A nurse is conducting discharge and teaches parents about the care of their infant after cardiac surgery.

The nurse instructs the parents to notify the physician if the conditions occur. (Select all that apply.)

Swimming is one of the best sports for people with hemophilia because it strengthens the muscles without putting stress on the joints. Swimming is also recommended by most sports physicians and hematologists for patients with hemophilia.

Choice A is wrong because soccer is a contact sport that can cause injuries and bleeding episodes in people with hemophilia. Soccer is not recommended by most sports physicians or hematologists for patients with hemophilia.

Choice C is wrong because basketball is also a contact sport that can lead to injuries and bleeding episodes in people with hemophilia. Basketball may be safe for young children, but the risk increases with the intensity of the game.

Choice D is wrong because football is a collision sport that can cause severe injuries and bleeding episodes in people with hemophilia. Football is not recommended by most sports physicians or hematologists for patients with hemophilia.

Normal ranges for hemophilia are:

• Mild hemophilia: 5% to 40% of normal clotting factor
• Moderate hemophilia: 1% to 5% of normal clotting factor

Severe hemophilia: less than 1% of normal clotting factor

An Apgar score of 10 at 1 minute after birth indicates that the infant is having no difficulty adjusting to extrauterine life but who should be assessed again at 5 minutes after birth. The Apgar score is a scoring system that evaluates the health of newborns at 1 and 5 minutes after birth based on five criteria: appearance, pulse, grimace, activity, and respiration. Each criterion is scored from 0 to 2, and the total score ranges from 0 to 10. A score of 7 to 10 is considered reassuring, a score of 4 to 6 is moderately abnormal, and a score of 0 to 3 is concerning.

Choice A is wrong because an Apgar score of 10 at 1 minute does not mean that the infant needs no further testing. The infant should still be assessed again at 5 minutes and monitored for any signs of distress or complications.

Choice B is wrong because an Apgar score of 10 at 1 minute does not indicate an infant in severe distress who needs resuscitation. An Apgar score of 0 to 3 would indicate a concerning condition that may require immediate intervention.

Choice C is wrong because an Apgar score of 10 at 1 minute does not predict a future free of neurologic problems. The Apgar score alone cannot be considered as evidence of, or a consequence of, asphyxia or brain injury; it does not predict individual neonatal mortality or neurologic outcome; and it should not be used for that purpose.

Normal ranges for each criterion are as follows:

• Appearance (color): pink all over (2 points), body pink but extremities blue (1 point), blue, bluish-gray, or pale all over (0 points)
• Pulse (heart rate): greater than 100 beats per minute (2 points), less than 100 beats per minute (1 point), absent (0 points)
• Grimace (response to stimulation): cough or sneeze, cry and withdrawal of foot with stimulation (2 points), facial movement/grimace with stimulation (1 point), absent (0 points)
• Activity (muscle tone): active movement (2 points), limbs flexed (1 point), limp or floppy (0 points)
• Respiration (breathing): good, strong cry (2 points), irregular, weak crying (1 point), absent (0 points)