The nurse is planning to instruct a new mother on ways to prevent ...

[SO00]

The nurse is planning to instruct a new mother on ways to prevent hypothermia in her newborn. What should this teaching include?
 
  Select all that apply.
  A) Expect the baby to shiver.
  B) Keep the newborn's head covered.
  C) Cover the newborn with a light sheet during afternoon naps.
  D) Notice changes in the baby's respirations and take the appropriate action.
  E) Cover the newborn with minimal blankets when out of doors in temperatures in the 50s.

Question 2

A client has a body temperature of 95 F and exhibits slurred speech and poor coordination. Which is the priority nursing diagnosis for this client?
 
  A) Disturbed Sensory Perception
  B) Acute Confusion
  C) Hypothermia
  D) Imbalanced Body Temperature

[hollysheppard095]

Answer to Question 1

Answer: B, D

Chilling can cause signs of respiratory distress in the newborn. The nurse should instruct the mother to be aware of changes in respirations, which would indicated that the baby is cold and needs to be protected. Covering the newborn's head will also reduce heat loss. The newborn should be covered with more than a light sheet during afternoon naps. The newborn should be protected with many blankets when out of doors in temperatures in the 50s. Shivering is not expected and means that the baby's metabolic rate has doubled.

Answer to Question 2

Answer: D

The client is demonstrating signs of a mild reduction in body temperature. The nursing diagnosis appropriate at this time is Imbalanced Body Temperature. A body temperature below 90 F would indicate hypothermia. Confusion is a manifestation of mild hypothermia and not the priority nursing diagnosis. Sensory impairment may or may not be present in this client.

[SO00]

Thank you

[hollysheppard095]

Happy to help you