A nurse is assessing a newborn at 2 hours of life. Which of the following findings should the nurse report to the neonatologist?

A) It could make respiratory distress syndrome worse:
The most critical reason to protect a preterm infant from cold stress is that hypothermia can exacerbate respiratory distress syndrome (RDS). Cold stress leads to an increased oxygen demand, which can worsen the infant’s already compromised respiratory function. In preterm infants, the immature lungs and underdeveloped surfactant production contribute to RDS, and hypothermia worsens the situation by increasing metabolic demands and impairing pulmonary function. Maintaining a stable body temperature is crucial for minimizing respiratory complications.

B) Shivering to produce heat may use up too many calories:
While it is true that preterm infants may not have the metabolic reserves to generate heat via shivering (as they lack significant brown fat), the primary concern is not shivering. Preterm infants generally do not shiver, and cold stress does not trigger this response. Instead, their body tries to conserve heat through vasoconstriction and increased metabolism, which can lead to hypoxia and worsening respiratory distress.

C) A low temperature may make the infant less able to digest nutrients:
Cold stress can affect a preterm infant’s gastrointestinal function by reducing blood flow to the digestive organs, which can impair nutrient absorption and digestion. However, the most immediate and serious consequence of cold stress is the increased metabolic demand and worsening of respiratory distress, rather than a direct impact on digestion. Protecting the infant from hypothermia helps prevent these secondary complications.

D) Cold decreases circulation to the extremities:
While cold stress can indeed lead to vasoconstriction and decreased circulation to the extremities, this is not the most significant concern. The primary issue with cold stress in preterm infants is the overall increase in metabolic demands, oxygen consumption, and exacerbation of respiratory problems, which can lead to more severe respiratory distress syndrome. The loss of peripheral circulation is a secondary concern.

A. Ask the patient to empty her bladder:
A boggy uterus that is displaced above and to the right of the umbilicus is often a sign of bladder distention. A full bladder can push the uterus out of its normal position, preventing it from contracting properly and leading to uterine atony. Asking the patient to empty her bladder is the most appropriate initial action, as it can help reposition the uterus and promote uterine contraction, reducing the risk of postpartum hemorrhage.

B. Notify the MD about an impending hemorrhage:
While a boggy, displaced uterus can be a sign of uterine atony and the risk of hemorrhage, the first action should be to address the likely cause—bladder distention. Emptying the bladder may resolve the issue and help the uterus contract. Notifying the healthcare provider may be necessary later if other complications arise, but it’s not the most immediate intervention in this situation.

C. Assess blood pressure and pulse:
Assessing vital signs, including blood pressure and pulse, is important for monitoring the patient’s overall condition, especially if there is suspicion of hemorrhage. However, this is a secondary action after addressing the immediate problem (bladder distention). The priority is to help the uterus contract and reposition it before worrying about potential hemorrhage.

D. Evaluate lochia:
Evaluating lochia is an important step in assessing the patient’s postpartum status, especially to monitor for excessive bleeding. However, the immediate concern in this case is the displaced uterus, which is most likely due to bladder distention. The most effective action would be to address the bladder fullness first. After addressing this, lochia should be assessed to monitor for bleeding.