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Which finding should the nurse identify as an early clinical manifestation of neonatal encephalopathy related to hyperbilirubinemia?Mental retardation.Rigid extension of all extremities.Lethargy or irritability.Increased or unstable temperature.Submit

Question

Which finding should the nurse identify as an early clinical manifestation of neonatal encephalopathy related to hyperbilirubinemia?Mental retardation.Rigid extension of all extremities.Lethargy or irritability.Increased or unstable temperature.Submit

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Solution

The early clinical manifestation of neonatal encephalopathy related to hyperbilirubinemia that a nurse should identify is "Lethargy or irritability."

Here's why:

  1. Hyperbilirubinemia is a condition characterized by high levels of bilirubin in the blood. This is often seen in newborns and can lead to a yellowing of the skin and eyes (jaundice).

  2. In severe cases, if left untreated, the bilirubin can move into the brain, causing a type of brain damage known as kernicterus or bilirubin encephalopathy.

  3. The early signs of this condition are often subtle and can include changes in behavior such as lethargy (a lack of energy and enthusiasm) or irritability.

  4. The other options like "Mental retardation", "Rigid extension of all extremities", and "Increased or unstable temperature" are typically seen in more advanced stages of the condition.

Therefore, a nurse should be alert to changes in a newborn's behavior, such as increased lethargy or irritability, as these could be early signs of neonatal encephalopathy related to hyperbilirubinemia.

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