus arteriosus protects the lungs against circulatory overload by shunting blood into the descending aorta, bypassing the pulmonary circulation. The foramen ovale is located in the septum between the atria and allowed blood to flow from the right atrium directly the left atrium. The ductus venous allowed the majority of the blood to bypass the liver. The umbilical vessels carried oxygenated blood to the fetus and removed deoxygenated blood and waste products from the fetus.

A neonate is born, and the nurse realizes that the infant is at risk for evaporative heat loss. Which intervention would best prevent this from occurring?

Wrap the infant in a warm, dry blanket. Evaporation is one of the 4 ways a newborn can lose heat. As moisture evaporates from the body surface of the infant, the newborn loses heat. Wrapping the infant in a warm, dry blanket will allow the moisture to be absorbed, limiting heat loss from evaporation. Bathing the infant will only add to the evaporative heat loss. The newborn's skin is wet, so placing him on the mother' abdomen will not prevent evaporation and heat loss. Increasing the ambient temperature in the birth room does not address the evaporation problem.

Which finding would alert the nurse to suspect that a newborn is experiencing respiratory distress?

asymmetrical chest movement Chest movements should be symmetrical. Typical newborn respirations range from 30 to 60 breaths per minute. Acrocyanosis is a common finding in newborns and does not indicate respiratory distress. Periods of apnea of less than 15 seconds are considered normal in a newborn. However, if these periods last more than 15 seconds and are accompanied by cyanosis and heart rate changes, additional evaluation is needed.

What is the primary mechanism for temperature regulation in a newborn infant?

brown fat store usage Brown fat stores are the stores used by the newborn infant to maintain warmth until feeding begins and the infant is able to maintain temperature without assistance. The infant's thermoregulatory system is not fully functional at birth. Infants cannot shiver to warm themselves. The use of external blankets as well as skin to skin contact with the mother assist in keeping the baby's temperature within the normal range, but they are not the primary mechanism for temperature regulation in the newborn infant.

Forces of contractions, mild asphyxia, increased intracranial pressure, and cold stress all play a role in the newborn transition by releasing which critical component?

catecholamines The physical forces of contractions at labor, mild asphyxia, increased intracranial pressure, and cold stress immediately experienced after birth lead to an increased release of catecholamines, which is critical for the changes involved in the transition to extrauterine life.

Eliminating drafts in the birth room and in the nursery will help to prevent heat loss in a newborn through which mechanism?

convection Convection refers to loss of heat from the newborn's body to the cooler surrounding air.

What are the functions of kangaroo care? Select all that apply.

helps the parents bond with their neonate keeps the neonate warm is skin-to-skin contact The method of keeping the neonate warm, kangaroo care, is an excellent way to meet the needs of the neonate and provide family-centered care. Kangaroo care does not cause hypothermia; it actually normalizes the neonate's temperature.

A nurse needs to monitor the blood glucose levels of a newborn under observation at a health care facility. When should the nurse check the newborn's initial glucose level?

on admission to the nursery Typically, a newborn's blood glucose levels are assessed with use of a heel stick sample of blood on admission to the nursery, not 4 or 24 hours after admission to the nursery. It is also not necessary or even reasonable to check the glucose level only after the newborn has been fed.

When conducting a class for new parents, the nurse explains that newborns demonstrate several predictable responses when interacting with their environment. Which behavioral responses would the nurse integrate into the discussion? Select all that apply.

orientation habituation self-quieting ability Expected newborn behaviors include orientation, habituation, motor maturity, self-quieting ability, and social behaviors. Any deviation in behavioral responses requires further assessment because it may indicate a complex neurobehavioral problem.

The nurse is assessing the stools of a 36-hour-old neonate who is being breastfed. The nurse determines that the stools are within normal parameters based on which finding?

yellowy mustard color with seedy appearance The evolution of a stool pattern begins with a newborn's first stool, which is meconium. Meconium is composed of amniotic fluid, shed mucosal cells, intestinal secretions, and blood. It is greenish black, has a tarry consistency, and is usually passed within 12 to 24 hours of birth. The first meconium stool passed is semi-sterile, but this changes rapidly with ingestion of bacteria through feedings. After feedings are initiated, a transitional stool develops, which is greenish brown to yellowish brown, thinner in consistency, and seedy in appearance. If breastfed, the stools will resemble light mustard with seed-like particles. If formula-fed, the stools will be tan or yellow in color and firmer. The neonate's stool should not appear brownish-black and mucous-like.

A nurse is assessing the temperature of a newborn using a skin temperature probe. Which point should the nurse keep in mind while taking the newborn's temperature?

Place the temperature probe over the liver. The nurse should place the temperature probe over the newborn's liver. Skin temperature probes should not be placed over a bony area like the forehead or used in an open bassinet with no heat source. The newborn should be in a supine or side-lying position.

The nurse wants to maintain a neutral thermal environment for her assigned neonatal clients. Which intervention would best ensure that this goal is met?

Promote early breastfeeding for the infants. The nurse should promote early breastfeeding to provide fuels for nonshivering thermogenesis. The nurse can bathe the newborn if he or she is medically stable. The nurse can also use a radiant heat source while bathing the newborn to maintain the temperature. Skin-to-skin contact with the mother should be encouraged, not discouraged, if the newborn is stable. The infant transporter should be kept fully charged and heated at all times.

A nurse is teaching a new mother about what to expect for bowel elimination in her newborn. Because the mother is breastfeeding, what should the nurse tell her about the newborn's stools?

Stools should be yellow-gold, loose, and stringy to pasty. The stools of a breast-fed newborn are yellow-gold, loose, and stringy to pasty in consistency. The stools of the formula-fed newborn vary depending on the type of formula ingested. They may be yellow, yellow-green, or greenish and loose, pasty, or formed in consistency, and they have an unpleasant odor. pg 577

A primiparous mother gave birth to an 8 lb 12 oz (4 kg) infant daughter yesterday. She is being bottle fed, is Rh positive, has a cephalohematoma, and received her hepatitis A vaccine last evening. Which factor places the newborn at risk for the development of jaundice?

cephalohematoma Risk factors for the development of jaundice include bruising as seen in a cephalohematoma, male gender and being breastfed. Blood type incompatabliity is only an issue if the infant's blood type differs from the mother and the maternal blood type is not stated. Administering hepatitis A vaccine does not increase the risk of jaundice.

A new mother is concerned that the infant is not eating enough and will not have enough energy. The nurse explains that storage of which substance will provide energy for the first 24 hours after birth?

glucose Glucose is the main source of energy for the first several hours after birth. With the newborn's increased energy needs after birth, the liver releases glucose from glycogen stores for the first 24 hours. Stored protein, brown fat, or carbohydrate are not associated with energy production in the newborn.

All the options are signs of respiratory distress in the newborn except:

respiratory rate >50 breaths/minute. Coughing and sneezing are normal reflexes present in newborns. The expected respiratory rate of newborn is 30 to 60 breaths per minute. pg 569

A nurse is reviewing the laboratory test results of a neonate. Which finding would be a cause of concern for the nurse? Select all that apply.

hematocrit 34% red blood cells 3.2 (1,000,000/uL) The neonate's hematocrit, which is below the normal value of 46% to 68%, and red blood cell count, which is below the normal range of 4.5 to 7.0 (1,000,000/uL) are a cause for concern. The hemoglobin, platelets, and white blood cells are within normal ranges for a neonate.

Which laboratory test results would the nurse consider as a normal finding in a newborn soon after birth?

hemoglobin: 17.5 g/dL Hemoglobin typically ranges from 17 to 20 g/dL. White blood cells are initially elevated soon after birth as a result of birth trauma, typically ranging from 10,000 to 30,000/mm3. The newborn's platelet count is the same as that for an adult, ranging between 100,000 and 300,000/uL. After birth, the red blood cell count gradually increases as the cell size decreases. Normal count ranges from 5,100,000 to 5,800,000/uL.

At birth, changes from fetal to newborn circulation must occur. What change causes the ductus arteriosus to close?

higher oxygen content of the circulating blood The first few breaths greatly increase the oxygen content of circulating blood. This chemical change (i.e., higher oxygen content of the blood) contributes to the closing of the ductus arteriosus, which eventually becomes a ligament.

A nurse is explaining the benefits of breastfeeding to a client who has just given birth. Which statement correctly explains the benefits of breastfeeding to this mother?

Immunoglobulin IgA in breast milk boosts a newborn's immune system. Breast milk is a major source of IgA, so breastfeeding is believed to have significant immunologic advantages over formula feeding. Breastfeeding does not provide more iron or calcium to the infant, maternal breast size does not increase, and most breastfed infants gain weight faster the first 2 months and then weight gain slows down.

A male baby is born at 5:15 a.m. on a Wednesday. At 1:15 p.m. on the same day, the nurse notes yellow staining of the skin on the head and face of this infant. What does this finding likely indicate?

The infant has pathologic jaundice. Bilirubin is released as blood cells are broken down in the body of the infant. The liver is immature and not able to break down the bilirubin, and the infant demonstrates excessive bilirubin the blood by a yellow tinged skin. Elevated bilirubin levels in the first 24 hours of life are considered pathologic. Physiologic jaundice is characterized by jaundice that occurs after the first 24 hours of life (usually on day 2 or 3 after birth). Jaundice appears first on the head and face; then as bilirubin levels rise, jaundice progresses to the trunk and then to the extremities in a cephalocaudal manner. Hyperbilirubinemia, high levels of unconjugated bilirubin in the bloodstream (serum levels of 4 to 6 mg/dL and greater), can lead to jaundice. pg 575

A newborn is challenged to maintain an adequate body temperature. If a baby is placed too close to a cold air vent, the nurse can assume that the infant will lose heat by which mechanism?

convection There are four main ways that a newborn loses heat; convection is one of the four and occurs when cold air blows over the body of the infant resulting in a cooling to the infant. Conductive heat loss occurs when the newborn's skin touches a cold surface, causing body heat to transfer to the colder object. Heat loss occurs by radiation to a cold object that is close to, but not touching, the newborn. Evaporative heat loss happens when the newborn's skin is wet. As the moisture evaporates from the body surface, the newborn loses body heat along with the moisture. The cold air blowing on the infant's skin will cause heat loss.

A nurse is conducting a class for expectant parents about newborns and the changes that they experience after birth. The nurse discusses the neonatal period, describing it as which time frame?

first 28 days of life The neonatal period is defined as the first 28 days of life. During this time period numerous physiologic changes occur as the infant adapts to the new environment

A nursing student observing newborns in the nursery is amazed that a crying infant put her fingers in her mouth, instantly stops crying, and then falls asleep. This behavior can best be explained as:

self-quieting ability. Self-quieting ability refers to newborns' ability to quiet and comfort themselves. Assisting parents to identify consoling behaviors also helps. The sleep state is noted as an infant becoming drowsy and less attentive to the parents and his surroundings. Social behaviors are things such as cuddling and snuggling into the arms of the parents when the newborn is held. Motor maturity refers to posture, tone, coordination, and movements of the newborn.

A newborn infant born by a cesarean birth is experiencing a common problem seen in these type of births. What finding would the nurse anticipate in an infant following a cesarean birth?

tachypnea The infant born from a cesarean birth has not had the opportunity to exit the birth canal and experience the squeezing of fluid from the lungs. The lungs have more amniotic fluid than the lungs of a baby from a vaginal birth and are at greater risk for respiratory complications. An infant born by cesarean birth is not at increased risk for hyperthermia, hypoglycemia, or a cardiac murmur. pg 568

A nurse is assessing a newborn who is about 8 hours old. The nurse suspects that the newborn may be experiencing cold stress based on which findings? Select all that apply.

tachypnea lethargy hypotonia Cold stress is excessive heat loss that requires a newborn to use compensatory mechanisms (such as nonshivering thermogenesis and tachypnea) to maintain core body temperature (Davidson, 2014). The consequences of cold stress can be quite severe. As the body temperature decreases, the newborn becomes less active, lethargic, hypotonic, and weaker. All newborns are at risk for cold stress, particularly within the first 12 hours of life. Jaundice and hypoglycemia may result from cold stress if not reversed.

A 2-month-old infant is admitted to a local health care facility with an axillary temperature of 96.8° F (36° C). Which observed manifestation would confirm the occurrence of cold stress in this client?

lethargy and hypotonia The nurse should look for signs of lethargy and hypotonia in the newborn in order to confirm the occurrence of cold stress. Cold stress leads to a decrease, not increase, in the newborn's body temperature, blood glucose, and appetite.

A nurse is preparing to place a skin temperature probe on a neonate who is lying on his back. To ensure an accurate reading, which location would be most appropriate to use for placement?

over the liver A skin temperature probe should not be placed over a bony area or one with brown fat (such as between the scapulae, at the nape of the neck or above the kidneys) because it does not give an accurate assessment of the whole body temperature. To ensure the best accuracy, most temperature probes are placed over the liver when the newborn is supine or side-lying

When the nurse is applying a skin temperature probe to a newborn who is lying on his side, which location would be most appropriate?

over the liver To obtain accurate assessment of whole body temperature, a skin temperature probe should be placed over the liver if the newborn is supine or in the side-lying position. Bony areas such as the hip or areas with brown fat such the mediastinum or between the scapulae should be avoided because these areas do not give accurate readings.

A nurse is assessing a newborn with the parents. The nurse explains that which aspect of newborn behavior is an important indication of neurologic development and function?

reflex The presence and strength of a reflex is an important indication of neurologic development and function. It is built into the nervous system and does not need the intervention of conscious thought to take effect. These reflexes end at different levels of the spine and brain stem, reflecting the function of the cranial nerves and motor system.

The nurse is assessing a neonate as he transitions to extrauterine life. The nurse integrates understanding that which structure closes as a result of tne neonate's first breath?

foramen ovale Before birth, the foramen ovale allowed most of the oxygenated blood entering the right atrium from the inferior vena cava to pass into the left atrium of the heart. With the newborn's first breath, air pushes into the lungs, triggering an increase in pulmonary blood flow and pulmonary venous return to the left side of the heart. As a result, the pressure in the left atrium becomes higher than in the right atrium. The increased left atrial pressure causes the foramen ovale to close, thus allowing the output from the right ventricle to flow entirely to the lungs. The closure of the ductus arteriosus depends on the high oxygen concentration of the aortic blood that results from aeration of the lungs at birth. Closure of the ductus venosus occurs because shunting from the left umbilical vein to the inferior vena cava is no longer needed. The umbilical arteries and vein begin to constrict at birth because with placental expulsion blood flow ceases.

The nurse observes a newborn. He notes that the respiratory rate is 66, the newborn's nostrils flare out, and the newborn makes a grunting sound during respiration. What does the nurse conclude from these findings? The infant is:

in respiratory distress. The assessment findings discussed are signs of respiratory distress. An infant with a respiratory rate of greater than 60 with noise requires further assessment. All newborns burn brown fat to produce heat for their bodies. This is not something the nurse can assess. The scenario described does not indicate that the newborn is cold-stressed nor experiencing radiation heat loss.