Which is true about newborns classified as small for gestational age (SGA)?

Choice A) Weight gain of 0.5 kg during the past 2 weeks: This is a normal weight gain for a pregnant woman and does not indicate preeclampsia.

Choice B) Pitting pedal edema at the end of the day: This is a common symptom of pregnancy and does not necessarily indicate preeclampsia. It can be relieved by elevating the legs and wearing compression stockings.

Choice C) Blood pressure increase to 138/86 mm Hg: This is a mild elevation of blood pressure and does not meet the criteria for preeclampsia, which is defined as a systolic blood pressure of 140 mm Hg or higher or a diastolic blood pressure of 90 mm Hg or higher on two occasions at least four hours apart.

Choice D) Dipstick value of 3+ for protein in her urine: This is a sign of significant proteinuria, which is one of the main features of preeclampsia. Proteinuria is defined as a urinary protein excretion of 300 mg or more in 24 hours or a dipstick reading of 1+ or higher. A dipstick value of 3+ indicates severe proteinuria and requires immediate attention and treatment. This woman has the highest risk of developing complications from preeclampsia, such as eclampsia, HELLP syndrome, placental abruption, or fetal growth restriction . Therefore, she should be seen by the nurse first.

Choice A) Increase oral intake of water between feedings is incorrect because this is not a helpful or recommended measure to help reduce the bilirubin in a newborn who is receiving phototherapy. Bilirubin is a yellow pigment that is produced when red blood cells are broken down. It is normally excreted by the liver into bile and then eliminated by the intestines. However, some newborns have high levels of bilirubin in their blood, which can cause jaundice, a condition that makes the skin and eyes look yellow. Phototherapy is a treatment that uses blue light to help break down the bilirubin and make it easier for the liver to process. Increasing oral intake of water between feedings does not have any effect on the bilirubin level, as water does not contain any nutrients or calories that can stimulate the liver or bowel function. Moreover, giving water to a newborn can cause hyponatremia, which is a low level of sodium in the blood that can lead to seizures, brain damage, or death. Therefore, this measure should be avoided or used with caution for newborns who are receiving phototherapy.

Choice B) Wrap the infant in triple blankets to prevent cold stress during phototherapy is incorrect because this is not a safe or appropriate measure to help reduce the bilirubin in a newborn who is receiving phototherapy. Cold stress is a condition that occurs when a newborn loses too much heat and has difficulty maintaining a normal body temperature. It can cause complications such as hypoglycemia, hypoxia, acidosis, or bleeding. Wrapping the infant in triple blankets may seem like a good way to prevent cold stress, but it can actually cause overheating, dehydration, or hyperthermia, which are equally dangerous for the newborn. Moreover, wrapping the infant in blankets can reduce the effectiveness of phototherapy, as it blocks the exposure of the skin to the blue light. Therefore, this measure should be avoided or used with caution for newborns who are receiving phototherapy.

Choice C) How to prepare the newborn for an exchange transfusion is incorrect because this is not a relevant or necessary measure to help reduce the bilirubin in a newborn who is receiving phototherapy. An exchange transfusion is a procedure that involves replacing some of the newborn's blood with donor blood to lower the bilirubin level and prevent brain damage. It is usually reserved for severe cases of jaundice that do not respond to phototherapy or other treatments. Preparing the newborn for an exchange transfusion involves obtaining informed consent from the parents, placing an umbilical venous catheter, monitoring vital signs and blood tests, and administering medications and fluids. However, these steps are not part of routine care for newborns who are receiving phototherapy, and they do not help to reduce the bilirubin level by themselves. Therefore, this measure should be done only when indicated by the physician and explained by the nurse.

Choice D) Increase the frequency of feedings is correct because this is an effective and recommended measure to help reduce the bilirubin in a newborn who is receiving phototherapy. Feeding provides nutrients and calories that can stimulate the liver and bowel function, which are essential for processing and eliminating bilirubin from the body. Feeding also helps to prevent dehydration, which can worsen jaundice and increase the risk of complications.

Feeding can be done by breast milk or formula, depending on the mother's preference and availability. The frequency of feedings should be increased to at least every 2 to 3 hours or on demand, as long as the newborn shows signs of hunger and satisfaction. Therefore, this measure should be encouraged and supported by the nurse for newborns who are receiving phototherapy.