A nurse is performing a physical examination of a term newborn upon admission to the nursery.
In which order should the nurse perform the following assessments?

Choice A rationale

Acrocyanosis, characterized by bluish discoloration of the hands and feet, is a common and usually benign finding in newborns, especially shortly after birth due to immature peripheral circulation. It does not typically indicate neonatal abstinence syndrome, which is a neurological and systemic hyperexcitability response to opioid withdrawal.

Choice B rationale

Hypotonia, or decreased muscle tone, is generally a sign of central nervous system depression or neuromuscular disorder. In contrast, newborns with neonatal abstinence syndrome typically exhibit hypertonia, characterized by increased muscle tone, tremors, and hyperreflexia, due to the overstimulation of the central nervous system following cessation of maternal opioid exposure.

Choice C rationale

An exaggerated Moro reflex, characterized by an overly robust and prolonged startle response, is a common manifestation of central nervous system irritability seen in newborns experiencing neonatal abstinence syndrome. This hyperreflexia is a direct result of the withdrawal symptoms, indicating an overactive nervous system in response to the absence of the previously supplied opioid.

Choice D rationale

Tachypnea, or rapid breathing, is a frequent finding in newborns with neonatal abstinence syndrome. This symptom is often attributed to central nervous system irritability and increased metabolic demand associated with withdrawal, leading to respiratory distress. The respiratory rate often exceeds the normal range of 30-60 breaths per minute.

Choice E rationale

A shrill-pitched cry, often described as inconsolable or high-pitched, is a classic and distinctive symptom of neonatal abstinence syndrome. This abnormal cry pattern is indicative of central nervous system irritation and dysregulation, reflecting the newborn's discomfort and hyperirritability stemming from opioid withdrawal. This cry often differs from a typical hunger or discomfort cry.

Abruptio Placentae: Typically does not cause increased contraction frequency; contractions may be normal or decreased due to uterine irritation or pain.

Uterine Tachysystole: Characterized by more than 5 contractions in 10 minutes averaged over 30 minutes, indicating excessive contraction frequency, which can reduce uteroplacental perfusion.

Uterine Tone
Abruptio Placentae: The uterus often becomes firm, rigid, and tender due to bleeding and inflammation caused by premature placental separation, increasing baseline uterine tone.

Uterine Tachysystole: Uterine tone is elevated because contractions are prolonged and close together, causing the uterus to remain tense with insufficient relaxation.

Pain Report
Abruptio Placentae: Patients usually report sharp, severe abdominal or back pain due to the sudden placental detachment and uterine irritation.

Uterine Tachysystole: Pain may be present but is typically related to frequent contractions rather than sharp, localized pain.

FHR Pattern
Abruptio Placentae: Commonly causes fetal heart rate abnormalities like late decelerations, bradycardia, or absent variability due to fetal hypoxia from compromised placental perfusion.

Uterine Tachysystole: Can cause decreased fetal heart rate variability and late decelerations because frequent contractions reduce oxygen delivery during inadequate relaxation.