The nurse is performing an assessment on a 24-hour-old male who was born breech via vaginal birth at 36 weeks gestation. Which assessment finding requires immediate evaluation by the health care provider?

Question

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An imperforate anus is a congenital malformation of the anorectal opening that prevents normal stool passage. The anus may be absent or nonpatent, causing stool accumulation in the intestines or, rarely, stool excretion via a fistula between the rectum and genitourinary system (eg, vagina, male urethra). During a newborn assessment, the nurse should carefully examine the anorectum for malformation and determine anal patency by monitoring the location and quantity of stool excretion. If no stool (ie, meconium) is noted within 24 hours of birth, the nurse should notify the health care provider because immediate evaluation of the client is necessary to facilitate diagnosis and correction (eg, surgical intervention) of the suspected defect (Option D). (Option A) In general, foreskin adheres to the glans penis in a male newborn and is not fully retractable until approximately age 3, if the child remains uncircumcised. (Option B) Scrotal edema may result from pressure on the scrotum during labor, especially with breech vaginal birth, but typically resolves spontaneously. (Option C) Undescended testes (eg, palpated in the inguinal canal, found in the abdomen) occur more commonly in male newborns of preterm gestation. Further evaluation is required only if the testes fail to descend over time. Educational objective: Imperforate anus is a congenital malformation of the anorectal opening that prevents normal stool passage. If no stool (ie, meconium) is noted within 24 hours of birth, the nurse should request immediate evaluation of the newborn to facilitate diagnosis and correction of the suspected defect.

The Nurse Is Performing an Assessment on a 24-Hour-Old Male