Inspection of a newborn's head following birth reveals a hard ...

[humphriesbr@me.com]

Inspection of a newborn's head following birth reveals a hard ridged area and significant molding. The anterior and posterior fontanels show no sign of depression.
 
  Delivery history indicates that the mother was pushing for over 3 hours and had epidural anesthesia, and vacuum extraction was used. Based on this information the nurse would first:
 
  a. continue to monitor newborn and anticipate that molding will subside.
  b. inspect and document location of fontanels to complete the head assessment.
  c. contact the neonatologist.
  d. note findings as being within normal limits as a result of the strenuous birth process.

Question 2

The clients says, My baby is so thin and wrinkled. It looks like he has too much skin. Which is the most therapeutic response by the nurse to the new client's statement?
 
  a. You sound disappointed about how your infant looks.
  b. All mothers are concerned about how their babies look.
  c. Don't worry. In no time he'll fill out his skin and look just fine.
  d. You know, all the cigarettes you smoked interfered with the nourishment he needed.

[hanadaa]

Answer to Question 1

ANS: C
Assessment data reveal a significant finding, and the nurse should suspect craniosynostosis (premature closing of sutures) and therefore should contact the neonatologist immediately. Even though the birth process was difficult and vacuum extraction was used, this does not account for the physical findings. Continuing to monitor is not a prudent action and, because this is more than molding, it will not go away. Although it is important to note the presence of fontanels, the immediate action would be to make the appropriate referral for medical intervention.

Answer to Question 2

ANS: A
The nurse should clarify the client's statement and allow her to verbalize her feelings. All mothers are concerned about how their babies look generalizes her concerns and does not answer the mother's question. Don't worry. In no time he'll fill out his skin and look just fine does not directly answer the mother's question and could leave her feeling like she asked an unacceptable question. You know, all the cigarettes you smoked interfered with the nourishment he needed is condescending and hurtful and would not allow for further conversation between the nurse and mother.