A nurse is caring for a client prescribed Heparin. Which nursing action is most appropriate regarding monitoring aPTT levels and preparing protamine sulfate as an antidote?

• 1 Administer naloxone 0.05 mg/kg via the umbilical vein; using a reduced dose and the slower venous route minimizes the risk of precipitating withdrawal while still reversing respiratory depression. Continue to monitor the newborn and provide supportive care, but the modified naloxone approach is safe for infants of methadone-dependent mothers. ✓ Correct answer
• 2 Avoid naloxone in this newborn; provide warmth, dry, stimulate, position, suction as needed, and initiate positive pressure ventilation per Neonatal Resuscitation Program (NRP) guidelines because naloxone is contraindicated in newborns of opioid-dependent mothers as it precipitates severe acute neonatal abstinence syndrome including seizures.
• 3 Administer naloxone 0.1 mg/kg intramuscularly; this is the recommended dose for opioid-induced respiratory depression in newborns and will promptly reverse the opioid effects to restore spontaneous breathing without significant adverse effects. Provide supportive care after naloxone, but naloxone remains the priority to reverse respiratory depression from methadone.
• 4 Provide supplemental oxygen via face mask and monitor the newborn in the nursery for respiratory depression; if no seizures occur, discharge after 24 hours with a follow-up appointment for outpatient methadone weaning because the respiratory depression from maternal methadone is typically transient and does not require naloxone administration.

For study reference only. Always follow current clinical guidelines and your institution’s protocols.