Which of the following actions should a nurse take for a newborn who has herpes simplex virus as a result of in utero transmission?

Choice A reason: Dark, concentrated urine in a 5-day-old newborn indicates inadequate milk intake, as effective breastfeeding produces pale, dilute urine due to sufficient hydration. Breast milk provides water and nutrients, supporting renal function and urine output. This finding suggests dehydration, requiring intervention to ensure adequate feeding and prevent neonatal metabolic complications.

Choice B reason: Expecting only two to three wet diapers in 24 hours is inadequate for a 5-day-old breastfed newborn. Effective breastfeeding results in six to eight wet diapers daily, reflecting sufficient milk intake and hydration. Low diaper counts indicate poor feeding, risking dehydration and weight loss, which does not align with successful breastfeeding physiology.

Choice C reason: A tugging sensation during breastfeeding indicates effective latch and suckling, ensuring milk transfer. This sensation reflects the infant’s strong suck, stimulating milk ejection via oxytocin release. Proper latch promotes adequate nutrition and hydration, supporting neonatal growth and preventing dehydration, aligning with the physiological mechanics of successful breastfeeding.

Choice D reason: Breasts staying firm after breastfeeding suggests incomplete milk transfer, indicating ineffective feeding. Effective breastfeeding softens breasts due to milk removal, stimulated by infant suckling and oxytocin-mediated letdown. Firm breasts may signal poor latch or insufficient feeding frequency, risking engorgement or reduced milk supply, contrary to successful breastfeeding outcomes.

Choice A reason: Immediately bathing a newborn with herpes simplex virus (HSV) is not recommended, as it may spread lesions or increase infection risk. HSV, a viral infection, requires antiviral therapy, not bathing, to manage cutaneous lesions. Bathing could disrupt skin integrity, potentially exacerbating viral spread or secondary bacterial infections in a compromised neonate.

Choice B reason: Administering ampicillin, a bacterial antibiotic, is ineffective against HSV, a viral infection. Neonatal HSV requires antiviral drugs like acyclovir to target viral replication. Ampicillin addresses bacterial infections, such as group B streptococcus, but lacks efficacy against herpesviruses, making it an inappropriate treatment choice for this condition based on microbiological principles.

Choice C reason: Withholding breastfeeding is unnecessary unless active HSV lesions are present on the breast. HSV transmission via breast milk is rare, and breastfeeding supports neonatal immunity. If the mother has no active lesions, breastfeeding is safe with proper hygiene, as the virus primarily spreads through direct contact with lesions, not milk.

Choice D reason: Initiating contact precautions is critical for neonatal HSV, as the virus spreads through direct contact with lesions or secretions. Precautions, including gloves and gowns, prevent transmission to healthcare workers and other patients. HSV’s high infectivity in neonates, due to immature immunity, necessitates strict isolation to control viral spread in clinical settings.