What should be the initial nursing action for a newborn with bluish discoloration of extremities?

The initial nursing action for a newborn with bluish discoloration of the extremities is to apply oxygen and count respirations. In newborns, bluish discoloration, particularly in the extremities, can indicate a condition known as peripheral cyanosis, which may occur due to inadequate oxygenation or circulation. Providing supplemental oxygen is a critical intervention to improve the infant's oxygen saturation levels.

Counting respirations is also essential as it helps assess the newborn’s respiratory rate and effort. This pairing allows the nurse to determine if further interventions are needed, such as additional oxygen support or other resuscitation measures.

In contrast, simply observing for expiratory grunting or assessing heart sounds might not provide immediate support for a newborn who is displaying signs of potential respiratory distress or hypoxia. Placing the infant skin-to-skin with the mother, while beneficial for bonding and thermoregulation, does not address the urgent need for potential respiratory support in this scenario. Thus, providing oxygen and monitoring the respiratory status is the most appropriate and effective initial nursing action.