You are assessing the baby and notice that their hands and feet are bluish-purple. You:

Don't do anything, this is a normal finding

Check the infant's 02 sat

Call the MD for referral

Put socks and mittens on the infant to keep them warm

Answer and Explanation

The Correct Answer is B

A) Don't do anything, this is a normal finding:
While it's true that acrocyanosis (bluish-purple discoloration of the hands and feet) can be a normal finding in the first 24-48 hours of life due to immature circulation, it’s important to assess the severity of the condition and rule out more serious causes. Just ignoring it without assessing the infant’s oxygenation status could lead to missing a potential respiratory issue.

B) Check the infant's O2 sat:
The most appropriate action is to assess the infant’s oxygen saturation levels. Acrocyanosis is typically benign and resolves on its own, but persistent cyanosis or a drop in oxygen saturation could indicate a more serious issue, such as respiratory distress or congenital heart disease. A pulse oximeter is a non-invasive tool that can help determine whether the infant’s oxygenation is adequate. This would help guide further clinical decisions.
C) Call the MD for referral:
Calling the doctor should only be considered if the baby’s oxygen saturation levels are low, or if other concerning symptoms (like poor feeding, lethargy, or significant difficulty breathing) are present. If the O2 saturation is normal, there’s no immediate need for referral. The key is to assess first before escalating to the provider.

D) Put socks and mittens on the infant to keep them warm:
Although providing warmth can help with maintaining body temperature, simply putting socks and mittens on the baby is not sufficient to rule out respiratory issues or other causes of cyanosis. If the infant’s oxygen saturation is normal and the baby is otherwise stable, this may be appropriate. However, checking the O2 saturation first is the correct step to ensure that no underlying respiratory problems are contributing to the cyanosis.

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Correct Answer is A

Explanation

A) Dry the infant thoroughly and place on mom skin to skin:
The priority intervention for a newborn immediately after birth is to dry the infant thoroughly and promote skin-to-skin contact with the mother. Drying the infant helps prevent heat loss, a major concern for newborns as they are at risk of hypothermia due to their large body surface area relative to their weight. Skin-to-skin contact not only helps maintain the newborn's body temperature but also promotes bonding, regulates heart rate, and supports breastfeeding initiation. This is the most critical step in the immediate post-birth period.
B) Determine Apgar Score:
While assessing the newborn with the Apgar score is an important task, it is usually done within the first minute and five minutes after birth. However, ensuring the infant’s warmth and stability by drying and placing the baby on the mother's chest should take priority. The Apgar score can be recorded after ensuring that the newborn is stable and appropriately warmed.

C) Encourage mother to begin breastfeeding:
Encouraging breastfeeding is an important aspect of newborn care, as it provides essential nutrients and promotes bonding. However, skin-to-skin contact and ensuring the infant is warm and stable take precedence over breastfeeding initiation. Once the baby is stable and has been dried and placed on the mother’s chest, breastfeeding can begin naturally.

D) Administer medication for eye prophylaxis:
Administering eye prophylaxis (typically erythromycin or tetracycline ointment) is important to prevent neonatal conjunctivitis caused by gonorrhea or chlamydia. However, this is a secondary concern compared to maintaining the newborn's temperature and ensuring initial bonding. The medication can be administered after the initial stabilizing interventions have been completed.

A. Excessive uterine bleeding B. A bladder rupture C. Bladder wall atony D. Urinary tract infection

Correct Answer is A

Explanation

A) Excessive uterine bleeding: A distended bladder can cause the uterus to become displaced to the right, preventing it from contracting effectively. This lack of uterine contraction can lead to uterine atony, which is a significant risk factor for excessive postpartum bleeding. When the uterus cannot contract well, it may result in continued
hemorrhage, which is a serious and immediate concern for postpartum patients.

B) A bladder rupture: While bladder rupture is a rare and severe complication, it is unlikely to occur in this situation. Bladder distention is a concern, but the most immediate danger is related to the uterus, not the bladder itself. A rupture would require significant trauma or extreme overdistention of the bladder, neither of which are described here.
C) Bladder wall atony: Bladder wall atony, where the bladder loses its ability to contract and expel urine, is not the most serious immediate consequence of bladder distention postpartum. While it may be uncomfortable and problematic, the main concern in this scenario is how bladder distention affects uterine contraction, which can lead to excessive bleeding.

D) Urinary tract infection: Although urinary retention can increase the risk of urinary tract infections (UTIs) due to incomplete bladder emptying, this is a less immediate and life-threatening concern compared to excessive bleeding. The primary concern in the immediate postpartum period is the potential for hemorrhage from uterine atony, which is worsened by bladder distention.

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