18-Nursing Management Of the Newborn Flashcards
What are some assessment findings during the initial newborn assessment that can indicate a problem
Nasal flaring, chest retractions, grunting on exhalation, labored breathing, generalized cyanosis, abnormal breath sounds, abnormal respiratory rates, flaccid body temperature, abnormal heart rates, abnormal newborn size
When are the assessments of a newborn done?
Initial assessment completed in birthing area to see if newborn can stay with parents. A second assessment is done within the first 2-4 hours when the newborn is admitted to the nursery or LDR where the parents are
What is the Apgar score
Used to evaluate a newborns physical condition at 1 minute and 5 minutes after birth
When would you do an additional Apgar assessment
If the 5 minute score is less than 7 you then do one at 10 minutes
What does the Apgar assessment at 1 minute provide
Data about the newborns initial adaption to extrauterine life
What does the Apgar assessment at 5 minutes provide
A clearer indication of the newborns overall central nervous system status
What are the five parameters assessed with Apgar scoring
A= appearance (color) P= pulse (heart rate) G= grimace (reflex irritability) A= activity (muscle tone) R= respiratory (respiratory effort)
Each Apgar parameter is assigned a score ranging from ___ to ____
0 to 2
What does a score of 0 indicate
Absent or poor response
What is the Apgar score where no interventions are needed besides maintaining normal respiratory efforts and thermoregulation
8 or higher
Apgar score that indicates moderate difficulty
4-7
What Apgar score signifies severe distress in adjusting to extrauterine life
0-3
What are some things that influence the Apgar score
Infection, congenital anomalies, physiologic immaturity, maternal sedation via medications, labor management, and neuromuscular disorders
What is the predictable manner of characteristics disappearing when a newborn is experiencing physiologic depression
First pink coloration is lost, next respiratory effort, and then the tone, followed by reflex irritability and finally heart rate
How is length of a newborn measured
Head of newborn to the heel with the newborn unclothed
What position should newborn be in when measuring length
Supine position and extend the leg completely when measuring the length
What is expected length range of a full term newborn
44-55 cm ( 17-22 inches)
How is the weight of newborns usually read? What is a typical newborn weight?
Using a digital scale that reads weight in grams
2,500-4,000 g ( 5 pounds, 8 ounces to 8 pounds, 14 ounces)
Newborns typically lose ____% or their initial birth weight by ____ to ____ days of age
10% by 3-4 days of age
What are some of the causes of newborns weight loss
Loss of meconium, extracellular fluid, and limited food intake
When is the newborn weight loss usually regained by ?
By the 10th day of life
Low birth weight=
Very low birth weight=
Extremely low birth weight=
Low birth weight=< 1,000 g (<2.5 lb)
How do you take a heart rate on a newborn? What is a typical heart rate?
Apical pulse for 1 full minute
120-160 bpm
When are newborns respirations assessed? How do you assess them?
When they are quiet or sleeping. Place a stethoscope on the right side of the chest and count the breaths for 1 full minute to identify any irregularities
Normal newborn respiratory rate
30 to 60 breaths/minute with systemic chest movement
How long are respiratory and heart rates assessed
Every 30 minutes until stable for 2 hours after birth, then once stable every 8 hours
When is axillary temperature typically assessed?
Not immediately after birth but upon arrival to the nursery or in LDR room when initial,newborn assessment is carried out
Normal axillary temperature range
97.7* F - 99.5* F
Why are rectal temperatures no longer taken
Because of the risk of perforation
How often should you assess temperature
Every 30 minutes until it has been stable for 2 hours then every 8 hours until discharge
Is blood pressure normally assessed as part of the normal newborn examination?
No it is not. Blood pressure is not normally assessed unless there is a clinical indication or low Apgar score
If blood pressure is assessed what is used?
Oscillometer (Dinamap)
Typical BP range for newborn
50-75 mm Hg (systolic) / 30-45 mmHg (diastolic)
What will increases the systolic BP of a newborn
Crying, moving, and late clamping of the umbilical cord
How do you determine a newborns gestational age? What is gestational age?
Assess physical signs and neurologic characteristics. Gestational age is the stage of maturity
How is gestational age typically determined?
By using a tool such as a Dubowitz/Ballard or New Ballard Score system. This scoring system provides an objective estimate of gestational age by scoring the specific parameters of physical and neuromuscular maturity
How does the Dubowitz/Ballard or New Ballard Scoring System work?
Points are given for each assessment parameter
With a low score of -1 point or -2 points for extreme immaturity to 4 to 5 points for post maturity. The scores from each section are added to correspond to a specific gestational age in weeks.
When is the physical maturity section of the Gestational Age Assessment done?
During the first 2 hours of birth
Physical maturity Gestational Age Assessment categories
Skin texture Lanugo Plantar creases Breast tissue Eyes and ears Genitals
What is typical skin texture
Sticky to transparent to smooth. With varying degrees of peeling and cracking, to parchment-like or leathery with significant cracking and wrinkling
What is lanugo? What is normal?
Soft downy hair on the newborns body, which is present in preterm babies and usually mostly gone by the time a term baby is born
Do preterm newborns have lanugo
No
What are plantar creases? What is normal?
Creases on the soles of the feet. Range from absent to covering the entire foot, depending on maturity (the greater number of creases, the greater the newborns maturity)
What will you see with ear cartilage of a more mature newborn
Greater amount of stiff ear cartilage
When dealing with genitals what determines maturity in males
Evidence of testicular descent and appearance of scrotum (which can range from smooth to covered with rugae) determine maturity
When dealing with genitals what determines maturity in females
Appearance and size of clitoris and labia determine maturity ( a prominent suitor is with a flat labia suggest prematurity, whereas a clitoris covered by labia suggests greater maturity
When is the neuromuscular maturity section usually completed
Within 24 hours after birth
Six activities to determine newborns maturity with neuromuscular maturity section
Posture Square window Arm recoil Popliteal angle Scarf sign Heel to ear
Born prior to 37 completed weeks gestation, regardless of birth weight
Preterm or premature
Born between 38 and 42 weeks gestation
Term
Born after completion of week 42 gestation
Post-term or postdates
Born after 42 weeks and demonstrating signs of placental aging
Postmature
Weight less than the 10th percentile on standard growth charts (usually less than 5.5 lbs)
Small for gestational age (SGA)
Weight between 10th and 90th percentiles
Appropriate foe gestational age (AGA)
Weight more than the 90th percentile on standard growth charts (usually more than 9 pounds)
Large for gestational age (LGA)
Nursing interventions with newborn
Maintaining airway patency, ensuring proper identification, administering prescribed meds, and maintaining thermoregulation
What is done immediately after birth to help maintain airway patency
Newborn is suctioned to remove fluids and mucus from the mouth and nose
What is newborn typically suctioned with
with a bulb syringe
What should you do before placing bulb syringe in newborns mouth or nose
Compress the bulb
What position of newborn facilitates drainage
Head down and to the side position
Why should you,always keep a bulb syringe near a newborn
In case he or she develops sudden choking or blockage in the nose
Is vitamin K fat or water soluble
Fat-soluble
What does vitamin K do
Promotes blood clotting by increasing the synthesis of prothrombin by the liver
What does a deficiency of vitamin K do
Delays clotting and may lead to hemorrhage
When is vitamin k produced in newborns?
The bowel is sterile so vitamin k is not produced in the intestine until after microorganisms have been introduced, such as the first feeding
How long does it take a newborn to produce enough vitamin k to prevent vitamin k deficiency bleeding
About a week
When should newborns get Vitamin K
The AAP recommends that vitamin k be administered to all newborns soon after birth in a single IM dose of 0.5 to 1mg
What should happens to a newborns eyes after birth
Should relieve a prophylactic agent in their eyes within an hour or two after birth
What is the prophylactic agent in newborns eyes preventing
Ophthalmia neonatorum, which can cause neonatal blindness
When are the head and chest circumference usually equal?
By about 1 year of age
Persistent cyanosis of fingers, hands, toes, and feet with mottled blue or red discoloration or coldness is called
Acrocyanosis
When do you see acrocyanosis?
During the first few weeks of life in newborns in response to exposure of cold. It is normal and intermittent
What is a thick white substance that protects the skin of the fetus
Vernix caseosa
What are superficial vascular areas found on the nape of the neck, on the eyelids, and between eyes and the upper lip
Stork bites
What are unopened sebaceous glands frequently found on a newborns nose
Milia
What are blue or purple splotches that appear on the lower buttocks or newborns
Mongolian spots
What is erythema toxicum
Benign, idiopathic, generalized, transient rash that occurs in up to 70% of all newborns during the first week of life
What is the dilation of blood vessels on only one side of the body, giving the newborn the appearance of wearing a clown suit
Harlequin sign
