High risk newborn

High risk newborn

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Multiple Choice

The nurse develops a plan of care for a post-term small for gestational age (SGA) newborn and documents that the priority nursing action is to monitor:

• Urinary output

• Blood glucose levels

• Total bilirubine levels

• Hemoglobin and hematocrit

Blood glucose levels

The most common metabolic complication in the SGA newborn is hypoglycemia, which can produce central nervous system abnormalities and mental retardation if not corrected immediately. Urinary output, although important, is not the highest priority action because the post-term SGA newborn is typically dehydrated from placental dysfunction. Hemoglobin and hematocrit levels are monitored because the post-term SGA newborn exhibts polycythemia, although this also does not require immediate attention. The polycythemia contributes to increased bilirubin levels, usually beginning on the second day after delivery.

Multiple Choice

A nurse is performing an assessment on a postterm infant. Which physical characteristic should the nurse expect to observe?

• Peeling of the skin

• Smooth soles without creases

• Lanugo covering the entire body

• Vernix that covers the body in a thick layer

Peeling of the skin

The postterm infant (born after the 42nd week of gestation) exhibits dry, peeling, cracked, almost leather-like skin over the body. The preterm infant (born between 24 and 37 weeks gestation) exhibits thick vernix covering the entire body, somooth soles without creases, and lanugo covering the entire body.

Multiple Choice

A postterm infant, delivered vaginally, is exhibiting tachypnea, grunting, retractions, andnasal flaring. The nurse interprets that these assessment findings are indicative of:

• Hypoglycemia

• Respiratory distress syndrome

• Meconium aspiration syndrome

• Transient tacypnea of the newborn

Meconium aspiration syndrome

Tachypnea, grunting, retractions, and nasal flaring are symptoms of respiratory distress related to meconium aspiration syndrome (MAS). MAS occurs often in postterm infants and develops when meconium in the amniotic fluid enters the lungs during fetal life or at birth. Transient tachypnea of the newborn is primarily found in infants delivered via cesarean section. Respiratory distress syndrome is a complication of preterm infants. The symptoms noted in the question are unrelated to hypoglycemia.

Multiple Choice

A nurse is monitoring a preterm newborn infant for signs of respiratory distress syndrome (RDS). The nurse monitors the infants for:

• Acrocyanosis, emphysema,and interstitial edema.

• Acrocyanosis, apnea, pneumothorax, and grunting

• Barrel-shaped chest, hypotension, and bradycardia

• Cyanosis, tachypnea, retractions, grunting respirations, and nasal flaring.

Cyanosis, tachypnea, retractions, grunting respirations, and nasal flaring.

The newborn infant with RDS may present with clinical signs of cyanosis, tachypnea, or apnea, nasal flaring, chest wall retractions, or audible grunts. Acrocyanosis, the bluish discoloration of the hands and feet is associated with immature peripherial circulation and is not uncommon in the first few hours of life. Options 1, 2, and 3 do not indicate clinical signs of RDS.

Multiple Choice

Two hours ago, a neonate at 38 weeks gestation and weighing 3,175 g (7 lb) was born to a primiparous client who tested positive for GBS. Which of the following would alert the nurse to notify the primary health care provider?

• Alkalosis

• Increased muscle tone

• Temperature instability

• Positive Babinski reflex

Temperature instability

The neonate is at high risk for sepsis due to exposure to the mother's infection, Temperature instability in a neonate at 38 weeks' gestation is an early sign of sepsis. Other signs include tachycardia, decreased muscle ton

Multiple Select

Nursing interventions for the pre-term infant would include which of the following? Select all that apply

• Establish lactation

• Promote stimulation

• Promote bonding

• Place neonate in open crib

​Promote Bonding and Establish Lactation

​Nursing interventions for the preterm infant are aimed at maintaining cardiopulmonary function, nutrition & hydration, thermoregulation, and prevention of further complications. The parents will likely have many fears and anxieties in regards to caring for their infants.  It is important to support bonding.  Be supportive of the parents.  Allow them to verbalize their concerns, answer their questions.  Include them in the care while reassuring them.  The breastfeeding mother should pump and store any breastmilk, including colostrum.  Once the infant is ready for feeds, the NICU will give this colostrum and breastmilk first, as it is very beneficial to the infant by containing maternal antibodies.  Regular pumping also allows the mother to establish an adequate milk supply. 

​Infants are easily overstimulated in the NICU.  Overstimulation can lead to distress and behavior changes.  Steps should be taken to limit stimulation as much as possible. 

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Multiple Choice

A neonate born at 40 weeks' gestation, weighing 2300 grams (5 lb, 1 oz) is admitted to the newborn nursery for observation only. What is the nurse's first observation about the infant?

• The neonate is average for its gestational age.

• The neonate is small for its gestational age.

• The neonate is large for its gestational age.

• The neonate is fetal growth restricted.

​The neonate is small for its gestational age.

Small-for-gestational age (SGA) describes newborns that typically weigh less than 2,500 g (5 lb, 8 oz) at term due to less growth than expected in utero. A newborn is also classified as SGA if his or her birthweight is at or below the 10th percentile as correlated with the number of weeks of gestation. In some SGA newborns, the rate of growth does not meet the expected growth pattern. These infants are considered to have fetal growth restriction resulting in pathology.

​Transient Tachypnea of the Newborn

Transient tachypnea of the newborn (TTN) has a favorable outcome after several hours to several days. It is caused by inadequate fluid absorption and resolves in 24-72 hrs after birth.

Subject | Subject

Some text here about the topic of discussion

Multiple Select

The newborn nursery nurse suspects a newborn of having neonatal abstinence syndrome. What assessment findings would most correlate with the diagnosis? Select all that apply.

• vigorous rooting and feeding

• frequent yawning and sneezing

• positive Babinski and Moro reflexes

• cyanotic discoloration of the hands and feet

​frequent yawning and sneezing

Manifestations of neonatal abstinence syndrome include: CNS dysfunction such as hyperactive reflexes resulting in exaggerated Babinski and Moro reflexes; hypertonic muscle tone and constant movement; metabolic, vasomotor, and respiratory disturbances with frequent yawning and sneezing; gastrointestinal dysfunction, including poor feeding; and frantic sucking or rooting. Acrocyanosis is a normal newborn finding which is cyanotic discoloration of the extremities.

Multiple Choice

The nurse should carefully monitor which neonate for hyperbilirubinemia?

• neonate of African descent

• neonate of an Rh-positive mother

• neonate with ABO incompatibility

• neonate with Apgar scores 9 and 10 at 1 and 5 minutes

​neonate with ABO incompatibility

The mother's blood type, which is different from the neonate's, has an impact on the neonate's bilirubin level due to the antigen antibody reaction. Neonates of African descent tend to have lower mean levels of bilirubin. Chinese, Japanese, Korean, and Greek neonates tend to have higher incidences of hyperbilirubinemia. Neonates of Rh-negative, not Rh-positive, mothers tend to have hyperbilirubinemia. Low Apgar scores may indicate a risk for hyperbilirubinemia; 9 and 10 associate with normal adjustment to extrauterine life.