A 2 week old patient in the NICU has a 'machine like murmur, poor growth and bounding pulses. He has been diagnosed with a Patent Ductus Arteriosus. What medication would the nurse anticipate administering to this patient?

Rationale:

A. Perform meticulous oral care with a hard bristled toothbrush: A hard bristled toothbrush can easily damage the delicate and inflamed mucosa in a patient with mucositis, increasing pain, risk of bleeding, and potential entry points for infection. Using a soft-bristled toothbrush is safer.

B. Initiate NPO orders to minimize pain: Avoiding food altogether is generally not beneficial unless swallowing is unsafe, as it can lead to malnutrition and dehydration. Managing pain and modifying the diet is preferred so the patient can continue to receive nutrition and fluids.

C. Administer a mouthwash with numbing and antibacterial agents: These solutions help reduce discomfort during eating and oral care while lowering bacterial load in the mouth, which is important for infection prevention in immunocompromised patients.

D. Encourage a soft, bland diet and proper hydration: Soft, mild foods are less abrasive to oral tissues, and adequate fluid intake supports tissue healing and overall recovery. Eliminating rough, acidic, or spicy foods can help avoid worsening mucosal irritation.

E. Monitor for rectal involvement and administer stool softeners: Mucositis can affect the gastrointestinal tract beyond the mouth, leading to painful or fragile rectal mucosa. Stool softeners reduce the risk of trauma from straining during bowel movements, helping to prevent bleeding and discomfort.

Rationale:

A. "This is not normal, we should consult GI for a nissen fundoplication": A Nissen fundoplication is a surgical procedure reserved for severe gastroesophageal reflux disease (GERD). It is not an appropriate first step for an otherwise healthy infant.

B. "This is not normal, we need to send you to the emergency room": Frequent spitting up without distress, feeding problems, or poor weight gain is not an emergency. This response would unnecessarily alarm the mother.

C. "This is physiologically normal because baby's central nervous system is not developed and they don't know how to swallow effectively": While neuromuscular maturity plays a role in infant feeding, spitting up in healthy infants is more often due to anatomical immaturity of the gastrointestinal system, rather than poor swallowing reflexes.

D. In healthy, thriving infants, frequent spitting up is usually a benign form of gastroesophageal reflux caused by the immaturity of the lower esophageal sphincter. This muscle strengthens over time, and symptoms typically improve as the infant grows.