Final answer:
The nurse should intervene for substernal chest retractions while the newborn is sleeping, as this could indicate respiratory distress. Acrocyanosis is typically not concerning, a murmur may need additional evaluation, and a positive Babinski reflex is normal.
Step-by-step explanation:
The question is assessing the understanding of newborn physical examination and the Apgar score, which is a quick test performed on a baby at 1 and 5 minutes after birth. The Apgar score is a comprehensive test that assesses a baby's heart rate, respiration, muscle tone, reflex response, and skin color. Each of these areas is given a score of 0, 1, or 2, which are then summed to produce the overall Apgar score.
In the context of the student's question:
- (a) Acrocyanosis of the extremities is common in newborns and usually resolves within the first 24 hours after birth; it does not typically require intervention.
- (b) A murmur at the left sternal border could be a benign finding or an indication of a congenital heart defect; additional evaluation is warranted.
- (c) Substernal chest retractions while sleeping can be a sign of respiratory distress and need immediate intervention.
- (d) A positive Babinski reflex is normal in newborns and not a cause for concern.
The manifestation that requires intervention by the nurse is the substernal chest retractions while the newborn is sleeping, as this may indicate respiratory distress.