A nurse in a community clinic is caring for a 4-year-old child.

Exhibits

Which of the following findings should the nurse identify as long-term complications of elevated lead levels? Select all that apply.

Choice A reason: Leather-soled shoes can be slippery and are not recommended for use with crutches.

Choice B reason: Leaning forward can cause imbalance and is not a safe practice while using crutches.

Choice C reason: Wiping the rubber crutch tips to remove moisture is important to prevent slipping and ensure safety.

Choice D reason: Supporting body weight on the axillae can cause nerve damage; weight should be supported by the hands.

Nurses’ Notes:

3 weeks old:

Follow-up newborn weight check. Parent is smoking a cigarette in the living room while the infant sleeps. Parent reports the newborn is breastfeeding well. The newborn is asleep in their bassinet in the living room. Newborn currently asleep in prone position. Parent reports that the newborn sleeps in their bassinet in the parents’ bedroom overnight.

Vital Signs:

3 weeks old:

Temperature: 36.9°C (98.4°F) Heart rate: 138/min Respiratory rate: 42/min

The two findings from the nurse's notes that require further intervention:

Parent Smoking in Presence of Newborn and Newborn Asleep in Prone Position

Parent is smoking a cigarette in the living room while the infant sleeps.: Exposure to secondhand smoke is particularly harmful to infants, as their lungs are still developing. It can lead to severe health problems such as breathing difficulties, bad colds, respiratory issues, and delayed physical and mental development. More critically, it increases the risk of sudden infant death syndrome (SIDS). Therefore, it is imperative to educate the parent about the dangers of smoking around the newborn and to ensure that the infant is kept in a smoke-free environment.

Newborn currently asleep in prone position.: The safest sleeping position for a newborn is on their back, as recommended by the American Academy of Pediatrics (AAP). This position has been shown to reduce the incidence of SIDS. Sleeping in a prone position (on the stomach) can lead to less oxygen and more carbon dioxide re-breathing, which can be dangerous for the infant. The nurse should advise the parent to always place the newborn on their back to sleep, for naps and at night, to minimize the risk of SIDS.

The vital signs provided do not indicate any immediate concerns, as the temperature, heart rate, and respiratory rate are within normal ranges for a 3-week-old infant. However, the environmental factors noted in the nurse's observations are significant and require prompt attention.