CH 24: Conditions in the Newborn Related to Gestation Age, Size, Injury, and Pain

A nurse is conducting a class for a group of expectant couples on fetal growth and development. The nurse determines that additional teaching is needed when the class identifies which factor as playing an important role in fetal growth and development? A) paternal factors B) genetic factors C) placental factors D) maternal factors

A) paternal factors Fetal growth is dependent on genetic, placental, and maternal factors.

After teaching the parents of a newborn with periventricular hemorrhage about the disorder and treatment, which statement by the parents indicates that the teaching was successful? A) "We'll make sure to cover both of his eyes to protect them." B) "Our newborn could develop a learning disability later on." C) "Once the bleeding ceases, there won't be any more worries." D) "We need to get family members to donate blood for transfusion."

B) "Our newborn could develop a learning disability later on." Periventricular hemorrhage has long-term sequelae such as seizures, hydrocephalus, periventricular leukomalacia, cerebral palsy, learning disabilities, vision or hearing deficits, and intellectual disability. Covering the eyes is more appropriate for the newborn receiving phototherapy. The bleeding in the brain can lead to serious long-term effects. Blood transfusions are not used to treat periventricular hemorrhage.

A preterm infant is placed on ventilatory assistance for respiratory distress syndrome. In light of her lung pathology, which additional ventilatory measure would you anticipate planning? A) Administration of chilled oxygen to reduce lung spasm B) Increased inspiratory pressure; decreased expiratory pressure C) Administration of dry oxygen to avoid over-humidification D) Positive end-expiratory pressure to increase oxygenation

D) Positive end-expiratory pressure to increase oxygenation Positive end-expiratory pressure, like expiratory grunting, prevents alveoli from fully closing on expiration and reduces the respiratory effort needed for inspiration.

A nurse is assessing a preterm newborn. Which finding would alert the nurse to suspect that a preterm newborn is in pain? A) bradycardia B) oxygen saturation level of 94% C) decreased muscle tone D) sudden high-pitched cry

D) sudden high-pitched cry The nurse should suspect pain if the newborn exhibits a sudden high-pitched cry, oxygen desaturation, tachycardia, and increased muscle tone.

Periventricular leukomalacia

Injury to the white matter of the brain and the most common cause of cerebral palsy

lecithin/sphingomyelin ratio

Test of amniotic fluid that predicts fetal lung maturity

Circumoral

around the mouth

preterm infant

before 37 weeks

Impedance pneumography:

A method of monitoring the activity of breathing via electrical leads placed on the chest

A newborn is diagnosed with a patent ductus arteriosus and despite supportive treatment, the newborn continues to exhibit symptoms. Which of the following would the nurse anticipate as being prescribed? A) Indomethacin B) Aspirin C) Surfactant D) Penicillin

A) Indomethacin Indomethacin or ibuprofen are used to close a patent ductus arteriosus

When does jaundice peak in a newborn?

3-5 days

Postterm infant

>42 weeks

During the newborn's assessment, which finding would lead the nurse to suspect that a large-for-gestational-age newborn has experienced birth trauma? A) asymmetrical movement B) temperature instability C) seizures D) feeble sucking

A birth injury is typically characterized by asymmetrical movement. Temperature instability, seizures, and feeble sucking suggest hypoglycemia.

A nurse is administering prescribed enteral feedings to assist in preparing the gut of a preterm newborn. The nurse integrates understanding of this measure, administering the feedings at which rate? A) 0.5 to 1 mL/kg/h B) 1 to 1.5 mL/kg/h C) 1.5 to 2 mL/kg/h D) 2 to 2.5 mL/kg/h

A) 0.5 to 1 mL/kg/h Minimal enteral feeding is used to prepare the preterm newborn's gut to overcome the many feeding difficulties associated with gastrointestinal immaturity. It involves the introduction of small amounts, usually 0.5 to 1 mL/kg/h, of enteral feeding to induce surges in gut hormones.

The health care provider has determined that the source of dystocia for a woman is related to the fetus size. The nurse understands that macrosomia would indicate the fetus would weigh: A) 4,000 g or more. B) 3,500 g or more. C) 4,500 g or more. D) 3,000 g or more.

A) 4,000 g or more. Macrosomia occurs when the fetus measures 4,000 g (8.13 lbs) or more at birth and complicates approximately 10% of all pregnancies. The excessive fetal size and abnormalities contribute to labor and birth dysfunctions.

A nurse is assessing a term newborn and finds the blood glucose level is 23 mg/dl. The newborn has a weak cry, is irritable, and exhibits bradycardia. Which intervention is most appropriate? A) Administer dextrose intravenously. B) Monitor the infant's hematocrit levels closely. C) Administer PO glucose water immediately. D) Place the infant on a radiant warmer.

A) Administer dextrose intravenously. The infant is demonstrating signs and symptoms of significant hypoglycemia. IV dextrose should be administered to the term newborn intravenously when the blood glucose level is less than 40 mg per dL, and the newborn is symptomatic for hypoglycemia. Administration of IV glucose assists in stabilizing blood glucose levels. Providing oral glucose feedings or placing the infant on a radiant warmer will not help maintain the glucose level. Monitoring the infant's hematocrit level is not a priority and not related to the problem at hand.

A nurse is caring for an infant. A serum blood sugar of 40 was noted at birth. What care should the nurse provide to this newborn? A) Begin early feedings either by the breast or bottle. B) Give dextrose intravenously before oral feedings. C) Place infant on radiant warmer immediately. D) Focus on decreasing blood viscosity by introducing feedings.

A) Begin early feedings either by the breast or bottle. The nurse should provide some nutrition to any infant born with hypoglycemia. Dextrose should be given intravenously only if the infant refuses oral feedings, not before offering the infant oral feedings. Placing the infant on a radiant warmer will not help maintain blood glucose levels. The nurse should focus on decreasing blood viscosity in an infant who is at risk for polycythemia, not hypoglycemia.

At birth, the newborn was at the 8th percentile with a weight of 2350g and born at 36 weeks gestation. Which documentation is most accurate? A) The infant was a preterm, low birth weight and small for gestational age B) The infant was born at term but at a low birth weight and small for gestational age C) The infant was born at term but a very low birth weight and small for gestational age D) The infant was a preterm, very low birthweight and small for gestational age

A) The infant was a preterm, low birth weight and small for gestational age Born at 36 weeks gestation is a preterm age (under 37 weeks). The infant was a low birthweight (under 2500g) and small for gestational age at the 8th percentile (under the 10th percentile). The other documentation is not accurate.

Assessment of a 26-week-old premature newborn reveals that the newborn is having problems with thermoregulation. The nurse would be alert for the development of which of the following? A) Apnea B) Tachycardia C) Sleepiness D) Crying

A) apnea A premature infant has thin skin, an immature central nervous system (CNS), lack of brown fat stores, and an increased weight-to-surface area ratio. These are predisposing thermoregulation problems that can lead to hypothermia. As a result, the infant may become apneic, have respiratory distress, increase his or her oxygen need, or be cyanotic. Tachycardia, sleepiness, and crying are unrelated to thermoregulatory problems.

Which condition may cause intrauterine asphyxia? Select all that apply. A) cord compression B) placenta abruption C) intrauterine growth restriction D) gestational diabetes E) group B strep infection

A) cord compression B) placenta abruption C) intrauterine growth restriction

A client has given birth to a small-for-gestation-age (SGA) newborn. Which finding would the nurse expect to assess? A) head larger than body B) round flushed face C) brown lanugo body hair D) protuberant abdomen

A) head larger than body Head being larger than the rest of the body is the characteristic feature of small for gestational age infants. Small for gestational age infants weigh below the 10th percentile on the intrauterine growth chart for gestational age. The heads of SGA infants appear larger in proportion to their body. They have an angular and pinched face and not a rounded and flushed face. Round flushed face and protuberant abdomen are the characteristic features of large for gestational age (LGA) infants. Preterm infants, and not SGA infants, are covered with brown lanugo hair all over the body.

An infant that is diagnosed with meconium aspiration displays which symptom? A) intercostal and substernal retractions B) pink skin C) respirations of 45 D) no heart murmur

A) intercostal and substernal retractions Meconium aspiration is when the infant passes the first stool in utero and some of stool particles are ingested into the lungs at birth. This can cause the infant to be in distress displayed by mild cyanosis, tachypnea, retractions, hyperinflated chest, and hypercapnia.

While caring for a preterm newborn receiving oxygen therapy, the nurse monitors the oxygen therapy duration closely based on the understanding that the newborn is at risk for which condition? A) retinopathy of prematurity B) metabolic acidosis C) infection D) cold stress

A) retinopathy of prematurity Oxygen therapy has been linked the pathogenesis of retinopathy of prematurity and is associated with the duration of oxygen use rather than the concentration of oxygen. Therefore, the nurse monitors the newborn's oxygen therapy closely. Metabolic acidosis may occur due to anaerobic metabolism used for heat production. Infection may occur for numerous reasons, but they are unrelated to oxygen therapy. Cold stress results from problems due to the preterm newborn's inadequate supply of brown fat, decreased muscle tone, and large body surface area.

The nurse determines a newborn is small-for-gestational age based on which characteristics? A) wasted appearance of extremities, thin umbilical cord, and reduced subcutaneous fat stores B) wasted appearance of extremities, gelatinous umbilical cord, and abundant subcutaneous fat stores C) reduced subcutaneous fat stores to buttocks, thicker umbilical cord, and smaller head compared to body D) normal subcutaneous fat stores, cord-like umbilical cord, and increased development to extremities

A) wasted appearance of extremities, thin umbilical cord, and reduced subcutaneous fat stores The nurse should perform a thorough physical examination of the newborn and closely observe the newborn for typical SGA characteristics, which include the following: a newborn head that is disproportionately large compared with rest of body; a wasted appearance of extremities with reduced subcutaneous fat stores; a reduced amount of breast tissue; poor muscle tone over buttocks and cheeks; and a thin umbilical cord.

At a prenatal class the nurse describes the various birth weight terms that may be used to describe a newborn at birth. The nurse feels confident learning has has occurred when a participant makes which statement? A) "Appropriate for gestational age means a newborn is born with a weight that falls in the 10th percentile." B) "Newborns who are appropriate for gestational age at birth have lower chance of complications than others." C) "Appropriate for gestational age describes a newborn with a weight over the 90th percentile at birth." D) "Infants who are larger for gestational age at birth have fewer complications than the other groups."

B) "Newborns who are appropriate for gestational age at birth have lower chance of complications than others." Birth weight variations include appropriate for gestational age (AGA), which describes a newborn with a weight that falls within the 10th to 90th percentile for that particular gestational age. This describes approximately 80% of all newborns. Infants who are appropriate for gestational age have lower morbidity and mortality than other groups.

A one-day-old neonate born at 32 weeks' gestation is in the neonatal intensive care unit under a radiant overhead warmer. The nurse assesses the morning axilla temperature as 95 degrees F (35 degrees C). What could explain the assessment finding? A) Conduction heat loss is a problem in the baby. B) The supply of brown adipose tissue is not developed. C) Axillary temperatures are not accurate. D) This is a normal temperature.

B) The supply of brown adipose tissue is not developed. Typically newborns use nonshivering thermogenesis for heat production by metabolizing their own brown adipose tissue. However, this preterm newborn has an inadequate supply of brown fat because he or she left the uterus early before the supply was adequate. Conduction heat loss allows an increased transfer of heat from their bodies to the environment, but there is nothing to substantiate conduction heat loss. Axillary temperatures are accurate and the mode of taking temperatures for neonates.

A nurse is assessing a newborn and notifies the primary health care provider because the nurse suspects increased intracranial pressure. When reporting the findings, which of the following would the nurse most likely include? A) Soft, nonbulging fontanels B) Overriding C) Seizure activity D) Vital signs within acceptable ranges

C) Seizure activity Seizure activity is a change in neurologic status and can indicate increased intracranial pressure. Overriding sutures; soft, flat (nonbulging) fontanels; and normal vital signs are normal newborn findings.

What is a consequence of hypothermia in a newborn? A) respirations of 46 B) heart rate of 126 C) holds breath 25 seconds D) skin pink and warm

C) holds breath 25 seconds Apnea is the cessation of breathing for a specific amount of time, and in newborns it usually occurs when the breath is held for 15 seconds. Apnea, cyanosis, respiratory distress, and increased oxygen demand are all consequences of hypothermia.

The nurse realizes the educational session conducted on due dates was successful when a participant is overheard making which statement? A) "The ability of my amniotic fluid to provide adequate oxygen and nutrients to my baby after 42 weeks' gestation is thought to be compromised." B) "The ability of my umbilical cord to provide adequate oxygen and nutrients to my baby after 42 weeks' gestation is thought to be compromised." C) "The ability of my body to provide adequate oxygen and nutrients to my baby after 42 weeks' gestation is thought to be increased." D) "The ability of my placenta to provide adequate oxygen and nutrients to my baby after 42 weeks' gestation is thought to be compromised."

D) "The ability of my placenta to provide adequate oxygen and nutrients to my baby after 42 weeks' gestation is thought to be compromised." The ability of the placenta to provide adequate oxygen and nutrients to the fetus after 42 weeks' gestation is thought to be compromised, leading to perinatal mortality and morbidity. After 42 weeks the placenta begins aging. Deposits of fibrin and calcium, along with hemorrhagic infarcts, occur and the placental blood vessels begin to degenerate. All of these changes affect diffusion of oxygen to the fetus. As the placenta loses its ability to nourish the fetus, the fetus uses stored nutrients to stay alive, and wasting occurs.

The nurse is teaching a group of parents who have preterm newborns about the differences between a full-term newborn and a preterm newborn. Which characteristic would the nurse describe as associated with a preterm newborn but not a term newborn? A) fewer visible blood vessels through the skin B) more subcutaneous fat in the neck and abdomen C) well-developed flexor muscles in the extremities D) greater surface area in proportion to weight

D) greater surface area in proportion to weight Preterm newborns have large body surface areas compared to weight, which allows an increased transfer of heat from their bodies to the environment. Preterm newborns often have thin transparent skin with numerous visible veins, minimal subcutaneous fat, and poor muscle tone.

A nurse completes the initial assessment of a newborn. According to the due date on the antenatal record, the baby is 12 days' postmature. Which physical finding does not confirm that this newborn is 12 days' postmature? A) meconium aspiration B) absence of lanugo C) hypoglycemia D) increased amounts of vernix

D) increased amounts of vernix Vernix caseosa is a whitish substance that serves as a protective covering over the fetal body throughout the pregnancy. Vernix usually disappears by term gestation. It is highly unusual for a 12-day postmature baby to have increased amounts of vernix. A discrepancy between EDC and gestational age by physical examination must have occurred. Meconium aspiration is a sign of fetal distress but does not coincide with gestation. The presence of lanugo is greatest at 28 to 30 weeks and begins to disappear as term gestation approaches. Therefore, an absence of lanugo on assessment would be expected with a postmature infant. Hypoglycemia can occur at any gestation.