Which of the following findings in the newborn's electronic medical record (EMR) are risk factors for the newborn to develop a complication? (Select all that apply.)

Choice A rationale

The Lamaze technique for childbirth preparation utilizes conditioned responses to cope with labor pain, which includes specific signals from the coach, a learned response (like a specific breathing pattern), and relaxation techniques. This approach aims to reduce the perception of pain by focusing attention and promoting muscular release through psychoprophylaxis.

Choice B rationale

Using tennis balls on the sacral area to lean against is a non-pharmacological pain relief technique, but it's a form of counter-pressure applied to the lower back, often effective for back labor, not an instruction specific to the technique of acupressure. Counter-pressure helps to relieve the referred pain caused by the fetus's occiput pressing against the sacrum.

Choice C rationale

Using light, rhythmic strokes on the abdomen, known as effleurage, along with rhythmic breathing, is a touch/massage technique often taught in childbirth classes. It provides a distracting sensory input and promotes relaxation, but it is not the specific method for applying acupressure, which involves sustained pressure on specific body points.

Choice D rationale

Immersing oneself in a tub of warm water is hydrotherapy, a non-pharmacological technique used to relax muscles and reduce pain perception during labor. The warmth promotes vasodilation and aids in relaxation, providing a soothing environment. This method is distinct from the localized pressure application of acupressure.

Choice A rationale

Weighing a newborn's wet diaper is an essential component of monitoring fluid balance and renal function, which is critical as neonatal abstinence syndrome (NAS) infants may have diarrhea leading to fluid loss. However, it is not the first priority action. NAS symptoms, caused by central nervous system hyperexcitability, necessitate stabilization of vital functions, with respiratory status being paramount. Normal urine output for a newborn is typically 1-3 mL/kg/hr.

Choice B rationale

Swaddling provides non-pharmacological comfort by simulating the confined uterine environment, reducing excessive stimulation, and minimizing the hyperirritability and tremors associated with central nervous system dysfunction in neonatal abstinence syndrome. While a beneficial and frequent intervention, stabilizing the newborn's physiological status, specifically respiratory effort and rate, must be assessed and secured as the immediate priority due to potential for respiratory distress.

Choice C rationale

Determining the newborn's respiratory rate is the highest priority because respiratory depression and distress are critical potential complications in a newborn experiencing neonatal abstinence syndrome, often associated with poly-drug exposure or direct effects of opioids. NAS can lead to hyperthermia and increased metabolic demand, escalating oxygen consumption. A normal newborn respiratory rate is typically 30 to 60 breaths per minute; deviations require immediate intervention.

Choice D rationale

Auscultating the newborn's bowel sounds assesses gastrointestinal motility, which can be affected by the hyper-excitability seen in NAS, potentially leading to diarrhea, poor feeding, and fluid-electrolyte imbalances. However, this assessment is secondary to ensuring adequate oxygenation and ventilation, which is always the initial and most crucial step in the hierarchy of needs for any compromised neonate experiencing withdrawal symptoms.