A nurse is assessing a 4 hr old newborn who is to breastfeed and notes hands and feet that are cool and slightly blue What action should the nurse
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a. check the newborns temp using temporal thermometer
b. place the naked newborn on the mothers bare chest and cover both with a blanket
c. apply an o2 hood over the newborns head and neck
d. give the newborn glucose water between feedings correct answers b. place the naked newborn on the mothers bare chest and cover both with a blanket
Exposure to a cool environment causes vasoconstriction, which results in cool extremities with a bluish discoloration. Placing the newborn skin-to-skin with his mother helps stabilize his temperature and promotes bonding.
A nurse is caring for a newborn immediately following delivery. What actions should the nurse take first?
a. place the newborn directly on the client's chest
b. administer erythromycin ophthalmic ointment
c. give the newborn vit K IM
d. perform a detailed physical assessment correct answers a. place the newborn directly on the client's chest
The nurse should apply the safety and risk reduction priority-setting framework when caring for this client. This framework assigns priority to the factor or situation posing the greatest safety risk to the client. When there are several risks to client safety, the one posing the greatest threat is the highest priority. The nurse should use Maslow's Hierarchy of Needs, the ABC priority-setting framework, or nursing knowledge to identify which risk poses the greatest threat to the client. Therefore, the greatest risk to the newborn is cold stress, which increases the need for oxygen and glucose. Placing the newborn directly on the client's chest will help maintain the newborn's temperature.
A nurse is planning care for a newborn who is receiving phototherapy for an elevated bilirubin level. What action should the nurse take?
a. apply barrier ointment to the newborn's perianal region
b. offer the newborn glucose water between feedings
c. use photometer to monitor the lamp's energy
d. keep the newborn's eye patches on during feedings correct answers c. use photometer to monitor the lamp's energy
the nurse should monitor the lamp's energy throughout the therapy to ensure the newborn is receiving the appropriate amount to be effective [Show Less]