A newborn with a repaired gastroschisis is transferred to the pediatric unit after several days in the pediatric intensive care unit. The infant is receiving parenteral nutrition and continuous enteral feedings. To maintain normal growth and development of the infant, which action should the nurse include in plan of care?
Ensure placement of the enteral tube with an abdominal x-ray.
Speak to the healthcare provider about instituting physical therapy.
Offer a pacifier for non-nutritive sucking.
Use sterile technique during feedings.
The Correct Answer is C
A. Ensure placement of the enteral tube with an abdominal x-ray: Verifying enteral tube placement is essential for safety, but it is not related to maintaining the newborn's growth and development. Tube placement should already have been verified prior to initiating feedings.
B. Speak to the healthcare provider about instituting physical therapy: Physical therapy may be beneficial for infants with specific motor delays, but it is not a routine intervention for all infants recovering from gastroschisis.
C. Offer a pacifier for non-nutritive sucking: Non-nutritive sucking (e.g., using a pacifier) is crucial for the growth and development of newborns, especially those unable to feed orally. It helps promote oral-motor development, soothes the infant, and lays the foundation for transitioning to oral feeding. This is particularly important for an infant receiving parenteral or enteral nutrition to ensure they develop the skills and comfort needed for future oral feeding.
D. Use sterile technique during feedings: Clean technique is generally sufficient or routine enteral feedings unless there is a specific indication for sterility (e.g., immunocompromised clients). Further, this does not directly support growth and development.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Reactions to any previous hospitalizations can provide some insight into the child's previous healthcare experiences, but it may not be as directly relevant to planning care for an umbilical hernia repair.
B. A history of rubella, rubeola, or chicken pox is important for the child's medical history, but it may not be the most critical information when planning care for an umbilical hernia repair.
C. The mother's use of alcohol, drugs, or cigarettes during pregnancy is particularly relevant when planning care for a child undergoing surgery, as it can affect the child's overall health and potential complications during and after the procedure. Exposure to these substances during pregnancy can lead to various health issues that need to be considered in the child's care plan.
D. A list of achievement timeline for developmental milestones is important for understanding the child's developmental progress, but it may not be the primary consideration when planning care for an umbilical hernia repair.
Correct Answer is D
Explanation
A. Plays "peek-a-boo."
This is a social and cognitive milestone. Infants typically develop social interactions like peek-a-boo around 6-9 months of age. This behavior is normal for a 6-month-old and demonstrates social engagement.
B. Has doubled birth weight.
Infants generally double their birth weight by around 6 months of age. This is a typical growth and developmental milestone, indicating adequate nutrition and growth.
C. Turns head to locate sound.
This is a normal developmental milestone for an infant. By 6 months of age, infants should demonstrate localization of sounds, indicating appropriate auditory and neurological development.
D. Demonstrates startle reflex.
The startle reflex, also known as the Moro reflex, is normal in newborns but typically disappears by 3-6 months of age. If a 6-month-old still exhibits this reflex, it could be a sign of delayed neurological development and might require further evaluation.
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