A nurse takes a newborn's initial set of vital signs and records the following: Temperature: 97.9 °F (36.6C), pulse: 198 beats/minute, respirations: 78 breaths/minute, blood pressure: 64/44 mm Hg. What does the nurse conclude about this infant?
A.
Hypotensive: needs IV fluid administration
B.
Hypothermic: needs to be put in an incubator
C.
Tachycardic: take pulse again when baby is not crying
D.
Tachypneic: suction if needed, administer oxygen per protocol
ANS: D
A normal respiratory rate for an infant is 30-60 breaths/minute. This respiratory rate is too rapid, and the nurse needs to suction the infant if needed and provide oxygen per protocol. The blood pressure and temperature are normal. The heart rate is too fast, even for a crying baby.
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