A nurse is assisting in the care of a newborn who is 72 hours old and is receiving treatment for neonatal abstinence syndrome.

Exhibits

Which of the following data collection findings should the nurse identify as requiring immediate follow-up? (Select all that apply.).

Choice A reason:

Slow growth is a common symptom of thalassemia, especially in children. It is caused by the reduced production of hemoglobin and red blood cells, which leads to anemia and poor oxygen delivery to the tissues. Slow growth can also affect the development of facial bones and cause deformities.

Choice B reason:

Fatigue is another common symptom of thalassemia, also related to anemia and low oxygen levels in the body. People with thalassemia may feel tired, weak, and short of breath even after mild physical activity. Fatigue can also affect their mood, concentration, and quality of life.

Choice C reason:

Hematoma is not a typical symptom of thalassemia. Hematoma is a collection of blood under the skin or in an organ, usually caused by trauma, injury, or bleeding disorders. People with thalassemia may have a higher risk of bleeding due to low platelet counts or frequent blood transfusions, but this does not necessarily result in hematoma.

Choice D reason:

Pruritus is not a typical symptom of thalassemia. Pruritus is a sensation of itching that can affect any part of the body. It can have many causes, such as dry skin, allergies, infections, or liver problems. People with thalassemia may experience pruritus as a side effect of iron overload or iron chelation therapy, but it is not a direct consequence of the condition.

Choice E reason:

Ecchymoses are not typical symptoms of thalassemia. Ecchymoses are large bruises that appear on the skin due to bleeding under the surface. They can be caused by trauma, injury, or bleeding disorders. People with thalassemia may have a higher risk of bleeding due to low platelet counts or frequent blood transfusions, but this does not necessarily result in ecchymoses.

Choice A reason:

Hypoglycemia is a common complication for newborns whose mothers have diabetes mellitus. This is because the newborn's pancreas produces excessive insulin in response to the high glucose levels in the mother's blood during pregnancy. After birth, the newborn's glucose levels drop rapidly, while the insulin levels remain high, resulting in hypoglycemia. The nurse should monitor the newborn's blood glucose levels and signs of hypoglycemia, such as jitteriness, lethargy, poor feeding, and temperature instability.

Choice B reason:

Decreased RBC is not a likely complication for newborns whose mothers have diabetes mellitus. In fact, these newborns may have increased RBC due to chronic fetal hypoxia caused by placental insufficiency. The nurse should monitor the newborn's hematocrit and signs of polycythemia, such as ruddy skin, jaundice, and respiratory distress.

Choice C reason:

Hyperbilirubinemia is not a likely complication for newborns whose mothers have diabetes mellitus. In fact, these newborns may have increased bilirubin levels due to hemolysis of excess RBC and delayed hepatic clearance. The nurse should monitor the newborn's serum bilirubin levels and signs of jaundice, such as yellow skin and sclera, poor feeding, and lethargy.

Choice D reason:

Hypercalcemia is not a likely complication for newborns whose mothers have diabetes mellitus. In fact, these newborns may have hypocalcemia due to decreased parathyroid hormone secretion and increased calcium binding to albumin. The nurse should monitor the newborn's serum calcium levels and signs of hypocalcemia, such as jitteriness, tremors, seizures, and cardiac arrhythmias.