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A nurse is providing newborn discharge teaching to a client whose newborn recently had a circumcision done in the hospital.

Exhibits

Which of the following statements should the nurse include when providing discharge teaching for the parent about circumcision care? For each statement made by the nurse, click to specify whether the statement is essential or contraindicated.

A.

“The glans penis will appear red and have a yellow crust as it heals. Do not remove this.”

B.

“Ensure the diaper is really tight to keep the gauze attached to the penis.”

C.

“Notify your pediatrician if your baby has not voided in 24 hours.”

D.

“Coat the glans penis with petroleum jelly and cover with gauze.”

E.

“Check for bleeding every 4 hours for the first 24 hours and notify your pediatrician if there is bleeding at the circumcision site.”

Answer and Explanation

The Correct Answer is {"A":{"answers":"A"},"B":{"answers":"B"},"C":{"answers":"A"},"D":{"answers":"A"},"E":{"answers":"A"}}

  1. “The glans penis will appear red and have a yellow crust as it heals. Do not remove this.”
    • Essential: This is a normal part of the healing process.
  2. “Ensure the diaper is really tight to keep the gauze attached to the penis.”
    • Contraindicated: The diaper should be loose to avoid pressure on the circumcision site.
  3. “Notify your pediatrician if your baby has not voided in 24 hours.”
    • Essential: This could indicate a problem that needs medical attention.
  4. “Coat the glans penis with petroleum jelly and cover with gauze.”
    • Essential: This helps prevent the diaper from sticking to the circumcision site and aids in healing.
  5. “Check for bleeding every 4 hours for the first 24 hours and notify your pediatrician if there is bleeding at the circumcision site.”
    • Essential: Monitoring for bleeding is crucial to ensure there are no complications.


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Related Questions

Correct Answer is D

Explanation

Choice A rationale

The xiphoid process is not the correct anatomical landmark for measuring chest circumference in newborns. It is located at the lower end of the sternum and does not provide a consistent measurement point.

Choice B rationale

The fifth intercostal space is not used for measuring chest circumference in newborns. This space is located between the ribs and is not a reliable landmark for consistent measurements.

Choice C rationale

The sternal notch is not the correct landmark for measuring chest circumference. It is located at the top of the sternum and does not provide a consistent measurement point.

Choice D rationale

The nipple line is the correct anatomical landmark for measuring chest circumference in newborns. This method ensures that the measurement is taken at a consistent and reproducible location, providing an accurate assessment of the chest size relative to growth and development standards.

Correct Answer is []

Explanation

Hyperbilirubinemia

  • Symptoms: The neonate does show signs of jaundice (yellowish skin), which is a symptom of hyperbilirubinemia. However, the primary concern here is thelow blood glucose level (30 mg/dL), which is more immediately life-threatening and needs urgent attention.
  • Diagnostic Results: The total serum bilirubin level is 5 mg/dL, which is elevated but not critically high. Hyperbilirubinemia might be a secondary concern, but the immediate symptoms and diagnostic results point more towards hypoglycemia.

Neonatal Abstinence Syndrome (NAS)

  • Symptoms: NAS typically occurs in newborns exposed to addictive substances in utero, leading to withdrawal symptoms after birth. Common symptoms include irritability, high-pitched crying, tremors, and feeding difficulties.
  • History: There is no mention of maternal substance use or withdrawal symptoms like frequent yawning or irritability. The jitteriness and poor feeding could overlap with NAS, but the history of gestational diabetes and the low blood glucose level make hypoglycemia a more likely diagnosis.

Summary

  • Hypoglycemia: The neonate’s symptoms (jitteriness, lethargy, poor feeding) and the critically low blood glucose level (30 mg/dL) strongly indicate hypoglycemia. This condition is common in infants of diabetic mothers and large-for-gestational-age infants.

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