A nurse is assessing a newborn who is 4 hr. old. Which of the following findings should the nurse identify as the priority to report to the provider?
Overlapping of the cranial bones
Small, distended white sebaceous glands on the face
Forward and lateral positioning of the ears
Bluish discoloration of the hands and feet
The Correct Answer is D
In a newborn, bluish discoloration of the hands and feet may indicate a condition called peripheral cyanosis, which suggests poor oxygenation. It is important to report this finding to the healthcare provider promptly, as it may indicate a respiratory or circulatory problem that requires immediate attention.
Option a) Overlapping of the cranial bones is a common finding in newborns due to the molding of the head during delivery. This is not a priority finding to report unless there are other signs of concern, such as abnormal head shape or signs of trauma.
Option b) Small, distended white sebaceous glands on the face are called milia and are a normal finding in newborns. They are not a priority finding to report and typically resolve on their own within a few weeks.
Option c) Forward and lateral positioning of the ears is a normal finding in a newborn and is not a priority to report. The ears may appear folded or positioned differently due to the pressure and positioning in the womb.
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Correct Answer is A
Explanation
Maternal hypotension is a common complication of spinal anesthesia for cesarean section, and it can cause adverse effects on the mother and the fetus, such as nausea, vomiting, dizziness, decreased placental perfusion, fetal acidosis, and fetal distress¹². To prevent or treat maternal hypotension, various techniques have been used, such as fluid preloading or co-loading, vasopressors, lower limb compression devices, and left lateral tilt position¹². Among these, fluid administration is the most widely used and recommended
intervention¹²³. A bolus infusion of lactated Ringer's or other crystalloid solution can increase the intravascular volume and cardiac output, and counteract the decrease in blood pressure caused by spinal anaesthesia¹²³. The optimal timing and amount of fluid administration may vary depending on the individual patient's condition and response, but generally a bolus of 10 to 20 mL/kg is suggested before or during spinal anaesthesia¹²³.
The other options are incorrect because:
b) Applying oxygen via nonrebreather face mask at 2 L/min is not an effective intervention for maternal hypotension. Oxygen supplementation may be beneficial for improving fetal oxygenation in case of fetal distress, but it does not directly increase maternal blood pressure or cardiac output¹². Moreover, 2 L/min is a low flow rate for a nonrebreather face mask, which requires at least 10 L/min to deliver high concentrations of oxygen⁴.
c) Positioning the client in a knee-chest position is not a recommended intervention for maternal hypotension. This position may increase venous return and cardiac output in some cases, but it also increases intra-abdominal pressure and reduces uterine blood flow, which can compromise fetal oxygenation and well-being. A left lateral tilt position of 15 to 30 degrees is preferred to avoid aortocaval compression and improve placental perfusion¹².
d) Giving terbutaline subcutaneously is not an appropriate intervention for maternal hypotension. Terbutaline is a beta-agonist that relaxes the uterine smooth muscle and prevents preterm labor contractions. It has no direct effect on maternal blood pressure or cardiac output, and it may cause maternal tachycardia, palpitations, tremors, and hypokalemia as side effects. Vasopressors such as ephedrine or phenylephrine are more effective and safer drugs for treating maternal hypotension¹².
Correct Answer is A
Explanation
This is because a low pulse oximetry reading can indicate that the newborn is hypoxic and needs suctioning of the nasopharynx to clear any secretions that may be obstructing the airway²⁴. Hypoxia can cause bradycardia, acidosis, and brain injury in newborns, and should be corrected as soon as possible². The normal range of pulse oximetry for a newborn is 95% to 100%².
The other options are not correct because:
b) The newborn's respiratory rate is irregular
This is not a sign that suctioning is needed, as it is a normal finding in newborns. Newborns have periodic breathing patterns, which involve alternating periods of rapid and slow breathing, with occasional pauses of up to 10 seconds². This does not indicate respiratory distress or hypoxia, and does not require intervention unless the pauses are longer than 10 seconds or associated with cyanosis or bradycardia².
c) The newborn is beginning to cough
This is not a sign that suctioning is needed, as it is a normal reflex that helps the newborn clear the airway of secretions. Coughing can also stimulate breathing and prevent apnea in newborns². Coughing does not indicate respiratory distress or hypoxia, and does not require intervention unless it is persistent or associated with other signs of respiratory compromise².
d) The newborn's respiratory rate is 32/min
This is not a sign that suctioning is needed, as it is within the normal range for a newborn. The normal respiratory rate for a newborn is 30 to 60 breaths per minute². A respiratory rate that is too high or too low can indicate respiratory distress or hypoxia, and may require suctioning or other interventions².
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