A nurse is caring for a client who is receiving oxytocin for induction of labor and notes late decelerations of the fetal heart rate on the monitor tracing. Which of the following actions should the nurse take?

Choice A rationale:
Swaddling the newborn with his legs extended is not the appropriate action for a newborn with neonatal abstinence syndrome (NAS). NAS occurs when a baby is born dependent on drugs, usually because the mother used opioids during pregnancy. Swaddling may provide some comfort, but extending the legs could increase discomfort and agitation.

Choice B rationale:
Scheduling larger volume feedings at less frequent intervals is not the correct approach for a newborn with NAS. These infants often have feeding difficulties and may require smaller, more frequent feedings to reduce the risk of aspiration.

Choice C rationale:
Maintaining eye contact with the newborn during feedings may not be well-tolerated by a baby with NAS. They can be irritable and easily overstimulated, and eye contact during feeding may exacerbate their agitation.

Choice D rationale:
Planning care to minimize handling of the newborn is the most appropriate action for a baby with NAS. These infants are sensitive to stimuli and can become agitated easily, so minimizing unnecessary handling helps reduce their distress.

The correct answer is D. Plan care to minimize handling of the newborn.

Here's why:

• Swaddling with legs extended: This is not recommended as it can be uncomfortable for the newborn and may exacerbate withdrawal symptoms.
• Larger volume feedings at less frequent intervals: This can be difficult for newborns with NAS due to their increased metabolic rate and may lead to overfeeding.
• Maintaining eye contact during feedings: While this is important for bonding, it can be overwhelming for newborns with NAS, who often prefer a calm environment.

Minimizing handling is a key intervention in caring for newborns with NAS. Excessive handling can trigger withdrawal symptoms and make the newborn more irritable. Instead, focus on gentle, soothing techniques like swaddling with arms tucked in, rocking, and providing a quiet, dimly lit environment.

The correct answer is c. Ampicillin.

Rationale:

• Group B Streptococcus (GBS) B-hemolyticis a bacterium that can colonize the vagina and rectum of pregnant women.While usually harmless to the mother,it can be passed to the newborn during birth and cause serious infections,including pneumonia,meningitis,and sepsis.
• Ampicillinis thefirst-line antibioticrecommended by the Centers for Disease Control and Prevention (CDC) for theprevention of GBS disease in newborns.It belongs to thepenicillin classof antibiotics,which are highly effective against GBS and generally well-tolerated by pregnant women and newborns.
• Doxycyclineis not recommended for GBS prophylaxis due to its poor penetration into amniotic fluid and potential for causing tooth discoloration and bone development problems in newborns.
• Cefotetanis an alternative option for women with penicillin allergy,but ampicillin is still preferred due to its lower cost and broader spectrum of activity against GBS strains.
• Fluconazoleis an antifungal medication and has no activity against GBS bacteria.

Detailed Rationale for Each Choice:

a. Doxycycline:

• Rationale against:
  • Poor penetration into amniotic fluid:Doxycycline does not effectively reach the amniotic sac,where the baby is surrounded,and therefore may not adequately protect the newborn from GBS infection.
  • Adverse effects in newborns:Doxycycline can cause tooth discoloration and bone development problems in infants exposed in utero.

b. Cefotetan:

• Rationale for:
  • Alternative for penicillin allergy:Cefotetan is a cephalosporin antibiotic effective against GBS and can be used in women with penicillin allergy.
• Rationale against:
  • Second-line option:Ampicillin is the preferred choice due to its lower cost and broader spectrum of activity against GBS strains.

c. Ampicillin:

• Rationale for:
  • First-line antibiotic:Ampicillin is the CDC-recommended first-line antibiotic for GBS prophylaxis due to its:
    • High effectiveness against GBS:Ampicillin has a broad spectrum of activity against GBS strains.
    • Good safety profile:Ampicillin is generally well-tolerated by pregnant women and newborns.
    • Cost-effectiveness:Ampicillin is a relatively inexpensive antibiotic compared to other options.

d. Fluconazole:

• Rationale against:
  • Antifungal medication:Fluconazole is an antifungal medication and has no activity against GBS,which is a bacterium.