A nurse is providing teaching to the parent of a newborn who is 1 day old and has a prescription for gavage feeding.
Which of the following information should the nurse include in the teaching?

Choice A rationale

While thermoregulation is critical for newborns, directly placing a newborn with an omphalocele under a radiant heat source without covering the exposed viscera first can lead to excessive fluid loss and potential hypothermia due to evaporation. The primary concern is protecting the exposed abdominal contents from injury and infection.

Choice B rationale

Positioning a newborn with an omphalocele in a supine position is generally appropriate, as it helps to keep the exposed viscera in a less compromised position. However, the most immediate and critical action is to protect the exposed organs from trauma, desiccation, and infection before considering positioning.

Choice C rationale

Using sterile plastic wrap to cover the viscera of a newborn with an omphalocele is a critical immediate nursing action. This creates a sterile barrier, prevents desiccation of the exposed abdominal contents, minimizes heat and fluid loss, and reduces the risk of infection, thus protecting the delicate organs until surgical repair.

Choice D rationale

Applying petroleum gauze to the exposed viscera is not the most appropriate or effective method for protecting an omphalocele. Petroleum gauze may stick to the delicate tissues, potentially causing trauma upon removal, and does not provide the same level of sterile barrier, moisture retention, or protection against environmental contaminants as sterile plastic wrap.

The client is at risk for developing HELLP syndrome as evidenced by Liver enzymes.

Rationale for correct answers:
HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets) is a severe form of preeclampsia often presenting in the third trimester. This client has thrombocytopenia (platelets 100,000/mm³; normal 150,000–400,000/mm³), elevated blood urea nitrogen (25 mg/dL; normal 10–20 mg/dL), borderline elevated creatinine (1.1 mg/dL; normal 0.5–1.0 mg/dL), and elevated uric acid (9.8 mg/dL; normal 2.7–7.3 mg/dL), which suggests possible renal impairment and oxidative stress typical in HELLP. Mild epigastric discomfort also aligns with liver involvement. Although liver enzymes are not listed in the labs here, the question implies liver enzyme elevation as a hallmark finding to confirm HELLP, which is essential to monitor. Hemolysis would typically manifest as anemia, but hemoglobin and hematocrit are near normal. Prompt recognition and further testing of liver enzymes (AST, ALT) are critical for diagnosis and management.

Rationale for incorrect Response 1 options:
Chorioamnionitis is an infection of the amniotic sac, usually presenting with fever, uterine tenderness, and elevated WBC, which are not present here. Gestational diabetes is characterized by hyperglycemia, but the client’s blood glucose is only mildly elevated and not diagnostic. Pyelonephritis involves urinary tract infection with systemic symptoms like fever and flank pain, absent in this case.

Rationale for incorrect Response 2 options:
Amniotic membrane status is unrelated here, as there is no rupture or infection evidence. Ketonuria reflects starvation or diabetes, which is not indicated. Blood glucose is only mildly elevated and insufficient to diagnose gestational diabetes or explain current symptoms.

Take home points:

• HELLP syndrome involves low platelets, elevated liver enzymes, and hemolysis, often with epigastric pain.
• Early lab monitoring including liver enzymes is vital for timely diagnosis.
• Elevated BUN, creatinine, and uric acid can signal renal impairment in HELLP.
• Differentiate HELLP from infections or gestational diabetes by clinical presentation and specific labs.