Reference no: EM133229133
Assessment and Management of a Newborn
You are working in the newborn nursery where you admit a newborn infant girl born via vaginal delivery two hours ago. As you perform your physical assessment of the newborn you find the following:
The infant's arms and legs are in moderate flexion with her fists clenched.
There is normal, spontaneous movement bilaterally asynchronous.
The heart rate is 120 beats per minute and you hear a murmur over the base of her sternal border in interspace 3-4.
Respirations are 18 and you hear crackles.
You also see the infant's abdomen and chest retract with an expiratory grunt.
The infant's weight is 2200 grams.
The axillary temperature is 36.2 degrees Celsius.
The newborn's skin color is pink except for blue hands and feet and a slight blue area around the nose and mouth.
When you check the neonate's umbilical cord, you note that there is one artery and one vein.
You also note a Mongolian spot on the infant's buttocks.
The infant passes meconium as you complete your examination.
You also complete your neuromuscular and physical maturity assessments in order to estimate the infant's gestational age. Upon completion, you note a maturity rating score of 30.
Included in the neonatologist's admission orders are several diagnostic tests including a PKU to be performed on day 2 of the infant's hospital stay and a bilirubin level to be completed and sent to lab stat.
Answer the following questions:
Based on the foregoing, which findings of the newborn's physical assessment are normal?
Based on the foregoing, which findings of the newborn's physical assessment deviate from normal?
For the findings that deviate from normal, what nursing intervention(s) are necessary, and why? Include any pertinent diagnostic tests that may apply to the deviations.
Why would a PKU test be ordered? What are the normal laboratory limits for the PKU test? What is one intervention for an abnormal PKU laboratory result?
Why would a bilirubin test be ordered? What are the normal laboratory limits for a bilirubin test at this age? What is one intervention for an abnormal bilirubin result that returns with a higher than normal result?
Of what significance is the maturity rating score of 30? Does that rating require additional nursing interventions and consideration to maximize the newborn's well-being? If so, what would the intervention(s) be, and why?
How would the nursing interventions change if the maturity rating score were 45 and the infant's weight were 4100 grams?
What maturity rating score would you expect to see if the infant was term?