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

While documenting findings is a crucial nursing responsibility, a white blood cell count of 28,000 mm³ in a newborn is significantly elevated. The normal range for a newborn's WBC count is typically between 9,000 to 30,000 mm³, but a value at the higher end or exceeding this range warrants further investigation to rule out infection or other underlying conditions. Simply documenting without further action could delay necessary interventions.

Choice B rationale

A WBC count of 28,000 mm³ in a newborn raises suspicion for neonatal sepsis, a serious bloodstream infection. Unit protocols for a sepsis workup typically involve obtaining blood cultures, a complete blood count with differential, and potentially a lumbar puncture and chest X-ray to identify the source and extent of infection. Prompt initiation of these measures is critical for timely diagnosis and treatment, improving the newborn's prognosis.

Choice C rationale

Taking vital signs is a standard nursing assessment, but in the presence of an abnormal lab value suggestive of a serious condition like sepsis, it is insufficient as the sole action. While changes in vital signs can indicate infection, they may not be present in the early stages. Notifying the provider is necessary, but initiating a sepsis workup concurrently based on unit protocol allows for quicker diagnostic evaluation.

Choice D rationale

A heel stick for a bedside blood glucose reading is indicated for assessing hypoglycemia, a common concern in newborns, particularly those at risk. However, it does not directly address the significantly elevated WBC count. While infection can sometimes affect blood glucose levels, this test would not provide information about the potential underlying cause of the leukocytosis.

Choice A rationale

Encouraging a hands-and-knees position may help rotate a malpositioned fetus or relieve back pain, but it does not directly address hypotonic uterine dysfunction, which is characterized by weak, ineffective contractions. While it can improve maternal comfort and potentially aid in fetal descent if malpositioning is a contributing factor to slow labor progress, it will not augment the strength or frequency of contractions necessary for cervical dilation.

Choice B rationale

Providing a comfortable environment with dim lighting can promote relaxation and potentially enhance the progress of labor in cases of hypertonic uterine dysfunction (uncoordinated, painful contractions). However, in hypotonic dysfunction, the issue is a lack of adequate uterine muscle activity. While comfort measures are always important, they do not directly stimulate stronger contractions.

Choice C rationale

Administering oxytocin is the primary medical intervention for hypotonic uterine dysfunction. Oxytocin is a synthetic hormone that stimulates uterine smooth muscle to contract more frequently and with greater intensity. This augmentation of uterine activity aims to establish an effective labor pattern, leading to cervical dilation and fetal descent when fetopelvic disproportion has been ruled out.

Choice D rationale

Preparing for an amniotomy (artificial rupture of membranes) might be considered to augment labor if the membranes are intact. However, the question states the membranes have already ruptured. Amniotomy can sometimes stimulate contractions by releasing prostaglandins, but it is not the first-line intervention for established hypotonic dysfunction after membrane rupture, and oxytocin is generally more effective in this situation.