Faqs W Ans (Potts 07FAQ)

Frequently Asked Questions

In tears, Mrs. Sojo brought her 2-week-old infant into the emergency department of the local community hospital. She was sure the baby had a tumor in his head, and she exclaimed, “Just look at how big it is!” What is the best response the nurse can give her and other mothers concerned about their newborn’s appearance?

Unlike many pictures or photos of newborns with perfectly round heads and open engaging smiles, the actual appearance of newborns can be somewhat startling when the head may appear out of proportion to the body and have dents or be misshapen, due to the labor and delivery process. Parents need to be reassured that these “abnormalities” will change over time and that the infant will assume the appearance of the “normal” infant. Parents are often also concerned about the infant’s “soft spot,” as they worry about causing injuries or that it will close either too soon or not soon enough. This provides the nurse with an opportunity for teaching about safety, other newborn cares, and physiological adaptations, such as skin changes and hair overgrowth.

Working in the newborn intensive care unit (NBICU) presents many challenges. Consider the following circumstances. Joshua Robinson was born at 36 weeks’ gestation, which is premature. Although his weight is not severely compromised, he is small and is having a difficult time keeping his temperature and glucose up. He is in a newborn intensive care unit (NBICU) with a temperature probe and cardiac-respiratory monitor on. Joshua is the son of a rabbi, and his parents want him to be circumcised on his 8th day in a religious ceremony. How will you respond to their request?

The tradition of male Jewish newborns being circumcised on the 8th day of life during a religious ceremony is very important. The traditional person to perform the ceremony is the mohel. The first step in responding to this request is to be open-minded regarding this very important religious procedure. Next, carry out a discussion with the physician to determine the infant’s health status. If Joshua’s heath status is stable, you can arrange a location and time for the ceremony with nursing and physician support on standby. You might also ask about specific cares related to the ceremony that would need to be considered and if necessary, modified while Joshua is in the NBICU.

Mary Adams, a 22-year-old first-time mother, is inquiring about breastfeeding. She asks, “What are the benefits from breastfeeding?”

Many mothers have questions regarding whether or not they should breastfeed. The American Academy of Pediatrics recommends that mothers breastfeed their infants for the first 6 to 12 months of life. Breastfeeding can also be advantageous because breast milk:

· is easily digested

· has antibodies and immunoglobulin to many types of organisms

· has fat that is well absorbed

· is cost-effective

· requires no sterilization

· is the correct temperature

However, many mothers choose to bottle feed their infants with commercial formulas that adequately provide for the baby’s nutritional needs. An important consideration is to provide information and encourage mothers to make the decision that best fits their life and family—those who choose not to breastfeed should not be made to feel guilty. It is also important to educate mothers not to use cow’s milk unless recommended by the physician (usually when the infant is at least 12 months of age).

Mrs. James has brought her 3-week-old daughter into the clinic because she fell off the couch. Mrs. James is very concerned. What are important safety ideas that should be presented to Mrs. James at this time?

Although a 3-week-old is less mobile than a 2-year-old, she is still able to move and can wiggle into a variety of positions. Major safety education should include ideas on safe positioning to prevent falls (e.g., keep infant in a crib with the side rails up, keep one hand on the infant at all times when infant is on top of areas like a couch or changing table), preventing water dangers (e.g., never leave infant unattended while bathing, test the water temperature to prevent burns), placing baby face up for sleeping, keeping the baby’s environment free of items that might put them at risk for suffocation, and selecting a safe pacifier.

Mrs. Hernandez has scheduled her son’s first well-child care visit. Miguel was born at home with a lay midwife 3 days ago. You, the registered nurse, suggest that Miguel receive the scheduled newborn vaccinations as well as the newborn screenings that are usually done in the hospital. She states she doesn’t think her son needs these “things.” What should your response be?

Shortly after birth, infants born in the hospital receive mandatory ophthalmic (eye) drops or ointment to prevent blindness from gonorrhea as well as an administration of vitamin K to prevent hemorrhagic disease. Other required screenings include a blood test to rule out phenylketonuria (PKU) and hypothyroidism. (Other screenings may also be required depending upon the state of occupancy.) It is important to also administer immunizations to promote disease resistance and to promote wellness. In your role as the registered nurse, it is important to obtain additional information to more clearly determine why Mrs. Hernandez is refusing these important preventive measures. Once you have clearly identified what she does and doesn’t know, provide the appropriate education and as necessary, the resources to facilitate Miguel receiving these important preventive measures.