A nurse is assisting with the care of a newborn 1 hr following birth.

Exhibits

Select the 5 findings that the nurse should report to the provider.

Choice A reason:

Heat facilitates the drainage of mucus for a premature newborn. This is incorrect because heat does not affect mucus drainage. Mucus drainage is more related to suctioning and hydration.

Choice B reason:

The newborn has a small body surface for his weight. This is incorrect because a small body surface area for weight would indicate a large newborn, not a premature one. A large newborn would have less risk of heat loss than a small one.

Choice C reason:

The newborn's temperature control mechanism is immature. This is correct because premature newborns have immature thermoregulation and are prone to hypothermia. Placing the newborn in an incubator helps maintain a stable temperature and prevent further complications.

Choice D reason:

Heat increases the flow of oxygen to the newborn's extremities. This is incorrect because heat does not directly affect oxygen delivery. Oxygen delivery is more related to ventilation, perfusion, and hemoglobin levels. The question is about a premature newborn who has signs of respiratory distress, such as nasal flaring, intercostal retractions, expiratory grunting, and mild cyanosis. These signs indicate that the newborn is having difficulty breathing and may have a condition such as respiratory distress syndrome, transient tachypnea of the newborn, or meconium aspiration syndrome. The nurse should place the newborn in an incubator to provide warmth and prevent heat loss, which can worsen respiratory distress. The nurse should also monitor the newborn's vital signs, oxygen saturation, blood gases, chest x-ray, and neonatal abstinence scoring system if indicated. The nurse should be prepared to administer oxygen, surfactant, or mechanical ventilation as ordered.

Choice A reason:

Hypoglycemia is a common complication for newborns whose mothers have diabetes mellitus. This is because the newborn's pancreas produces excessive insulin in response to the high glucose levels in the mother's blood during pregnancy. After birth, the newborn's glucose levels drop rapidly, while the insulin levels remain high, resulting in hypoglycemia. The nurse should monitor the newborn's blood glucose levels and signs of hypoglycemia, such as jitteriness, lethargy, poor feeding, and temperature instability.

Choice B reason:

Decreased RBC is not a likely complication for newborns whose mothers have diabetes mellitus. In fact, these newborns may have increased RBC due to chronic fetal hypoxia caused by placental insufficiency. The nurse should monitor the newborn's hematocrit and signs of polycythemia, such as ruddy skin, jaundice, and respiratory distress.

Choice C reason:

Hyperbilirubinemia is not a likely complication for newborns whose mothers have diabetes mellitus. In fact, these newborns may have increased bilirubin levels due to hemolysis of excess RBC and delayed hepatic clearance. The nurse should monitor the newborn's serum bilirubin levels and signs of jaundice, such as yellow skin and sclera, poor feeding, and lethargy.

Choice D reason:

Hypercalcemia is not a likely complication for newborns whose mothers have diabetes mellitus. In fact, these newborns may have hypocalcemia due to decreased parathyroid hormone secretion and increased calcium binding to albumin. The nurse should monitor the newborn's serum calcium levels and signs of hypocalcemia, such as jitteriness, tremors, seizures, and cardiac arrhythmias.