A mother expresses fear about changing her infant's diaper after he is circumcised with a clamp procedure.
What does the woman need to be taught to take care of the infant when she gets home?

Choice A rationale

Positioning the newborn supine on a radiant warmer is appropriate for maintaining thermoregulation. However, applying only a sterile gauze dressing to a large abdominal wall defect that is not covered by a membrane does not adequately protect the exposed organs from contamination, drying, or injury. This increases the risk of infection and fluid loss.

Choice B rationale

Placing the newborn into a sterile bowel bag up to the axilla is the recommended immediate action for an abdominal wall defect such as gastroschisis (protrusion without a membrane). The sterile bag helps to maintain a moist environment, prevent heat and fluid loss, and protect the exposed organs from trauma and contamination until surgical repair can be performed.

Choice C rationale

While breastfeeding promotes bonding and provides essential nutrients, it is not the priority action for a newborn with a large, uncovered abdominal wall defect immediately after birth. The immediate focus should be on protecting the exposed organs and stabilizing the newborn. Breastfeeding can be initiated once the newborn is stable and the abdominal defect is appropriately managed.

Choice D rationale

Providing intermittent suction via an orogastric tube may be necessary later to decompress the gastrointestinal system, but it is not the immediate priority for a newborn with a large, uncovered abdominal wall defect. The initial action should focus on protecting the exposed organs.

Rationales for Each Condition

Molar Pregnancy

1. Abdominal Pain: In a molar pregnancy, the uterus enlarges disproportionately due to abnormal trophoblastic growth. This excessive expansion can cause discomfort or mild cramping.
2. Blood Pressure: Molar pregnancies can be associated with gestational trophoblastic disease, which may lead to preeclampsia-like symptoms. However, this client’s blood pressure is currently within normal limits (120/78 mm Hg), so severe hypertension has not yet developed.
3. Ultrasound Findings: The presence of grape-like vesicles within the uterus and the absence of a fetal heartbeat are hallmark findings of a molar pregnancy, indicating abnormal placental tissue proliferation.
4. Perineal Pad Findings: The passage of small clear vesicles is a characteristic feature of a molar pregnancy, distinguishing it from other causes of vaginal bleeding in pregnancy.

Ectopic Pregnancy

1. Abdominal Pain: Ectopic pregnancies often cause sharp lower abdominal pain due to tubal rupture or irritation. However, in this case, the client’s pain is mild and less suggestive of tubal rupture.
2. Blood Pressure: If an ectopic pregnancy ruptures, hypotension due to internal bleeding would be expected. Since the client’s blood pressure is normal, this finding does not support an ectopic pregnancy.
3. Ultrasound Findings: The absence of a fetal heartbeat and vesicular structures inside the uterus make ectopic pregnancy unlikely, as ectopic pregnancies typically occur in the fallopian tube.
4. Perineal Pad Findings: Ectopic pregnancies rarely cause the passage of vesicular tissue, further suggesting that this is not an ectopic pregnancy.