A nurse is caring for a newborn who is 72 hr old.

Vital signs

0900:

• Heart rate 160/min
• Respiratory rate 80/min
• Temperature 38.1° C (100.6° F)
• Oxygen saturation 97%

1000:

• Heart rate 167/min
• Respiratory rate 72/min
• Temperature 38°C (100.4°F)
• Oxygen saturation 97%

Medical History

0900:

A term newborn 37 weeks of gestation is admitted to the newborn nursery following a precipitous vaginal birth. Birthing parent has a history of heroin use during pregnancy and prenatal care beginning at 34 weeks of gestation. Birthing parent and newborn drug screens positive for heroin.

The nurse is planning to contact the provider regarding the newborn's status. Which of the following prescriptions should the nurse anticipate? Select the 3 interventions the nurse should anticipate.

A. Abundant lanugo is incorrect because postmature newborns typically lose their lanugo before birth.

B. Vernix in the folds and creases is incorrect as vernix caseosa, the white, cheese-like substance covering the skin of the fetus, is often absent in postmature newborns due to it being absorbed as the gestation period extends beyond the normal term.

C. Short, soft fingernails are not expected in postmature newborns; instead, they may have long, overgrown nails.

D. Cracked, peeling skin is a common finding in postmature newborns due to prolonged exposure to amniotic fluid and a decrease in the protective vernix caseos

A.

E. A positive Moro reflex is a normal finding in newborns, including those who are postmature, indicating a healthy neurological response.

Rationale:

A. Preterm delivery: While preterm delivery can result in low birth weight, it is not typically considered a direct cause of being small for gestational age (SGA). SGA infants are generally small because of intrauterine growth restriction rather than preterm birth.

B. Fetal hyperinsulinemia: Fetal hyperinsulinemia may lead to macrosomia (large for gestational age) rather than SG

A.

C. Perinatal asphyxia: Perinatal asphyxia refers to oxygen deprivation around the time of birth and is not typically associated with SG

A.

D. Placental insufficiency: Placental insufficiency, resulting in poor nutrient and oxygen transfer to the fetus, is a common cause of SG

A. Insufficient placental function can limit fetal growth,

leading to a newborn being small for their gestational age.