A 20-hour-old neonate is suspected of having polycythemia. Which nursing intervention(s) will the nurse utilize to provide care for this neonate? Select all that apply.
Provide early feedings to prevent hypoglycemia
Maintain oxygen saturation parameters
Obtain hemoglobin and hematocrit laboratory tests
Monitor urinary output
Insert a peripheral IV
Correct Answer : A,B,C,D,E
A. Providing early feedings can help prevent hypoglycemia, a common complication of polycythemia.
B. Maintaining oxygen saturation parameters, which can indicate the adequacy of tissue oxygenation and perfusion.
C. Obtaining hemoglobin and hematocrit laboratory tests is essential for diagnosing and monitoring polycythemia.
D. Polycythemic neonates may have decreased urinary output due to reduced renal blood flow, dehydration, or increased risk of thrombosis. The nurse should monitor the urinary output and report any signs of oliguria, anuria, hematuria, or renal failure.
E. A peripheral IV is a catheter inserted into a vein to administer fluids, medications, or blood products. Polycythemic neonates may require a partial exchange transfusion, which is a procedure where some of the neonate's blood is removed and replaced with normal saline or donor blood. This can help lower the hematocrit and viscosity and improve oxygen delivery and tissue perfusion. The nurse should insert a peripheral IV and prepare for the transfusion as ordered by the physician.
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Related Questions
Correct Answer is ["A","B","D","E"]
Explanation
A. This principle aims to prevent or minimize the complications associated with preterm births, such as respiratory distress, bleeding, infection, and developmental delays.
B. Early identification of prenatal risk factors and taking actions to mitigate them can help reassure the client by demonstrating proactive care.
C. While important, this choice is more about addressing potential outcomes rather than preventing complications during pregnancy.
D. Ensuring care for mothers and infants to reduce adverse outcomes addresses the concerns about complicated pregnancies by emphasizing preventive measures.
E. This choice focuses on ensuring appropriate care for high-risk infants, which is relevant to addressing concerns about complicated pregnancies.
Correct Answer is A
Explanation
A. This technique might be appropriate for younger children, but not for teenagers who want more autonomy and respect. Letting him choose juice or soda might make him feel like he is being treated like a child, and not as a partner in his own care.
B. Seeking the teenager's input on decisions promotes autonomy and empowerment, which can be effective in adolescent healthcare.
C. Avoiding undue criticism of noncompliance is important for maintaining a supportive and trustful nurse-patient relationship, especially with adolescents.
D. The nurse should also discuss the benefits of chemotherapy with him, such as how it can kill cancer cells, shrink tumors, and improve his chances of survival. The nurse should explain the rationale and goals of chemotherapy in a clear and honest way, and answer any questions or concerns the teenager might have. By doing so, the nurse can help him understand the importance of adhering to the treatment plan, and motivate him to cope with the challenges.
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