Situation: A nurse works in the newborn nursery and the neon… | 마이메르시 MyMerci
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Nursing Practice II — Maternal and Child Health Nursing
문제

Situation: A nurse works in the newborn nursery and the neonatal intensive care unit (NICU) of a government hospital. She is responsible for newborn screening and for the unit's newborn screening records. The mother of a healthy term newborn who is 30 hours old declines newborn screening. She says, "We cannot afford another bill, and he looks healthy anyway." The family is a PhilHealth member. What should the nurse do?

해설
RA 9288 requires health practitioners to inform parents about newborn screening, and parents may refuse only on religious grounds with a written refusal. This mother's reasons are cost and the belief that a healthy-looking baby needs no test. The nurse explains that screening finds disorders before symptoms appear and that PhilHealth benefits cover it, then collects the sample within the 3-day window with her agreement.
같은 주제 다음 문제Situation: A nurse works in the newborn nursery and the neonatal intensive care unit (NICU…이 문제가 수록된 문제집PLNE Question Bank 150014,000원 · 무료 체험 가능

심화 해설

Address the reason for refusal first
The Newborn Screening Act of 2004 (RA 9288) requires health practitioners to inform parents about newborn screening. Parents may refuse screening only on religious grounds, and the refusal must be in writing. This mother's reasons are cost and the belief that a baby who looks healthy needs no test. Neither is a religious objection, and both come from a gap in information. The nurse explains what screening detects and that PhilHealth benefits cover it, then collects the sample with the mother's agreement.

Why information changes the decision
Newborn screening looks for disorders, such as congenital hypothyroidism and certain metabolic conditions, that cause no visible signs in the first days but can lead to intellectual disability or death if untreated. Key point! The whole purpose of screening is to find disease before symptoms appear, so a healthy appearance is not a reason to skip it. The family is a PhilHealth member, and newborn screening is part of the PhilHealth newborn care benefit, which removes the cost barrier.

The timing window
The sample is collected after 24 hours of life and not later than 3 days after birth. The baby is now 30 hours old, which is within the ideal window. Scheduling the test for a later clinic visit risks missing this window and delaying diagnosis of a treatable condition.

Why the other options are wrong
Having the mother sign a refusal form skips the education the law requires and accepts a reason that is not a legal ground for refusal. Collecting the sample over her objection because screening is mandatory ignores informed agreement; a procedure performed over a parent's objection can be considered battery. Postponing until the family can pay is unnecessary because the cost is covered, and it risks missing the collection window.

Exam takeaway
Under RA 9288, refusal is allowed only on religious grounds and in writing; any other reason calls for education first. Watch out! Do not jump to a refusal form or to forced testing. The nurse's first action is to correct the misunderstanding, then collect the sample within the window with the parent's agreement.

임상 시나리오

Parent Declines Newborn ScreeningCost concern in a PhilHealth member family

Under RA 9288, parents may refuse newborn screening only on religious grounds, in writing. Cost and a healthy appearance are not such grounds.

Explain that screening detects serious disorders before symptoms appear and that PhilHealth benefits cover the test.

Collect the heel sample after 24 hours and not later than 3 days of life, with the mother's agreement.

Caution

Do not collect over the parent's objection and do not accept a nonreligious refusal before giving full information.

핵심 개념

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