Chapter 23, High-Risk Newborn: ob
What does the nurse tell the parent of a preterm infant who has birth asphyxia and is at risk of necrotizing enterocolitis? 1 "Breast milk will be given enterally." 2 "Probiotics are not given after birth." 3 "Report skin rashes immediately." 4 "Provide skin-to-skin (kangaroo) contact.
1 Breast milk provides passive immunity, macrophages, and lysosomes to the infant and helps prevent necrotizing enterocolitis (NEC). Probiotics like Lactobacillus acidophilus and Bifidobacterium infantis are given enterally to reduce the severity of NEC in infants after birth. Lethargy and abdominal distention, not skin rashes, are symptoms of NEC. Skin-to-skin care does not help prevent NEC; it is used to help infants maintain thermal stability.
A male infant at 26 weeks of gestation arrives from the delivery room intubated. The nurse weighs the infant, places him under the radiant warmer, and attaches him to the ventilator at the prescribed settings. A pulse oximeter and cardiorespiratory monitor are placed. The pulse oximeter is recording oxygen saturations of 80%. The prescribed saturations are 92%. What is the nurse's most appropriate action? 1 Listen to breath sounds and ensure the patency of the endotracheal tube, increase oxygen, and notify the physician. 2 Continue to observe and make no changes until the saturations are 75%. 3 Continue with the admission process to ensure that a thorough assessment is completed. 4 Notify the parents that their infant is not doing well.
1 Listening to breath sounds, ensuring the patency of the endotracheal tube, increasing oxygen, and notifying the physician are appropriate nursing interventions to assist in optimal O2 saturation of the infant. Oxygenation of the infant is crucial. O2 saturation should be maintained at more than 92%. The nurse should delay other tasks to stabilize the infant. Notifying the parents is not appropriate. Further assessment and intervention are warranted before determination of fetal status.
Which is a serious inflammatory condition of the intestinal tract that can cause cellular death of areas in the intestinal mucosa? 1 Necrotizing enterocolitis 2 Retinopathy of prematurity 3 Intraventricular hemorrhage 4 Bronchopulmonary dysplasia
1 Necrotizing enterocolitis is a serious inflammatory condition of the intestinal tract that can cause cellular death of areas in the intestinal mucosa. Retinopathy of prematurity is a condition in which injury to the blood vessels in the eye leads to growth of new blood vessels that abnormally develop and may result in visual impairment or blindness. Intraventricular hemorrhage is bleeding into and around the brain. Bronchopulmonary dysplasia is a chronic condition that affects the lungs.
What does the nurse include in the plan of care of a high risk preterm infant? Select all that apply. 1 Routinely monitor blood pressure. 2 Assess intake and output records. 3 Assess for respiratory distress. 4 Maintain room temperature. 5 Encourage skin-to-skin (kangaroo) contact.
1,2,3,5 The nurse routinely monitors the infant's blood pressure to assess whether the values are increasing normally in the first month of life. Accurate intake and output records are necessary to understand the infant's fluid status. The preterm infant is at risk of respiratory distress. Therefore the nurse needs to assess the infant's respiratory function so that prompt actions can be taken. The nurse encourages the parents to provide skin-to-skin (kangaroo) contact with the infant to maintain thermal stability. A preterm infant needs application of external warmth. The room temperature may not be effective to maintain thermal stability. Therefore the infant is placed in a heated environment to prevent cold stress.
Which types of drugs are used for relieving pain in the preterm infant? Select all that apply. 1 Opioids 2 Sedatives 3 Topical anesthesia 4 Regional anesthesia 5 Nonnarcotic analgesics
1,3,4,5 Opioids, topical and regional anesthesia, and nonnarcotic analgesics are effective measures for pain control in the preterm infant. Sedatives can be used to reduce irritability in the infant, but they are not appropriate for controlling pain.
Which symptoms are signs of dehydration in an infant? Select all that apply. 1 Hypotension 2 Bulging fontanels 3 Poor tissue turgor 4 Difficulty breathing 5 Elevated hematocrit levels 6 Urine specific gravity greater than 1.012
1,3,5,6 Hypotension, poor tissue turgor, elevated hematocrit levels, and urine specific gravity greater than 1.012 are all associated with dehydration. Bulging fontanels and difficulty breathing are associated with overhydration.
Postterm infants are at the increased risk for which conditions? Select all that apply. 1 Asphyxia 2 Apneic spells 3 Respiratory distress syndrome 4 Meconium aspiration at delivery 5 Decreased amniotic fluid volume 6 Compression of the umbilical cord
1,4,5,6 Postterm infants are at risk for asphyxia, meconium aspiration at delivery (secondary to hypoxia before or during labor), decreased amniotic fluid volume, and compression of the umbilical cord if there is placental insufficiency. Apneic spells and respiratory distress syndrome are more common among preterm infants
An infant born after the 42nd week of gestation is known as what? 1 Preterm 2 Postterm 3 Full-term 4 Late preterm
2 A postterm infant is an infant born after the 42nd week of gestation. Preterm infants are born before the 42nd week of gestation. A full-term infant is born at the normal pregnancy duration. A late preterm infant is born before the 42nd week of gestation.
Which best describes containment? 1 Placing the infant in an incubator to provide extra warmth 2 Swaddling the infant to keep the extremities in a flexed position 3 Holding the infant close to the chest for an extended period of time 4 Showing the infant pictures of his or her parents for additional comfort
2 Containment refers to making the infant feel safe and comfortable, which is often achieved by swaddling the infant to keep the extremities in a flexed position. Containment does not relate to incubating the infant, holding the infant close to the chest for an extended period of time, or showing the infant pictures of his or her parents.
The nurse observes that a preterm infant has hypotonia, oliguria, reddening of the abdomen, and passes bloody stool. Radiographic examination reveals that the infant has pneumatosis intestinalis and pneumoperitoneum. Which intervention would help to prevent worsening of the condition? 1 Provide mechanical ventilator support. 2 Administer total parenteral nutrition (TPN). 3 Administer calfactan (Infrasurf) intravenously. 4 Administer nutrition through oral tube feedings.
2 Hypotonia, oliguria, reddened abdomen, and grossly bloody stools are the signs of necrotizing enterocolitis (NEC). NEC is an acute inflammatory disease of the gastrointestinal (GI) mucosa that is caused by bowel necrosis and perforation. The disease is diagnosed by the air in the wall of the bowel (pneumatosis intestinalis) and pneumoperitoneum through a radiographic examination. In order to rest the GI tract, the primary healthcare provider would often order total parenteral nutrition. Mechanical ventilation is provided to patients who have reduced oxygen supply. Calfactan (Infrasurf) is a surfactant that is administered via endotracheal tube to treat respiratory distress syndrome (RDS) in preterm infants. Oral or tube feedings are discontinued for the infant with confirmed NEC in order to rest the GI tract.
With regard to small-for-gestational age (SGA) infants and intrauterine growth restriction (IUGR), nurses should be aware of what information? 1 In the first trimester, diseases or abnormalities result in asymmetric IUGR. 2 Infants with asymmetric IUGR have the potential for normal growth and development. 3 In asymmetric IUGR, weight is slightly more than SGA, whereas length and head circumference are somewhat less than SGA. 4 Symmetric IUGR occurs in the later stages of pregnancy.
2 IUGR is either symmetric or asymmetric. The symmetric form occurs in the first trimester; SGA infants have reduced brain capacity. The asymmetric form occurs in the later stages of pregnancy. Weight is less than the 10th percentile; head circumference is greater than the 10th percentile. Infants with asymmetric IUGR have the potential for normal growth and development. In the first trimester, diseases or abnormalities result in symmetric IUGR. In asymmetric IUGR the head circumference remains within normal limits, whereas the birth weight falls below the 10th percentile.
Necrotizing enterocolitis (NEC) is an inflammatory disease of the gastrointestinal mucosa. The signs of NEC are nonspecific. What are some generalized signs? 1 Hypertonia, tachycardia, and metabolic alkalosis 2 Abdominal distention, temperature instability, and grossly bloody stools 3 Hypertension, absence of apnea, and ruddy skin color 4 Scaphoid abdomen, no residual with feedings, and increased urinary output
2 Some generalized signs of NEC include decreased activity, hypotonia, pallor, recurrent apnea and bradycardia, decreased oxygen saturation values, respiratory distress, metabolic acidosis, oliguria, hypotension, decreased perfusion, temperature instability, cyanosis, abdominal distention, residual gastric aspirates, vomiting, grossly bloody stools, abdominal tenderness, and erythema of the abdominal wall.
Necrotizing enterocolitis (NEC) is an inflammatory disease of the gastrointestinal mucosa. The signs of NEC are nonspecific. Some generalized signs include what? 1 Hypertonia, tachycardia, and metabolic alkalosis 2 Abdominal distention, temperature instability, and grossly bloody stools 3 Hypertension, absence of apnea, and ruddy skin color 4 Scaphoid abdomen, no residual with feedings, and increased urinary output
2 Some generalized signs of NEC include decreased activity, hypotonia, pallor, recurrent apnea and bradycardia, decreased oxygen saturation values, respiratory distress, metabolic acidosis, oliguria, hypotension, decreased perfusion, temperature instability, cyanosis, abdominal distention, residual gastric aspirates, vomiting, grossly bloody stools, abdominal tenderness, and erythema of the abdominal wall. The infant may display hypotonia, bradycardia, and metabolic acidosis. Hypotension, apnea, and pallor are signs of NEC. Abdominal distention, residual gastric aspirates, and oliguria are signs of NEC.
The nurse is caring for an infant with a body temperature of 34°C and a body weight of 1400 g. What other parameter is most important to monitor to prevent complications related to low birth weight? 1 Increased urinary output 2 Decreased respiratory rate 3 Cold extremities 4 Golden brown patches on sk
2 The normal birth weight of an infant should be more than 2500 g and the normal body temperature should be 36°C. A birth weight of 1400 g indicates low birth weight and temperature less than 35°C signifies that the infant has hypothermia. The nurse maintains the infant's body temperature by generating heat using radiant heaters. Heat generation increases the oxygen consumption in the infant, which may result in hypoxia. Therefore, the nurse should monitor the infant's respiratory rate. Decreased respiratory rate causes respiratory depression (RD). Increased urinary output is observed when the infant is administered dextrose for hyperglycemia. Hypothermia is characterized by cold extremities. Golden brown patches on the skin are usually observed in postpartum infants and are unrelated to hypothermia.
Which instruction about feeding does the nurse give to the parent of a low-birth-weight infant with septicemia? 1 "Don't breastfeed before administering the medications." 2 "You should breastfeed the infant every 3 hours." 3 "Use infant formulas for the first 2 weeks." 4 "You may choose not to breastfeed at all."
2 Breast milk contains iron-binding proteins that exert a bacteriostatic effect on E. coli. Breast milk also serves as a barrier to infection, because it contains macrophages and lymphocytes. The infant can be breastfed every 3 hours to ensure proper rest between the feeding intervals. It is not necessary to stop breastfeeding while administering medications, because the medicines do not interact with breast milk. Infant formulas are not advised, because they do not contain protective mechanisms against infection. The nurse should encourage the mother to breastfeed, because it is beneficial for the infant.
Which action describes kangaroo care? 1 Giving the mother and father equal time to hold the infant 2 Providing skin-to-skin contact between infants and mothers 3 Having a night nurse care for the infant so the parents can sleep 4 Carrying the infant around in a pouch that wraps around the chest
2 Kangaroo care is a method of providing skin-to-skin contact between infants and the parents. Kangaroo care does not refer to giving the mother and father equal time holding the infant, using the assistance of a night nurse, or carrying the infant around in a pouch.
The nurse provides care to a preterm infant who is receiving enteral feedings. How much will the infant need to eat? 1 90-105 kcal/kg/day 2 105-130 kcal/kg/day 3 130-165 kcal/kg/day 4 165-190 kcal/kg/day
2 Preterm infants receiving enteral feedings need 105-130 kcal/kg/day. The amount 90-105 kcal/kg/day is not enough. The amounts 130-165 and 165-190 kcal/kg/day are too much.
What instruction does the nurse provide to parents of a preterm infant who has physiologic immaturity? 1 "The child will have irreparable physiologic deformities." 2 "The child may be vulnerable to fluid and electrolyte imbalances later." 3 "The infant may need neurologic and developmental interventions later." 4 "The infant will have attention deficit hyperactivity disorder (ADHD)."
3 A preterm infant may have neurologic impairment after birth, which may result in behavioral and developmental problems later in life. Therefore the nurse instructs the parents that the infant may need neurologic and developmental interventions later. Telling the parents that the infant will have irreparable physiologic deformities will make the parents anxious. There may or may not be any deformities depending on the size and gestational age of infants at birth. Fluid and electrolyte imbalances are caused by fluid overload or dehydration and are treated with appropriate fluid replacement. The child may have ADHD or other neurologic problems, depending on the degree of immaturity at birth.
Which is a sign of dehydration in the newborn? 1 Edema 2 Bulging fontanels 3 Poor tissue turgor 4 Moist breath sounds
3 Poor tissue turgor is a sign of dehydration in the newborn. Edema, moist breath sounds, and bulging fontanels are signs of overhydrating.
What is post-maturity syndrome? 1 A condition in which the mother carries longer than the full term period 2 A condition in which the postterm fetus has reduced breath upon delivery 3 A condition in which the postterm fetus has malnourishment and hypoxia 4 A condition in which the mother of a postterm fetus develops toxins in the bloodstream
3 Post-maturity syndrome is a condition in which the postterm fetus has malnourishment and hypoxia due to not receiving appropriate amounts of oxygen and nutrients. Post-maturity syndrome does not indicate the mother carries longer than the full term, the infant has reduced breath upon delivery, or toxins develop in the mother's bloodstream.
The nurse reviews the medical chart of a preterm infant and sees that the infant is receiving feedings by gavage. What does the nurse understand? 1 The infant is having frequent regurgitation. 2 The infant is able to feed by sucking on a nipple. 3 The infant is not able to tolerate enteral feedings. 4 The infant is using a feeding tube for nutritional support.
4 Gavage feedings are enteral feedings with a feeding tube. Gavage does not mean the infant has frequent regurgitation, is sucking on a nipple, or is unable to tolerate enteral feedings.
The nurse is providing care to a preterm infant. The health care provider requests a measurement of the infant's presence of surfactant. Why is the health care provider concerned about the amount of surfactant produced by the infant? 1 Certain amounts of surfactant can be toxic to the infant. 2 Decreased amounts of surfactant can lead to dehydration. 3 Excess surfactant can cause altered thermoregulation in the infant. 4 Inadequate levels of surfactant can cause respiratory distress syndrome.
4 Some preterm infants are born before surfactant production is adequate. This puts the infant at risk for respiratory distress syndrome. Surfactant is not toxic, and it will not lead to dehydration or altered thermoregulation.
The nurse and a student nurse are caring for a preterm infant a few days after birth. The infant was less than 32 weeks of gestational age at birth. Which action made by the student is appropriate? 1 The student nurse gives the infant a bath every day using warm water and soap. 2 The student nurse allows the infant to play with the nurse's bracelet while changing the infant. 3 The student nurse applies alcohol-based skin protectant on the infant to help prevent skin breakdown. 4 The student nurse removes the silicon-based adhesive from the infant's skin by pulling horizontally parallel to the skin.
4 Special precautions must be taken when caring for preterm infants. Removing the silicon-based adhesive from the infant's skin by pulling horizontally parallel to the skin is a correct action to protect the infant's skin. Preterm infants should not be bathed every day, and their baths should not contain soap when they are at this age. Jewelry, such as bracelets, should not be worn when handling preterm infants. Alcohol-based skin protectants are not safe for the preterm infant's skin.
What are premature infants who exhibit 5 to 10 seconds of respiratory pauses followed by 10 to 15 seconds of compensatory rapid respiration experiencing? 1 Suffering from sleep or wakeful apnea 2 Experiencing severe swings in blood pressure 3 Trying to maintain a neutral thermal environment 4 Breathing in a respiratory pattern common to premature infants
4 The pattern of 5 to 10 seconds of respiratory pauses followed by 10 to 15 seconds is called periodic breathing, which is common in premature infants. It may require nursing intervention of oxygen and/or ventilation. Apnea is a cessation of respirations for 20 seconds or longer. It should not be confused with periodic breathing, which is common in the premature infant. An infant who presents with fluctuation of systemic blood pressure may have experienced a central nervous system injury. An infant attempting to maintain his or her body temperature is likely to have hypoglycemia, shivering, and mottled color.
Which problems are most common in the late preterm infant? Select all that apply. 1 Hypothermia 2 Hypoglycemia 3 Hyperbilirubinemia 4 Retinopathy of prematurity 5 Bronchopulmonary dysplasia
1,2,3 Hypothermia, hypoglycemia, and hyperbilirubinemia are all commonly encountered problems in the late preterm infant. Retinopathy of prematurity commonly occurs in infants weighing less than 2 lb, 12 oz at birth; this is more often true of preterm, rather than late preterm, infants. Bronchopulmonary dysplasia occurs most often in infants born prior to 32 weeks of gestation.
Which are risk factors for respiratory distress syndrome? Select all that apply. 1 Male 2 Female 3 Natural birth 4 Multiple births 5 Maternal diabetes
1,4,5 Being male, the mother having a history of multiple births, and the mother having maternal diabetes are risk factors for respiratory distress syndrome in the baby. Being female and having a natural birth are not risk factors.
The nurse is assessing a very low-birth-weight infant who had a preterm birth. Which condition is likely to be seen in the infant? 1 Facial nerve paralysis 2 Congenital sepsis 3 Germinal matrix hemorrhage-intraventricular hemorrhage (GMH-IVH) 4 Macrosomia
3 The increase or decrease in cerebral blood flow subsequent to asphyxia makes preterm infants vulnerable to ischemic injury. Facial nerve paralysis is a birth trauma due to difficult birth. Congenital sepsis in the infant may be caused by a maternal urinary tract infection. Macrosomia is seen in infants born to diabetic mothers.
The nurse places a newborn weighing 1400 g in a polyethylene bag. Why would the nurse do this? 1 To prevent heat loss 2 To prevent infections 3 To avoid electrolyte loss 4 To avoid bluish discoloration
1 Newborns weighing 1400 g are considered very low birth weight babies, and these infants are at a higher risk for hypothermia. Therefore, the nurse places the newborn in a polyethylene bag to decrease heat and water loss. The nurse should constantly monitor the neonate for an increase in body temperature to assess if the infant is developing an infection. The nurse administers antibiotics as ordered by the primary health care provider to treat infections. Total parenteral nutrition (TPN) is administered to avoid electrolyte loss in newborns and is unrelated to polyethylene bags. Using a polyethylene bag is not useful for improving the oxygen saturation levels in the baby. Therefore, its use would not help to prevent cyanosis or bluish discoloration.
For diagnostic and treatment purposes, nurses should know the birth weight classifications of high-risk infants. For example, extremely low birth weight (ELBW) is the designation for an infant whose weight is what? 1 Less than 1500 g 2 Less than 1000 g 3 Less than 2000 g 4 Dependent on the gestational age
2 At less than 1000 g, problems are so numerous that ethical issues regarding when to treat arise. Less than 1500 g is the designation for very low birth rate (VLBW); ELBW is less than 1000 g. Less than 2000 g is less than low but too high for extremely low, which is less than 1000 g. Gestational age is a factor with weight in the condition of the preterm birth, but it is not part of the birth weight categorization.
Which interventions does the nurse incorporate in the plan of care to comfort the parents after the death of their preterm infant? Select all that apply. 1 Takes the infant away to not cause any more grief to the family 2 Provides privacy for the family 3 Talks about the infant or attending the funeral 4 Notifies a member of the clergy if the parents desire 5 Avoids expressing grief for the infant in front of the parents
2,3,4 Privacy needs to be assured for the family during the dying process and after the death. The parents may not have any experience of infant death, so the nurse needs to talk to the parents about the funeral arrangements. The nurse will also notify a member of the clergy for any ritual if that is the parents' desire. The nurse keeps the infant's body in the unit for a few hours even if the mother is unwilling to see the infant. The mother or the parents may want to see the infant after adjusting to the initial shock of loss. The nurse may experience grief and feel sorrowful. The nurse need not control the grief and should work through the grief process by attending the funeral or memorial service.
Which is a priority nursing intervention when providing care for a high-risk infant? 1 Touching the infant often 2 Providing enteral feeding 3 Helping the infant conserve energy 4 Encouraging breastfeeding
3 Nursing interventions should be implemented in a way that facilitates the conservation of energy in a high-risk infant. The infant can then use this energy for growth and development. To prevent stress, the nurse avoids touching the infant often. Enteral feeding may be contraindicated in some infants to prevent complications. Breastfeeding may not be possible in infants with respiratory distress syndrome and therefore parenteral nutrition may be required.
Which infant is a likely candidate for receiving exogenous surfactant? 1 An infant with hypoglycemia born to a diabetic mother 2 A preterm infant with a soft cranium at risk of cranial molding 3 An infant at risk for inborn error of metabolism, like galactosemia 4 A preterm infant with respiratory distress syndrome at birth
4 Exogenous surfactant helps to maintain lung expansion in infants with respiratory distress syndrome. Oral glucose is used for an infant with hypoglycemia at birth. A preterm infant is placed on a waterbed or a gel mattress to minimize the risk of cranial molding. Galactosemia is managed by eliminating lactose-containing food and milk from the infant's diet.
