What should the nurse do first for a newborn with meconium-stained amniotic fluid who has good muscle tone?

For a newborn with meconium-stained amniotic fluid who presents with good muscle tone, the initial action should be to begin suctioning of the mouth and nose. This is an important first step because the presence of meconium in the amniotic fluid poses a risk for potential aspiration into the lungs. While the newborn has good muscle tone, which is a positive sign indicating the baby is responding well, it is nonetheless essential to ensure that the airway is clear prior to any further assessments or interventions.

Suctioning the mouth and nose helps remove any potential meconium that could obstruct the airway or lead to complications such as meconium aspiration syndrome. This procedure is quick, effective, and can significantly decrease the likelihood of respiratory distress due to aspirated meconium.

After ensuring the airway is clear, the healthcare team can assess the newborn further and determine if additional interventions, such as oxygen therapy or more invasive measures, are necessary based on the baby's condition.