A nurse in the newborn nursery is receiving a report on four newborns. Which of the following newborns should the nurse see first?
A.
A newborn who is 8 hr old and has acrocyanosis.
B.
A newborn who is 18 hr old and has not voided.
C.
A newborn who is 24 hr old and has not passed meconium.
D.
A newborn who is 12 hr old and has an axillary temperature of 37.8°C (100° F).
The Correct answer and Explanation is:
The correct answer is D. A newborn who is 12 hours old and has an axillary temperature of 37.8°C (100°F).
Explanation:
When prioritizing care, the nurse must assess which newborn is at the highest risk of complications and requires immediate attention. The newborn with an axillary temperature of 37.8°C (100°F) is the highest priority because this indicates a fever. A fever in a newborn is a serious concern as it may signal an infection or sepsis. Newborns have immature immune systems and are more vulnerable to infections. Additionally, newborns do not always show typical signs of infection, making temperature changes crucial indicators. Immediate intervention is necessary to prevent the progression of the underlying cause.
Option A describes a newborn with acrocyanosis, which is a common finding in newborns within the first 24 to 48 hours of life. Acrocyanosis is characterized by a bluish discoloration of the hands and feet and is typically caused by the immature circulatory system. It usually resolves without intervention and is not a priority unless accompanied by central cyanosis.
Option B involves a newborn who is 18 hours old and has not voided. While it is expected that newborns should void within the first 24 hours, the absence of voiding at 18 hours does not yet indicate a critical issue. However, the nurse should continue to monitor this newborn closely.
Option C refers to a newborn who is 24 hours old and has not passed meconium. It is concerning if a newborn does not pass meconium within the first 24 hours, as it may indicate a potential bowel obstruction or congenital anomaly such as Hirschsprung’s disease. This situation warrants further assessment but does not take priority over the fever.
In summary, the newborn with a fever (Option D) requires immediate attention due to the potential for sepsis or infection. Fever in a newborn is an urgent situation that necessitates prompt evaluation and intervention to prevent serious complications.