A nurse is collecting data from a newborn who has an infection of Candida albicans.
Which of the following findings should the nurse expect?

Choice A rationale

Light strokes on the abdomen with rhythmic breathing, known as effleurage, are a distraction technique during labor. This method stimulates large-diameter nerve fibers, competing with pain signals transmitted by smaller-diameter fibers, thus reducing the perception of pain. While helpful, it is not directly related to acupressure, which involves targeted pressure points.

Choice B rationale

Immersing oneself in warm water, or hydrotherapy, promotes muscle relaxation and reduces pain perception through buoyancy and heat transfer. The warmth increases blood flow and relaxes uterine muscles, providing comfort. This technique primarily acts on thermoreceptors and mechanoreceptors, facilitating systemic relaxation, distinct from the focused pressure of acupressure.

Choice C rationale

Placing tennis balls on the sacral area and leaning against them applies counterpressure, a technique effective for back labor. This external pressure can help alleviate pain by applying direct compression to the sacral nerves, which may be compressed by the fetal head. This method is a form of deep tissue manipulation, differing from the specific point stimulation of acupressure.

Choice D rationale

Acupressure involves applying pressure to specific anatomical points to alleviate pain and discomfort. Recognizing signals (e.g., contractions), responding (applying pressure), and relaxing (allowing the body's natural pain modulation) are key principles. This targets endogenous opioid release and influences neural pathways, promoting pain relief and often a sense of calm.

? Rationale for Correct Answers

Hypoglycemia is defined in neonates as a blood glucose level <40–45 mg/dL. This newborn had a glucose of 35 mg/dL at 1 hour of life, with symptoms including jitteriness, abnormal cry, and hypotonia—all classic signs of hypoglycemia. After breastfeeding, the glucose level rose to 50 mg/dL, and symptoms resolved, confirming the diagnosis and effectiveness of feeding.

Breastfeeding the newborn immediately is the first-line intervention for asymptomatic or mildly symptomatic hypoglycemia. Early feeding provides glucose and stimulates endogenous glucose production. The American Academy of Pediatrics recommends feeding as the initial management for glucose levels between 25–40 mg/dL in asymptomatic term infants.

❌ Rationale for Incorrect Response 1 Options

Neonatal abstinence syndrome (NAS) typically presents after 24–72 hours post-birth, not within the first hour. There is no maternal history of opioid use or signs such as hypertonia or high-pitched cry.

Sepsis may present with temperature instability, lethargy, or respiratory distress, but this newborn is alert, afebrile, and has stable vitals. No risk factors or signs support this diagnosis.

Respiratory distress would involve tachypnea, nasal flaring, or retractions. This newborn has even, unlabored respirations and a normal respiratory rate of 45/min.

❌ Rationale for Incorrect Response 2 Options

Administer morphine per protocol is appropriate for NAS, not hypoglycemia. There is no indication of opioid withdrawal.

Start oxygen therapy is indicated for respiratory distress or hypoxia, neither of which is present here.

Perform blood cultures is appropriate for suspected sepsis, but there are no signs of infection or systemic illness in this newborn.

? Take-Home Points

• Neonatal hypoglycemia is common in large-for-gestational-age infants and presents early with jitteriness and hypotonia.
• First-line treatment for mild hypoglycemia is immediate feeding, preferably breastfeeding.
• Hypoglycemia must be differentiated from NAS, sepsis, and respiratory distress based on timing, maternal history, and clinical signs.
• Monitoring glucose response to feeding helps confirm hypoglycemia and guides further management.