A 37-week newborn weighing 4.1 kg (9.02 lb) is 2 hours old and appears large for gestational age, flushed, and tremulous. What procedure should the nurse follow to implement a glucose screening? Arrange the steps from first on top to last on the bottom.

• A. Wrap the infant's foot with a heel warmer for 5 minutes; Collect a spring-loaded automatic puncture device; Restrain the newborn's foot with your free hand; Cleanse puncture site on the lateral aspect of the heel.
• B. Wrap the infant's foot with a heel warmer for 5 minutes; Restrain the newborn's foot with your free hand; Collect a spring-loaded automatic puncture device; Cleanse puncture site on the lateral aspect of the heel.
• C. Collect a spring-loaded automatic puncture device; Wrap the infant's foot with a heel warmer for 5 minutes; Restrain the newborn's foot with your free hand; Cleanse puncture site on the lateral aspect of the heel.
• D. Wrap the infant's foot with a heel warmer for 5 minutes; Cleanse puncture site on the lateral aspect of the heel; Restrain the newborn's foot with your free hand; Collect the spring-loaded automatic puncture device.

Answer: (A)

The main idea is to perform a quick, controlled heel-stick after warming the heel to maximize blood flow and ensure a clean sample while keeping the infant still and maintaining sterile technique. Warming the heel for 5 minutes increases capillary perfusion so a sufficient drop of blood can be obtained with a brief puncture. Having the puncture device ready before you begin reduces delays and helps you perform the stick smoothly once the foot is stabilized. Restraining the newborn’s foot with your free hand is essential to prevent movement during the puncture, which protects both the baby and the accuracy of the specimen. After the sample is collected, cleansing the puncture site on the lateral heel helps prevent infection and removes any residual moisture, completing the sterile, safe process.