A nurse is planning care for a newborn who is scheduled to start phototherapy using a lamp. Which of the following actions should the nurse include in the plan?

A newborn who is 1 hour old and has a respiratory rate of 50/min, a heart rate of 130/min, and an axillary temperature of 36.1°C (97°F) has normal vital signs for their age¹². However, the newborn is at risk of losing heat and developing hypothermia, which can cause serious complications such as hypoglycemia, metabolic acidosis, and respiratory distress³. Therefore, the nurse should take measures to prevent heat loss and maintain a neutral thermal environment for the newborn³⁴.
One of the effective ways to prevent heat loss in newborns is to apply a cap to their head. The head has a large surface area relative to the body mass and can account for up to 50% of heat loss in newborns³⁴. A cap can reduce heat loss through radiation, convection, and evaporation from the scalp³⁴. The cap should be dry, clean, and snug-fitting, and should not cover the eyes or ears of the newborn³⁴.

a) Giving the newborn a warm bath is not an appropriate action for the nurse to take. Bathing can increase heat loss through evaporation and conduction, especially if the water temperature is not optimal or the room temperature is too low³⁴. Bathing should be delayed until the newborn's temperature is stable and preferably after the first breastfeeding session³⁴.
b) Repositioning the newborn is not a sufficient action for the nurse to take. Repositioning may help reduce heat loss through conduction if the newborn is placed away from cold surfaces or objects, but it does not address heat loss through other mechanisms³⁴. Repositioning should be combined with other interventions, such as skin-to-skin contact, swaddling, or radiant warmers³⁴.
c) Obtaining an oxygen saturation level is not a relevant action for the nurse to take. Oxygen saturation is a measure of how much oxygen is carried by the hemoglobin in the blood. It is not directly related to temperature regulation or heat loss in newborns³⁴. Oxygen saturation should be monitored routinely in all newborns before discharge as part of screening for congenital heart disease, but it does not address the risk of hypothermia⁵.

This is the only option that is true and relevant to maternal cytomegalovirus infection. CMV can be transmitted from the newborn to the mother or other caregivers through contact with the saliva and urine of the newborn, which may contain high amounts of the virus. Therefore, it is important to practice good hygiene and avoid contact with these body fluids when caring for a newborn with congenital CMV.

a) This infection does not require that airborne precautions be initiated for the newborn. Airborne precautions are used to prevent the spread of infections that are transmitted by small droplets that can remain suspended in the air and travel over long distances, such as tuberculosis, measles, or chickenpox. CMV is not transmitted by airborne route, and standard precautions are sufficient to prevent exposure to blood or body fluids that may contain CMV
b) Mothers will not receive prophylactic treatment with acyclovir prior to delivery. Acyclovir is an antiviral medication that is used to treat herpes simplex virus (HSV) infections, such as cold sores, genital herpes, or neonatal herpes. It has no effect on CMV infection, and it is not recommended for pregnant women or newborns with CMV.
c) Lesions are not visible on the mother's genitals. Lesions are a sign of HSV infection, not CMV infection. HSV can cause painful blisters or ulcers on the mouth or genitals, and it can be transmitted to the newborn during delivery. CMV does not cause any visible symptoms on the mother's genitals, and it can be transmitted to the newborn during pregnancy, delivery, or breastfeeding.