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A nurse is caring for a neonate in the neonatal intensive care unit. Q122

Exhibits

Which findings in the client's electronic medical record (EMR) are risk factors for the client developing a complication? Select all that apply.

A.

Abdominal circumference

B.

Gestational age

C.

Respiratory distress

D.

UAC

E.

Feeding method

F.

5-minute Apgar score

Answer and Explanation

Correct Answer : A,B,C,D

A. Abdominal circumference: The increase in abdominal circumference by 1 cm (0.4 in) since the prior assessment is concerning and may indicate a complication such as abdominal distension, which could be a sign of necrotizing enterocolitis (NEC) or other gastrointestinal issues. NEC is a serious condition that is common in preterm infants, especially those receiving enteral feedings.

B. Gestational age: Being born at 34 weeks gestation is a significant risk factor. Prematurity increases the risk for complications like respiratory distress syndrome (RDS), infections, and feeding difficulties. Preterm infants are also at risk for problems with thermoregulation, which is why the neonate is on a radiant warmer.

C. Respiratory distress: The presence of substernal retractions, nasal flaring, and an elevated respiratory rate (70/min) indicates respiratory distress. Preterm neonates, especially those born at 34 weeks, are at risk for RDS due to insufficient surfactant production, which can lead to difficulty breathing and hypoxemia.

D. UAC: The umbilical arterial catheter (UAC) is commonly used for monitoring blood pressure and obtaining blood samples in neonates. However, it carries a risk for complications such as infection, thrombosis, and injury to blood vessels. This is an invasive device that could contribute to complications.

E. Feeding method (Continuous breast milk feedings via OG tube): Although feeding via an orogastric tube is a standard method for preterm neonates, it does not pose an immediate risk factor in this case. The method of feeding itself is not a complication risk. However, complications like feeding intolerance or aspiration can arise, which would require further monitoring.

G. 5-minute Apgar score: A 5-minute Apgar score of 7 is considered an acceptable score for a neonate. Although it indicates some initial difficulty, this score does not present a significant risk factor for complications by itself. A lower score would be more concerning, but a score of 7 typically suggests the neonate is transitioning well.


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Related Questions

Correct Answer is []

Explanation

Potential condition: Deep vein thrombosis

Based on the provided information, the client is most likely experiencing Deep Vein Thrombosis (DVT). This is suggested by the client's history of smoking, lack of exercise, obesity, recent surgery, and the fact that they are not wearing sequential compression devices due to discomfort.

Actions to Take

  1. Request a prescription for a lower-extremity Doppler flow study: This will help confirm the presence of a blood clot in the deep veins.
  2. Assess for Homan's sign: This is a clinical test used to check for DVT, although it's not always reliable.

Parameters to Monitor

  1. Signs of bleeding after anticoagulation initiation: This is crucial because anticoagulants are often used to treat DVT, and monitoring for bleeding is essential.
  2. PT/INR and platelet count: These parameters help assess the effectiveness and safety of anticoagulation therapy.

Correct Answer is D

Explanation

A. Schedule the client for retesting in 1 week: Retesting is typically done after 3 months, not 1 week.

B. Administer ceftriaxone via intermittent IV bolus: Ceftriaxone is used for gonorrhea, not chlamydia.

C. Instruct the client to abstain from sexual intercourse for 1 month: Abstinence is recommended until treatment is completed and partners are treated, not necessarily for 1 month.

D. Report the infection to the state department of health: Reporting is required by law to help track and reduce the spread of STIs.

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