4, 5, 6
Phototherapy is the use of intense fluorescent lights to reduce serum bilirubin levels in the newborn. Adverse effects from treatment, such as eye damage, dehydration, or sensory deprivation, can occur. Interventions include exposing as much of the newborn's skin as possible; however, the genital area is covered. The newborn's eyes are also covered with eye shields or patches, ensuring that the eyelids are closed when shields or patches are applied. The shields or patches are removed at least once per shift to inspect the eyes for infection or irritation and to allow eye contact. The nurse measures the lamp energy output to ensure efficacy of the treatment (done with a special device known as a photometer), monitors skin temperature closely, and increases fluids to compensate for water loss. The newborn will have loose green stools and green-colored urine. The newborn's skin color is monitored with the fluorescent light turned off every 4 to 8 hours and is monitored for bronze baby syndrome, a grayish brown discoloration of the skin. The newborn is repositioned every 2 hours, and stimulation is provided. After treatment, the newborn is monitored for signs of hyperbilirubinemia because rebound elevations can occur after therapy is discontinued.
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Nurses can prevent evaporative heat loss in the newborn by
• Drying the baby after birth and wrapping the baby in a dry blanket
• Keeping the baby out of drafts and away from air conditioners
• Placing the baby away from the outside wall and the windows
•
Warming the stethoscope and nurse's hands before touching the baby
ANS: A
Feedback
A Because the infant is a wet with amniotic fluid and blood, heat loss by
evaporation occurs quickly.
What is a result of hypothermia in the newborn?
• Shivering to generate heat
• Decreased oxygen demands
• Increased glucose demands
• Decreased metabolic rate
Increased glucose demands
In hypothermia, the basal metabolic rate (BMR) is increased in an attempt to
compensate, thus requiring more glucose.
Heat loss by convection occurs when a newborn is
• Placed on a cold circumcision board
• Given a bath
• Placed in a drafty area of the room
• Wrapped in cool blankets
Placed in a drafty area of the room
Convection occurs when infants are exposed to cold air currents.
Which nursing action is designed to avoid unnecessary heat loss in the newborn?
• Place a blanket over the scale before weighing the infant.
• Maintain room temperature at 70° F.
• Undress the infant completely for assessments so they can be finished quickly.
• Take the rectal temperature every hour to detect early changes.
Place a blanket over the scale before weighing the infant.
A Padding the scale prevents heat loss from the infant to a cold surface by conduction.
A new mother states that her infant must be cold because the baby's hands and feet are blue. The nurse explains that this is a common and temporary condition called
• Acrocyanosis
• Erythema neonatorum
• Harlequin color
• Vernix caseosa
Acrocyanosis
Acrocyanosis, or the appearance of slightly
cyanotic hands and feet, is caused by vasomotor instability, capillary stasis, and a high hemoglobin level.
Acrocyanosis is normal and appears intermittently over the first 7 to 10 days.
vering.
What are modes of heat loss in the newborn? (Select all that apply)
• Perspiration
• Convection
• Radiation
• Conduction
• Urination
Convection
Radiation
Conduction
Convection, radiation, evaporation, and conduction are the four modes of heat loss in the newborn.
The shivering mechanism of heat production is rarely functioning in the newborn.
Nonshivering _____________ is accomplished primarily by metabolism of brown fat, which is unique to the newborn, and by increased metabolic activity in the brain, heart, and liver.
hermogenesis
Brown fat is located in superficial
deposits in the interscapular region and axillae, as well
as in deep deposits at the thoracic inlet, along the vertebral column and around the kidneys.
Brown fat has a richer vascular and nerve supply than ordinary fat. Heat produced by
intense lipid metabolic activity in brown fat can warm the newborn by increasing heat
production by as much as 100%.
The nurse's initial action when caring for an infant with a slightly decreased temperature is to
• Notify the physician immediately
• Wrap the infant in two warmed blankets and place a cap on the head
• Tell the mother that the infant must be kept in the nursery and observed for the next 4 hours
• Change the formula, because this is a sign of formula intolerance
Wrap the infant in two warmed blankets and place a cap on the head
Warmed blankets will help to increase the infant's temperature by conduction, and the cap will prevent further heat loss from the head.
To prevent heat loss after the infant is born the nurse's first action should be to
• Dry the infant
• Cover the infant with several warm blankets
• Assess the infant's body temperature
• Attain an Apgar score
Dry the infant
To reduce evaporative heat loss, the infant should be dried after birth.
A student nurse is bathing a 1-day-old neonate. At the end of the bath, the student takes the infant's temperature and notes that it is down 1 °F from his temperature prior to the bath. This drop in temperature may be caused by __________.
evaporation
Evaporation is air-drying of the skin that results in cooling. Drying the infant immediately when wet helps prevent loss of heat by evaporation.
The most important reason to protect the preterm infant from cold stress is that
• It could make respiratory distress syndrome worse
• Shivering to produce heat may use up too many calories
• A low temperature may make the infant less able to digest nutrients
• Cold decreases circulation to the extremities
It could make respiratory distress syndrome worse
Cold stress may interfere with the production of surfactant, making respiratory distress syndrome worse.
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