A nurse is caring for a newborn immediately following birth.

Exhibits

The nurse is assessing the newborn 24 hr later.

How should the nurse interpret the findings?

For each finding, click to specify whether the finding is unrelated to the diagnosis, an indication that the client's condition is improving, or an indication that the client's condition is worsening.

Findings 24 hr later:

Choice A rationale:
Freezing embryos for future use is a personal decision and not something a nurse should instruct a client to avoid.
Choice B rationale:
In vitro fertilization can result in multiple pregnancies, and reduction of multiple fetuses may be necessary for the health of the mother and the remaining fetuses.
Choice C rationale:
The use of donor oocytes is a personal decision and not something a nurse should instruct a client to avoid.
Choice D rationale:
In in vitro fertilization, sperm is introduced to the egg in a laboratory, not the uterus.

Choice A rationale:
Yellow exudate will form at the surgical site in 24 hours, which is a normal part of the healing process.
Choice B rationale:
A dark red appearance of the penis could indicate a complication such as infection or necrosis, which would require medical attention.
Choice C rationale:
The Plastibell is not removed manually; it falls off naturally within 5 to 8 days.
Choice D rationale:
A snug diaper could cause pressure and discomfort on the surgical site; it’s recommended to fasten the diaper loosely.

The Plastibell circumcision technique is one of the most common methods of newborn circumcision. It involves placing a plastic ring under the foreskin and tying a suture around it to cut off blood flow. The foreskin then falls off naturally with the ring in seven to 10 days.

The correct answer is A. The nurse should include that “yellow exudate will form at the surgical site in 24 hours” as part of the teaching to the parents. This is because the yellow exudate is a normal sign of healing and should not be confused with infection.

The other options are incorrect because:

b. The parents should notify the provider if the end of the baby’s penis appears black, not dark red. This could indicate that the ring is too tight and is cutting off blood supply to the glans.
c. The Plastibell will not be removed 4 hours after the procedure. It will stay on the penis until the foreskin falls off naturally in seven to 10 days.
d. The newborn’s diaper should be loose, not snug. This is to prevent the ring from being dislodged or rubbing against the diaper.