The Health Care Provider orders gentamicin (Garamycin) for a 2-day old newborn whose weight is 1,653 grams and 38 centimeters long.

The drug reference states neonatal dosage of gentamicin for infants less than 1 week of age is 2.5 mg/kg every 12-24 hours.

The nurse would expect to administer which following safe, daily dosages for this medication? Round your answer to 2 decimal places.

Choice A rationale

Preterm newborns actually have a relatively larger body surface area compared to their body weight than full-term infants. This increased surface-to-mass ratio is a significant factor contributing to their rapid and excessive heat loss because a greater proportion of the heat-producing tissue is exposed to the environment, making it harder to maintain a stable core temperature.

Choice B rationale

The primary mechanism for nonshivering thermogenesis in newborns involves the metabolism of brown adipose tissue (brown fat). While a preterm newborn may have some brown fat, the amount is significantly less developed and less accumulated compared to a term infant, which, coupled with poor muscle tone, severely reduces their capacity to generate and maintain sufficient heat.

Choice C rationale

Preterm newborns are highly susceptible to cold stress because their central nervous system temperature control mechanisms are immature and inefficient. They lack the necessary muscle tone for flexion, have minimal subcutaneous fat for insulation, possess a thin skin barrier, and have inadequate brown fat reserves, all of which contribute to an inability to maintain a neutral thermal environment without external support.

Choice D rationale

Heat loss via evaporation occurs when moisture on the skin (like amniotic fluid, or from insensible water loss) converts to vapor. While the thin skin of a preterm newborn does lead to increased insensible water loss, the primary reason for placing them in an incubator is to counteract the combined effects of reduced heat production and increased heat loss via convection, radiation, and conduction, not merely to dry sweat. —.

Choice A rationale

Hemophilia A is a hereditary bleeding disorder caused by a deficiency in coagulation factor VIII. Administering factor X would not correct the underlying deficiency responsible for the child's impaired clot formation, as factor X is a different component of the coagulation cascade and is deficient in factor X deficiency, a distinct disorder.

Choice B rationale

Iron is a crucial component of hemoglobin, and an intravenous infusion of iron is indicated for treating severe iron deficiency anemia. While a child with repeated bleeding episodes could develop anemia, the immediate priority for an acute joint or soft tissue bleed in hemophilia is replacing the deficient clotting factor to stop the hemorrhage.

Choice C rationale

The immediate and definitive treatment for acute bleeding episodes in a child with hemophilia A is the intravenous infusion of the deficient clotting factor, which is factor VIII. Prompt administration helps to control the bleeding into the joint (hemarthrosis), preventing long-term damage and pain.

Choice D rationale

Intramuscular injections are strongly contraindicated in individuals with hemophilia because they pose a significant risk of causing a deep, painful hematoma due to uncontrolled bleeding into the muscle tissue. Iron administration, if needed, should be given orally or intravenously, but not intramuscularly.