A nurse is reinforcing teaching with the mother of a newborn about the proper use of a bulb syringe for suctioning.
Which of the following instructions should the nurse include in the teaching?

? 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.

Choice A rationale

Nonsteroidal anti-inflammatory drugs (NSAIDs) primarily exert their therapeutic effects through the inhibition of cyclooxygenase (COX) enzymes, thereby reducing prostaglandin synthesis. While they possess analgesic and anti-inflammatory properties that can alleviate pain and swelling associated with thrombophlebitis, NSAIDs do not directly prevent the formation of thrombi or address the underlying coagulopathy. Therefore, their administration is not a primary prophylactic measure against thrombophlebitis development.

Choice B rationale

Early and frequent ambulation promotes venous return by stimulating the calf muscle pump, which compresses deep veins and propels blood back towards the heart. This mechanical action counteracts venous stasis, a major component of Virchow's triad for thrombus formation. By maintaining blood flow velocity and preventing pooling in the lower extremities, ambulation significantly reduces the risk of deep vein thrombosis and subsequent thrombophlebitis.

Choice C rationale

Applying warm, moist packs to the lower legs can provide symptomatic relief by promoting vasodilation and improving local circulation, which may reduce pain and inflammation associated with existing thrombophlebitis. However, this intervention does not prevent the initial formation of a thrombus. In fact, vasodilation could theoretically increase blood flow to an area with an active clot, but it does not address the fundamental mechanisms of thrombogenesis, such as stasis or hypercoagulability.

Choice D rationale

Elastic stockings apply external graduated compression to the lower extremities, with the highest pressure at the ankle and gradually decreasing pressure proximally. This external pressure helps to reduce venous distention, increase venous blood flow velocity, and prevent the pooling of blood in the superficial and deep veins. By mitigating venous stasis, a critical factor in the pathogenesis of thrombophlebitis, elastic stockings effectively reduce the risk of thrombus formation.