The nurse in the newborn nursery is watchful for neonatal abstinence syndrome in the newborn of a crack-addicted mother.

What would be the manifestations of this syndrome? (Select all that apply.)

Choice A rationale

Molding is a temporary condition resulting from the fetal skull bones overlapping or shifting at the suture lines to navigate the narrow birth canal during labor. The fibrous, flexible sutures and fontanelles permit this adaptation. As the external pressure is removed, the fluid-filled spaces re-establish themselves, and the head shape gradually resolves within a few days or weeks as the bones return to their normal positions.

Choice B rationale

While the mode of delivery influences the degree of molding (more common and pronounced after vaginal birth), the immediate parental concern is reassurance and prognosis, not a history query. Molding is an expected, generally harmless physical finding after a vaginal delivery, and the nurse should prioritize education on the transient nature of this physiological process.

Choice C rationale

Although molding is generally benign and does not typically cause long-term neurological problems, this response is too dismissive and fails to provide the necessary scientific explanation and reassurance the mother is seeking. The best response explains the pathophysiology and expected resolution to alleviate anxiety effectively.

Choice D rationale

Associating molding with a "traumatic delivery" is incorrect and can unnecessarily alarm the mother. Molding is a physiological and protective adaptation of the fetal skull, not an indicator of trauma. A more accurate and supportive explanation focuses on the skull's normal capacity to conform to the birth canal pressure.

Choice A rationale

Adjusting the Pavlik harness straps is contraindicated, as the healthcare provider specifically set them to maintain the infant's hips in the optimal position of flexion and abduction, necessary for proper acetabular development. Frequent adjustment risks altering the prescribed angle, which could compromise treatment efficacy by allowing hip adduction or extension. Straps should only be adjusted by the provider during scheduled appointments to ensure optimal orthopaedic correction and joint congruence.

Choice B rationale

The Pavlik harness is designed to hold the femoral head within the acetabulum, promoting proper development but creating localized pressure points. Regular skin checks (e.g., three times daily or with diaper changes) are vital to detect signs of skin breakdown, redness, or irritation, especially under the straps and at pressure areas like the popliteal folds, which could lead to pressure ulcers or dermatitis if not addressed promptly by adjusting the padding or seeking provider consultation.

Choice C rationale

The diaper must be placed under the harness straps to prevent fecal or urinary soiling of the harness material, maintaining hygiene and preventing skin irritation from moisture trapped by the harness. Placing the diaper over the harness would necessitate unbuckling the leg straps for each change, which could disrupt the precisely set hip position required for therapeutic hip abduction and flexion.

Choice D rationale

Lotions and powders should be avoided under the harness or on skin areas in contact with the straps. These products can clump or retain moisture, leading to maceration and increased friction, which predisposes the skin to breakdown, dermatitis, and potential infection. Skin in contact with the harness should be kept clean and dry, allowing aeration to maintain skin integrity.