Question

A newborn has been diagnosed with exstrophy of the bladder. The nurse should position the newborn: A. Prone B. Supine C. On either side D. With the head elevated

Short answer

Answer: The most appropriate position for a newborn diagnosed with exstrophy of the bladder is the supine position, as it minimizes the risk of injury and complications while keeping the newborn comfortable.

Step-by-step solution

Understanding the Positioning Options

Let's briefly explain the different positions listed in the exercise: A. Prone: The newborn lies flat on their stomach, facing downward. B. Supine: The newborn lies flat on their back, facing upward. C. On either side: The newborn lies on their side, either left or right. D. With the head elevated: The newborn lies in a position where their head is raised above the rest of the body.

Evaluating the Risks of Each Position

We need to take into account the exposed bladder and its potential to be harmed when considering the positions: A. Prone: This position can apply continuous pressure on the exposed bladder and increase the risk of injury, infection, and other complications. B. Supine: This position keeps the exposed bladder upward and minimizes the pressure on it, reducing the risk of injury and complications. C. On either side: Although this position may reduce the pressure on the exposed bladder, it may not completely eliminate the risk of injury and may not be as comfortable for the newborn as the supine position. D. With the head elevated: This position might lead to increased pressure on the exposed bladder due to gravitational force, raising the risk of complications.

Choosing the Best Position

After analyzing the risks and benefits associated with each position, it is clear that the supine position (option B) is the safest and most appropriate choice for a newborn with exstrophy of the bladder. This position minimizes the risk of injury and complications while keeping the newborn comfortable.

Key concepts

Newborn Care

Caring for a newborn with exstrophy of the bladder requires meticulous attention to the specific needs of the infant. This congenital condition, where the bladder is turned inside out and exposed outside the body, necessitates a delicate approach to minimize the risk of infection and injury.

In the immediate newborn period, focusing on maintaining the integrity of the exposed bladder tissue is crucial. Newborns with this condition should be handled gently, and only necessary contact with the bladder area should be made to avoid trauma. Keeping the area clean and applying a non-adherent dressing can help protect the bladder mucosa and support healing.

Hygiene is another pivotal aspect of newborn care in this situation. Frequent diaper changes and the use of a barrier cream can help maintain skin integrity and reduce irritation. The goal is to foster a healing environment while preparing for corrective surgical procedures that the newborn may undergo later.

Patient Positioning

Ensuring proper patient positioning is an integral part of the management plan for newborns with exstrophy of the bladder. As discussed in the exercise, the four main positioning options present varying levels of risk and comfort for the infant.

Opting for the supine position is not just a textbook recommendation; it is the preferred clinical practice to reduce pressure on the bladder. Keeping the newborn on their back with a protective dressing in place safeguards the exposed area. It prevents direct contact between the bladder and the bedding, thereby reducing the likelihood of infection and mechanical injury.

Additionally, the supine position facilitates easier access for healthcare providers to monitor and provide care, including the frequent evaluation of the bladder area, dressing changes, and the administration of medication if required.

Nursing Management

In the realm of nursing management for a newborn with bladder exstrophy, nurses play a pivotal role in both the initial stabilization and ongoing care of the infant. A central factor in effective management is continuous assessment to detect any signs of distress or complications.

Nurses are tasked with implementing physician orders, which may include the use of specific dressings, administering antibiotics to prevent infection, and ensuring the newborn maintains an optimal position for comfort and safety. They should also maintain a warm and clean environment, as well as provide support and education to parents about the condition and the specifics of home care post-discharge.

Family-centered Care

Emphasizing a family-centered approach, nurses act as mediators between the medical team and the family. They offer reassurance, clarify medical jargon, and demonstrate care techniques. By doing this, they empower parents to become competent caregivers, which is crucial for the long-term management of bladder exstrophy.