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?

Choice A rationale

Elevated maternal serum alpha-fetoprotein (MSAFP) levels are highly suggestive of neural tube defects (NTDs) such as spina bifida and anencephaly. Alpha-fetoprotein (AFP) is a glycoprotein produced by the fetal liver and yolk sac. In NTDs, the incomplete closure of the neural tube allows for leakage of AFP into the amniotic fluid and subsequently into the maternal bloodstream, leading to elevated serum levels.

Choice B rationale

Phenylketonuria (PKU) is an autosomal recessive metabolic disorder characterized by a deficiency in the enzyme phenylalanine hydroxylase, leading to an accumulation of phenylalanine. It is typically identified through newborn screening, not through elevated maternal serum alpha-fetoprotein levels. MSAFP screening is not used for the diagnosis or suspicion of PKU.

Choice C rationale

Trisomy 21, also known as Down syndrome, is a chromosomal disorder caused by the presence of an extra copy of chromosome 21. While maternal serum screening for Trisomy 21 typically involves assessing multiple markers, including alpha-fetoprotein, low levels of MSAFP, in conjunction with abnormal levels of other markers like human chorionic gonadotropin (hCG) and unconjugated estriol, are generally indicative of Trisomy 21. Elevated AFP is not characteristic.

Choice D rationale

Hemophilia is a group of hereditary bleeding disorders caused by deficiencies in specific blood clotting factors, most commonly factor VIII (hemophilia A) or factor IX (hemophilia B). These disorders are genetically inherited and are not associated with or detected by elevated maternal serum alpha-fetoprotein levels. MSAFP is a screening tool for fetal structural anomalies, not coagulation disorders.

Choice A rationale

Lubricating the bulb syringe with sterile water is unnecessary and could introduce fluid into the newborn's airway or mouth, potentially causing aspiration. The bulb syringe is designed for mechanical suctioning and does not require lubrication for effective and safe use in clearing secretions from the newborn's mouth and nose.

Choice B rationale

Depressing the bulb prior to insertion creates a negative pressure or vacuum within the syringe. This action allows for effective suctioning of secretions when the bulb is released after insertion into the newborn's mouth or nose, ensuring that mucus is drawn into the syringe for removal.

Choice C rationale

Placing the bulb in the center of the newborn's mouth could stimulate the gag reflex, potentially causing vomiting or aspiration of secretions. The bulb syringe should be inserted into the side of the newborn's mouth, between the cheek and gums, to facilitate effective suctioning without triggering an adverse response.

Choice D rationale

Suctioning the newborn's nose first, then the mouth, is an incorrect sequence. The mouth should always be suctioned first to prevent the newborn from aspirating any oral secretions into the lungs if they gasp or inhale after nasal suctioning, ensuring a clear airway before nasal passages are addressed.