The nurse has received shift change report on infants born within the last four hours. Which newborn should the nurse see first?
1. 37-week male, respiratory rate 45
2. 8 pound, 1 ounce female, pulse 150
3. Term male, grunting respirations
4. 1-day-old female who has not voided
3
Rationale:
1. A normal respiratory rate is 30–60. This infant has no unexpected findings.
2. A normal pulse is 110–160. This infant has no unexpected findings.
3. Grunting respirations are an indication of respiratory distress. This infant needs further assessment, and possibly intervention immediately.
4. Most infants will void within the first 24 hours of life, but this is not a life-threatening condition.
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