4500 Class 9 — NEONATAL Flashcards
Health assessment techniques and diagnostic tests r/t to the neinate
MAIN physiological processesof neonatal transition to extra-uterine life
Jaundice — neonate
Signs of integumentary problems in neonates
Name important newborn reflexes
Sucking and rooting
Swallowing
Palmar grasp
Plantar grasp
Moro (or startle)
Stepping or “walking”
Crawling
Babinski (plantar)
Pull to sit postural tone
Add
What is the therapy for hyperbilirubinemia
Newborn Nursing Interventions related to the postpartum period
MAIN physiological processes of neonatal transition to extra-uterine life
What ARE IMPORTANT changes/adaptation in the first 2 hours of life
ESTABLISH RESPIRATIONS
Adjust to circulatory changes
Regulate temp
Eliminate waste
What indicates poor sdaptation in fetal heart monitoring?
Minimal variability. Heart rate not in range, LATE DECELERATIONS
What does late deceleration indicate?
POOR OXYGENATION
WHAT DO WE ASSESS IN THE FIRST STAGE OF LABOUR
Fetal positioning/presentation
Internal electronic fetal monitoring
Length
Rupture of membranes — time of ROM (length of ROM), note presence of Scalp
Scalp sampling?
Any sign of fetal distress?
Any complication in labour? Bleeding, eclampsia, tx with magnesium sulphate)
Birther analgesia/anesthesia (fentanyl, morphine)
When GBS pos? How to treat?
1 initial dose of 5M units of PENICILLIN
What is a meconium?
Color? When does it usually pass?
Where does it pass?
What can cause it
First stool
Green-black in colour, viscous and sticky!
Usually passes within 12-24 hours after birth
May pass in utero — chnages of passing meconium increases in utero after 38 weeks gestation. It is common in breech presentation. Common in anything after 40 weeks — postdates.
It can be caused by hypoxia (induced peristalsis), and spihincter relaxation
Fetal Circulation?
Top CHANGES in the heart FROM FETAL TO NEWBORN CIRCULATION
DUCTUS VENOSUS
FORAMEN OVALE
Shuts
Why are preterm infants at higher risk of ineffective osygen supply
Has immature alveoli
Decrease elasticity, recoil
Less surfactant
How can meconium present itself? (Meconuim Aspirarion Syndrome) MAS
How do we manage
Abnormal / atypical FHR patterns
Complications include terminal airway obstruction, respiratory distress, inflammation, and infection
Persistent pulmonary hypertension of newborn!
EFM in labour!!! ⭐️
When during birth, not breathing or crying, has a flat tone
- may intubate to suction below the cords, may need ventilate! ⭐️
What are three things we look for before starting a NEONATAL RESUSCITATION?
- Term gestation? ~over 37 weeks?
- Crying or breathing>
- Good tone?
If mo, STAR RESUS
What’s the routine care for neonatal transition?
A. Prone on birther’s chest (skini to skin) — maintain warmth/normal temp
B. Clear secretions as needed
C. Dry and stimulate to breathe
D. Delayed cord clamping
E. Newborn stays w parents
F. Ongoing observations
ESTABLISH EFFECTIVE RESPIRATIONS
What are potential benefits of delayed cord clamping in preterm newborns?
Decreased mortality
Higher bp and blood volume
Less need for blood transfusion after birth
FEWER brain hemorrhages and
Lower risk of necrotizing enterocolitis
Potential benefits of cord clamping in term newborns
Decrease chance of developing iron-deficiency anemia
Maybimprove neurodevelopmental outcomes
Potential adverse effects of DELAYED CORD CLAMPING
Delaying resuscitation for compromised newborns
Increased risk of POLYCYTHEMIA (high red blood cell concentration)
Jaundice
CONTRAINDICATIONS of delayed cord clamping (DCC)
those who require immediate resus
For infants less than 37 weeks gestational age, DCC only for at least 1 minute
For infants 37 weeks or more. DCC for 1-2 minutes!
COMTRAINDICATIONS OTHERS:
Known or suspected placental abruption
Uncontrolled maternal hemorrhage
Vasa previa
Fetuses with pre-existing volume overload such as hydrops fetalis
Multiple gestation deliverieswhere the second twin is in distress
When do we expect an o2 of 10p%
10 mins after birth
Body pink, extremities blue
Acrocyanosis
Apgar score that means newborn is on severe distress
0-3
Apgar score that means normal transition, little difficulty
7-10
What physiological mechanisms happen when a newborn is cold (hypothermia)
- Thermogenesis - newborns attempt to generate heat by increasing muscle activity, could appear restless and cry, could feel cool due to vasocontriction
- Increase in cellular metabolic activity — which increases consumption of oxygen and glucose
- Flexiom to reduce exposure
- Constriction of blood vessels
- Shovering mechanism is not operable in new born — in turn brown fat metabolism — these are higher in preterm infants (increases metabolic activity in the brain, heart, and liver)
What can cold stress lead to? Adverse effect
- RESPIRATORY DISTRESS
/metabolic distress - HYPOGLYCEMIA!! They would need more glucose