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.

Meconium aspiration syndrome (MAS) occurs when a newborn breathes in meconium present in the amniotic fluid before or during birth, which can cause respiratory problems. In this case, the presence of meconium-stained fluid, rapid and shallow respiration with occasional expiratory grunting, and fine crackles auscultated throughout lung fields are clinical indicators that suggest the newborn is at risk for MAS.

The newborn is at the greatest risk for meconium aspiration syndrome because meconium-stained fluid was noted during labor. This condition occurs when a newborn inhales a mixture of meconium and amniotic fluid into the lungs, which can lead to respiratory issues such as grunting and fine crackles, both of which were observed in the newborn. It is important for the healthcare team to monitor the baby closely and initiate appropriate interventions to support ventilation and oxygenation as needed.

- A. Administer oxygen via face mask.
- Administering oxygen can be beneficial as it increases maternal oxygenation, which can improve fetal oxygenation. However, it is not the first-line action for late decelerations.Late decelerations are a sign of uteroplacental insufficiency, and while oxygen helps, repositioning the mother is more critical to address the root cause. Oxygen administration is a supportive measure but does not directly address the potential compression of the umbilical cord or placental perfusion issues.

- B. Position the client on her side.
Positioning the client on her side, specifically the left side, can improve uteroplacental circulation, addressing the cause of late decelerations.This position helps to relieve pressure on the inferior vena cava, enhancing blood flow to the placenta and fetus.It is a non-invasive, immediate intervention that can potentially correct the issue of late decelerations quickly.

- C. Increase the infusion rate of the IV fluid.Increasing the infusion rate of IV fluids can improve maternal blood volume, potentially improving placental perfusion.However, this action is not as immediate in effect as repositioning the client and is considered a secondary measure.It may be used in conjunction with other actions but should not be the priority intervention for late decelerations.

- D. Elevate the client's legs.
Elevating the client's legs can increase venous return to the heart, potentially improving maternal cardiac output and placental blood flow.However, this action is less effective than lateral positioning in addressing uteroplacental insufficiency.It is not the first-line response for late decelerations and may not provide the immediate correction needed.