A nurse administered 400 mg of ibuprofen to a client 2 hr ago to treat pain following a biopsy. The client is crying and states. "It really still hurts a lot. Which of the following actions should the nurse take?

Rationale for Correct Choices

• Swaddle the newborn in a blanket: Swaddling helps reduce heat loss through convection and evaporation, which is essential for a preterm newborn who has limited brown fat and poor thermoregulation. Maintaining warmth helps stabilize respiratory effort and metabolic demand. It is appropriate because the newborn’s temperature is below normal and continues to trend low.

• Dry the newborn: Drying reduces evaporative heat loss, which is a major risk immediately after birth, especially for late-preterm infants. Removing moisture from the skin supports temperature stabilization and reduces metabolic stress. This action is essential when temperatures remain below 36.5° C.

• Monitor the newborn’s vital signs: Frequent monitoring helps detect changes in temperature, heart rate, and respiratory drive, all of which can fluctuate rapidly in late-preterm newborns. Continuous monitoring allows the nurse to evaluate whether interventions for temperature and oxygenation are effective.

• Place the newborn under a radiant warmer: A radiant warmer provides controlled heat to support thermoregulation in preterm newborns who cannot maintain temperature independently. With temperatures at 36° C and 36.4° C, thermoregulation support is indicated to prevent cold stress. Radiant warming also helps stabilize oxygenation and metabolic rate.

• Administer free-flow oxygen: The newborn’s oxygen saturation is low at 90–91% on room air, indicating mild respiratory compromise. Providing free-flow oxygen improves oxygenation without requiring invasive airway management. This is appropriate for a newborn with increased respiratory effort but stable heart rate.

• Clear airway using bulb suction: Bulb suctioning is appropriate if secretions contribute to increased respiratory rate or difficulty maintaining saturation. Clearing the airway helps remove mucus that may impair airflow in preterm newborns. It supports spontaneous breathing and improves oxygenation.

Rationale for Incorrect Choices

• Initiate chest compressions: Chest compressions are only indicated when the newborn’s heart rate is below 60/min after at least 30 seconds of effective ventilation. This newborn’s heart rate is between 124–144/min, which is well above the threshold for resuscitation. Chest compressions are unnecessary and inappropriate for this clinical status.

• Place the newborn in prone position: Prone positioning is not recommended for routine stabilization and can compromise airway patency in a newborn requiring continuous monitoring. Supine or side-lying positioning reduces risk of airway obstruction and allows optimal chest expansion. Prone positioning increases risk for respiratory compromise in the acute period.

A. Instill normal saline drops to nares before meals: Saline drops are used to loosen nasal secretions in conditions like the common cold or bronchiolitis. They do not address epiglottitis and are not a primary intervention for this life-threatening airway condition.

B. Perform chest percussion and postural drainage twice per day: Chest physiotherapy is indicated for conditions with increased pulmonary secretions, such as cystic fibrosis or pneumonia. Epiglottitis primarily affects the upper airway, so these interventions are not appropriate.

C. Initiate droplet precautions: Epiglottitis is often caused by Haemophilus influenzae type b and can be transmitted via respiratory droplets. Implementing droplet precautions protects healthcare workers and other clients from infection while the child receives care.

D. Administer pancreatic enzymes with meals: Pancreatic enzyme replacement is used in conditions like cystic fibrosis to aid digestion. It is unrelated to epiglottitis and does not address the acute respiratory risk posed by airway inflammation.