A nurse assesses a newborn's lab values and notes a WBC of 28,000 mm³. What action by the nurse is best?

Choice A rationale

While documenting findings is a crucial nursing responsibility, a white blood cell count of 28,000 mm³ in a newborn is significantly elevated. The normal range for a newborn's WBC count is typically between 9,000 to 30,000 mm³, but a value at the higher end or exceeding this range warrants further investigation to rule out infection or other underlying conditions. Simply documenting without further action could delay necessary interventions.

Choice B rationale

A WBC count of 28,000 mm³ in a newborn raises suspicion for neonatal sepsis, a serious bloodstream infection. Unit protocols for a sepsis workup typically involve obtaining blood cultures, a complete blood count with differential, and potentially a lumbar puncture and chest X-ray to identify the source and extent of infection. Prompt initiation of these measures is critical for timely diagnosis and treatment, improving the newborn's prognosis.

Choice C rationale

Taking vital signs is a standard nursing assessment, but in the presence of an abnormal lab value suggestive of a serious condition like sepsis, it is insufficient as the sole action. While changes in vital signs can indicate infection, they may not be present in the early stages. Notifying the provider is necessary, but initiating a sepsis workup concurrently based on unit protocol allows for quicker diagnostic evaluation.

Choice D rationale

A heel stick for a bedside blood glucose reading is indicated for assessing hypoglycemia, a common concern in newborns, particularly those at risk. However, it does not directly address the significantly elevated WBC count. While infection can sometimes affect blood glucose levels, this test would not provide information about the potential underlying cause of the leukocytosis.

Choice A rationale

Wrapping the baby in warmed blankets addresses heat loss through conduction (direct contact with a cooler surface) and radiation (heat transfer to cooler surroundings). While helpful for maintaining warmth, it does not directly prevent heat loss from convection.

Choice B rationale

Convection is the loss of heat to cooler air currents moving across the skin surface. A blowing fan increases the rate of convective heat loss by continuously moving cooler air over the newborn. Moving the infant away from a blowing fan minimizes this heat transfer mechanism, thus preventing heat loss from convection.

Choice C rationale

Drying the baby after a bath primarily prevents heat loss through evaporation, as the evaporation of water from the skin surface cools the body. While important for thermoregulation, it does not directly address convective heat loss.

Choice D rationale

Placing the baby in a warmer, such as a radiant warmer, primarily prevents heat loss through radiation by providing a warm surface that emits infrared heat towards the infant. It also helps maintain the ambient air temperature, indirectly reducing convective heat loss, but moving away from a direct air current is the most direct way to prevent convection.