A 5-Day-Old Girl Is Brought to the Physician for Her

question 389

Multiple Choice

A 5-day-old girl is brought to the physician for her first checkup.  She was born full term to a primigravid mother by uncomplicated vaginal delivery.  She was discharged from the well-baby nursery 3 days ago.  Since then, she has been breastfeeding exclusively every 1-3 hours for 15 minutes per breast.  She has had 5-6 wet diapers and 3-4 "yellow, seedy" stools daily.  Birth weight was 3402 g (7 lb 8 oz) .  Current weight is 3260 grams (7 lb 3 oz) .  On examination, the girl is awake and alert.  The anterior fontanelle is open, soft, and flat.  Her mucous membranes are moist and capillary refill is <2 seconds.  Peeling of the hands and feet is seen, as is acrocyanosis.  Her diaper is shown below. Which of the following is the most appropriate next step in management of this patient?

• A)Continue current feeding regimen
• B)Fortification of breast milk with powdered formula
• C)Intravenous fluids
• D)Serum electrolytes
• E)Supplementation with infant formula in addition to breastfeeding
• F)Supplementation with water in addition to breastfeeding
• G)Urinalysis

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Definitions:

Archetypes

Universal, symbolic images or characters that appear across different cultures and literature, representing fundamental human experiences.

Universal Experiences

Phenomena or events that are common and relatable across different cultures and individuals, suggesting a shared aspect of human existence.

Manifest Content

The literal surface content and storyline of a dream, as opposed to its latent content or underlying meaning.

Dream

A succession of images, ideas, emotions, and sensations occurring involuntarily in the mind during certain stages of sleep.