A newborn delivered via cesarean birth at 32 weeks to a mother who experienced placenta previa has a low pulse rate, low blood pressure, and a capillary filling time of 3.6 seconds. Which interventions are indicated for the care of this newborn? Select all that apply

Question

1. Start the infant on phototherapy.
2. Start the infant on iron supplements.
3. Have isotonic saline ready for transfusion.
4. Draw several vials of blood for laboratory testing.
5. Monitor the infant's cardiac and respiratory status.
6. Have O-negative packed red cells ready for a transfusion.

Answer 1

2, 5, 6
Explanation:
1. Phototherapy should only be started if the infant has jaundice.
2. Iron supplements should be given to help increase red blood cell production.
3. Isotonic saline transfusion is not used to treat anemia.
4. Blood draws should be kept to a minimum for clients with anemia.
5. This is an appropriate nursing intervention. Monitoring the infant's cardiac and respiratory status will allow the nurse to detect symptoms of shock and assess the effectiveness of treatment.
6. Clients with severe anemia will need a blood transfusion. If the infant's blood type is not known, O-negative packed red cells can be used for transfusions. If the infant's blood type is known, the appropriate typed and cross-matched packed red cells should be used.