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?

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.

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.