A newborn has meconium aspiration at birth. The nurse notes increasing respiratory distress. What action takes priority?

Choice a) 100 to 120 is incorrect because this is too low for a normal newborn's heart rate. The heart rate of a newborn is influenced by factors such as gestational age, activity level, temperature, and health status. A full-term, quiet, alert newborn should have a heart rate between 120 and 160 beats per minute, which reflects their high metabolic rate and oxygen demand. A heart rate below 100 beats per minute may indicate bradycardia, which can be caused by hypoxia, hypothermia, or cardiac problems.

Choice b) 120 to 160 is correct because this is the normal range for a full-term, quiet, alert newborn's heart rate. The apical pulse is the best way to measure the heart rate of a newborn, as it reflects the actual contractions of the heart. The apical pulse can be auscultated at the fourth intercostal space on the left side of the chest, just below the nipple line. The nurse should count the apical pulse for a full minute, as it may vary with the respiratory cycle.

Choice c) 80 to 100 is incorrect because this is also too low for a normal newborn's heart rate. A full-term, quiet, alert newborn should have a heart rate between 120 and 160 beats per minute, which is higher than that of an adult or an older child. A heart rate below 100 beats per minute may indicate bradycardia, which can be caused by hypoxia, hypothermia, or cardiac problems.

Choice d) 150 to 180 is incorrect because this is too high for a normal newborn's heart rate. A full-term, quiet, alert newborn should have a heart rate between 120 and 160 beats per minute, which is lower than that of a preterm or a crying newborn. A heart rate above 160 beats per minute may indicate tachycardia, which can be caused by fever, infection, anemia, or hyperthyroidism.

Choice A) Spending extra time holding and rocking the infant is correct because this is an effective and recommended nursing care for an infant with neonatal abstinence syndrome. Neonatal abstinence syndrome (NAS) is a condition that occurs when an infant is exposed to drugs such as opioids, cocaine, or alcohol in utero and goes through withdrawal after birth. NAS can cause various physical and behavioral problems in the infant, such as irritability, poor feeding, vomiting, diarrhea, sweating, fever, or seizures. Holding and rocking the infant can provide comfort, warmth, and security to the infant, as well as reduce stress and pain. It can also promote bonding and attachment between the infant and the caregiver. Therefore, this nursing care should be included in the care plan for an infant with NAS.

Choice B) Feeding the infant on a 2-hour schedule is incorrect because this is not a helpful or appropriate nursing care for an infant with neonatal abstinence syndrome. Feeding is an important aspect of caring for any infant, as it provides nutrients and calories that support growth and development. However, feeding an infant with NAS on a 2- hour schedule may not be suitable or feasible, as NAS can affect the infant's feeding ability and tolerance. An infant with NAS may have difficulty sucking, swallowing, or coordinating breathing during feeding. They may also have frequent vomiting, diarrhea, or dehydration that can interfere with feeding. Therefore, feeding an infant with NAS should be done according to their cues and needs, rather than a fixed schedule. The infant should be offered small, frequent feedings of breast milk or formula, depending on the mother's preference and availability. The infant should also be burped often and held upright after feeding to prevent aspiration or reflux.

Choice C) Positioning the infant's crib in a quiet corner of the nursery is incorrect because this is not a sufficient or optimal nursing care for an infant with neonatal abstinence syndrome. Positioning is an important aspect of caring for any infant, as it affects their comfort, safety, and development. However, positioning an infant with NAS in a quiet corner of the nursery may not be enough or beneficial, as NAS can make the infant more sensitive and responsive to environmental stimuli. An infant with NAS may be easily disturbed or overstimulated by noise, light, or movement in the nursery. They may also feel isolated or neglected if they are placed away from other infants or caregivers.

Therefore, positioning an infant with NAS should be done in a way that minimizes stimulation and maximizes interaction. The crib should be placed in a dimly lit, low noise area of the nursery, but close enough to allow frequent monitoring and contact by the nurse. The crib should also be padded with soft blankets or pillows to prevent injury from excessive movements or seizures.

Choice D) Placing stuffed animals and mobiles in the crib to provide visual stimulation is incorrect because this is not a safe or suitable nursing care for an infant with neonatal abstinence syndrome. Stimulation is an important aspect of caring for any infant, as it enhances their learning and development. However, stimulating an infant with NAS with stuffed animals and mobiles may not be appropriate or advisable, as NAS can make the infant more irritable and restless. An infant with NAS may not enjoy or tolerate visual stimulation from toys or objects in their crib. They may also become agitated or overexcited by them, which can worsen their symptoms or cause complications. Moreover, placing stuffed animals and mobiles in the crib can pose a risk of suffocation, strangulation, or injury for the infant. Therefore, stimulating an infant with NAS should be done in a way that is gentle and gradual. The nurse should use soothing techniques such as talking softly, singing lullabies, or massaging the infant's skin to calm them down. The nurse should also use simple toys such as rattles or balls to engage them in play when they are alert and interested.