1229 Exam 3: Newborn Care/Skills Flashcards
Conversions
Fahrenheit: Celsius x 9/5 + 32
Celsius: Fahrenheit - 32 x 5/9
Weight: Convert lbs to grams, 1000g=1kg=2.2 lbs, G=#of lbs/2.2x1000
Length: Convert cm or in, 2.54cm/1in, Cm=2.54 x #of in, In= #of cm/2.54
Transitional Period
Newborns undergo phases of relative instability during first 6 to 8 hours
First Period of Reactivity
Birth to 30 min, normal HR up to 180, alert, bond and breast feed, sleep 1-1 1/2 hour
Second Period of Reactivity
4-8 hrs after birth, may have tachycardia, tachypnea, increase muscle tone, color improve, may be when first bowl is passed
Respiratory
Chemical-first breath is stimulated by hypoxia, surfactant in lungs can expand, first breath takes a lot of effort, may hear rales because of fluid in the first 6-8 hrs, inadequate lung inhale can cause tachycardia, crying helps clear the lungs
Sensory-noises, lights, touching, and cool air
Thermal-environmental temp drops
Apnea-normal in the neonatal period, 10-15 sec, <20 sec something is going on, can be caused by high or low temp
Cardiovascular
Blood volum-85-100ml/kg, placental function, placental loss at birth, PMI-fourth intercostal space, BP-normal, P-100-160, BP increases 10 days after birth
Blood coagulation-give vit K
Labs
Hemoglobin: 14-24 g/dl
Hematocrit: 44%-64%
Glucose: 45-65 mg/dl
Leukocytes: 9,000-30,000/mm
Bilirubin, total serum: <2.0 mg/dl
Arterial: pH 7.32-7.48
PCO2 26-42 mm Hg
PO2 60-70 mm Hg
Base excess: -10 to -2 mEq/L (whole blood)
Bicarbonate, serum: 21-28 mmol/L (arterial)
Anion gap: 7-16 mEq/L
Venous: pH 7.31-7.41
PCO2 40-50 mm Hg
PO2 40-50 mm Hg
**These values may change significantly in the first week of life.Nutrition, Fluid, Electrolytes
Weight- 5% weight loss in the first week, limited intake and fluid loss, two weeks should gain weight back
Calorie requirements- 117cal/kg/day
Blood sugar- Glyco is a major energy source at birth and 90% is used in first 3 hrs
Iron- storage at birth and enought for about 6 months
Capacity- 90mL and emptying time of stomach is 24 hrs, cardiac sphincter casue them to aspirate if they are fed too much or too fast, 2nd week more gas and colic
Numbers
Temp- 37C(98.6F) ax, Range: 36.5-37.2C (97.7-98.96F) HR: 100-160 R: 30-60 BP: 60-90/40-50 Head circumference: 33-35 cm Chest circumference: 30-33 cm Neutral Thermal Environment: 31.5-35 C
Temperature
BSA: sweat glands are ineffective first month, cannot lower their own temp
Brown fat: at nape of neck and scapula, blood warms as it circulates through fat
Nonshivering thermogenesis: the inability to shiver
Heat loss: convection, conduction, evaporation, radiation
Bowels
Meconium: the first bowel movement after birth
Transitional: days 3&4 greenish brown, 4&5 more yellow
Milk stool: breast fed will have yellow and a sour milk odor, bottle fed more brown
5-6 stools a day in the first two weeks of life
Bladder
Renal system: kidneys take over elimination and filtration, is immature, increased risk for dehydration, acidosis, and high potassium esp during times of stress, capacity 40 mL, urinate by first 24 hrs of life, 6-10 times a day for first few weeks, excrete uric acid will look like brick dust stain on the diaper
Neurological
Reflexes assessed in the quiet alert state, occer during infancy, some disappear, replaced by purposeful activity, head to toe mature, fontanels are important assessment, anterior closes at 18 mo, posterior closes 2-5 mo, bulging could indicate hydrocephalus, depressed will indicate dehydration
Muscle activity and rest
develop individually, each will do differently, develop individualized sleep patterns
Endocrine and Reproductive
maternal hormones affects the appearance of the breast and genitalia, milky substance and enlarged breast, vaginal discharge and bleeding due to mothers hormones, blood glucose, metabolic abnormalities can make blood sugar drop
Sensory
eye contact, contend to voices, respond to touch, 2-4 weeks when they start to produce tears, eyes may cross until muscle develop around 4 mo, like black and white, hear sounds, move head to sounds, turn away from strong odors, turn to mother or milk, like sweet taste better than any other
Integument
first line of defense, white bumps go away on their own, newborn rash look like pimples will go away by itself, vernix-white cheesy, lanugo-fine downy hair wear off by birth, sweat glands do not function til around 2 months
Immune System
first few weeks and months they are immune from diff things
Care of the Neonate
Wear gloves until first bath, change diapers
Delivery room Care
Suction mouth and nose, keep bulb in cribs at all times, baby is ID’d in delivery room with two bands, one on the wrist, one on the ankle and one band on the mother, should not leave the room before being identified, finger prints, foot prints, moms finger print
Care of Neonate cont
Admit to nursery, vital signs, initial assessment, measurements, medication, labs, feedings, admission bath
Daily Nursery Care
ID Daily weights Vital signs I&O Assessment Feedings Bathing Cord care Circumcision Bonding Teaching Phototherapy Discharge
Apgar Scale
Apgar scoring 0-2 points, perform at 1 min and 5 min
Apgar Heart Rate
Over 100 give 2 points
Less than 100 give 1 point
If Zero give 0 points
Apgar Respiratory
Crying-spontaneous give 2 points
Weak, irregular give 1 point
No resp give 0 points
Apgar Muscle Tone
Flexion good give 2 points
Some flexion give 1 point
Flaccid give 0 points
Apgar Reflex Irritability
When slapping foot or inserting nare catheter
If cries give 2 points
Grimaces give 1 point
No response 0 point
Apgar Skin Color
Central and extremities pink give 2 points
Central pink but extremities blue give 1 point
Both blue give 0 points
Physical Exam
Weighing, do in both lbs and grams
Length, using tape measure, crown to rump, then rump to heel, do both in cm and in
Eye med within one hr of birth
Temp, first temp done axillary
Assess cardiac and respiratory system
Resp 30-60/min, count for one min
Normal HR 100-160/min
Check BP, use newborn cuff, check both arms and legs
Systolic 65-80
Diastolic 30-40
If BP is lower in legs than arms this needs to be evaluated. Check brachial and femoral pulses, strength
Chest and Extremities
Check posture, proportion and color
Flexed
Head 1/4 of entire body
Acrocyanosis-blue hands and feet
